Late-term Pregnancy Research Articles

Stillbirth in term and late term gestations in Stockholm during a 20-year period, incidence and causes.

The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a lower incidence of stillbirth at term than other parts of Sweden. The risk of antepartum stillbirth increases in late term and postterm pregnancies which is one of the factors contributing to the current discussion regarding the optimal time of induction of labor due to postterm pregnancy. This is a cohort study based on the Stockholm Stillbirth Database which contains all cases of stillbirth from 1998-2018 in Stockholm County. All cases were reviewed systematically and the cause of death was evaluated according to the Stockholm Stillbirth Classification. Stillbirths diagnosed between gestational week (GW) 37+0 and 40+6 n = 605 were compared to stillbirths diagnosed from GW 41+0 and onwards n = 157, according to the cause of stillbirth and pregnancy and maternal characteristics. The aim was to evaluate the incidence of stillbirth over time and the incidence of stillbirth diagnosed from GW 41+0. In Stockholm County the overall incidence of stillbirth has decreased from 4.6/1000 births during the period 1998-2004 to 3.4/1000 births during the period 2014-2018, p-value <0.001. When comparing the same time periods, the incidence of stillbirth diagnosed from GW 41+0 and onwards has decreased from 0.5/1000 births to 0.15/1000 births, p-value <0.001. Among women still pregnant at GW 41+0 the incidence of stillbirth has decreased from 1.8/ 1000 to 0.5/ 1000. When comparing stillbirths diagnosed at GW 37+0-40+6 with stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of stillbirth in the latter group. In Stockholm County there was a decreasing incidence of stillbirth overall and in stillbirths diagnosed from 41+0 weeks of gestation and onwards during the period 1998-2018. In stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of death compared to stillbirths diagnosed between GW 37+0 and 40+6.

Heterogenous use of misoprostol for induction of labour: results of an online survey among midwives in German-speaking countries

PurposeThis online survey looked at the experiences and general perceptions of midwives concerning induction of labour and the specific use of misoprostol.MethodsWe published an online questionnaire with 24 questions in German on midwives’ experiences and perceptions of different methods of induction of labour.ResultsThe online survey was answered by 412 midwives between February 2016 and February 2017. At least 20% of the 24 questions were answered in 333 questionnaires, which were included in this analysis. Oral misoprostol was the most common induction method for primipara and for women with a previous vaginal birth and an unfavourable cervix. Apart from alternative methods for induction of labour like castor oil and complementary/alternative methods, oral misoprostol was the preferred method of induction of labour by midwives. Midwives described a wide range of dosage schedules concerning application intervals, starting doses, and the maximum daily dose of misoprostol. Approximately 50% of the participants of this study described prescriptions of more than 200 µg misoprostol daily for induction of labour.ConclusionMisoprostol is widely used in Germany and was one of the three preferred methods of induction of labour among midwives in our study next to castor oil and complementary/alternative methods. The preparation and dosage of misoprostol vary significantly among hospitals and do not adhere to international guidelines. Midwives voiced their concerns about inconsistent indications and heterogenous use of different methods and dosages of induction. They wished for more patience with late-term pregnancies and individualized shared decision-making between pregnant women and obstetricians.

Efficacy and safety of oral misoprostol vs transvaginal balloon catheter for labor induction: An observational study within the SWEdish Postterm Induction Study (SWEPIS).

Induction of labor is increasing. A common indication for induction of labor is late term and postterm pregnancy at 41 weeks or more. We aimed to evaluate if there are any differences regarding efficacy, safety, and women's childbirth experience between oral misoprostol and transvaginal balloon catheter for cervical ripening in women with a low-risk singleton pregnancy and induction of labor at 41+0 to 42+0 to 1 weeks of gestation. In this observational study, based on data from the Swedish Postterm Induction Study (SWEPIS), a multicenter randomized controlled trial, a total of 1213 women with a low-risk singleton pregnancy at 41 to 42 weeks of gestation were induced with oral misoprostol (n=744) or transvaginal balloon catheter (n=469) at 15 Swedish delivery hospitals. The primary efficacy outcome was vaginal delivery within 24h and primary safety outcomes were neonatal and maternal composite adverse outcomes. Secondary outcomes included time to vaginal delivery and mode of delivery. Women's childbirth experience was assessed with the Childbirth Experience Questionnaire (CEQ 2.0) and visual analog scale. We present crude and adjusted mean differences and relative risks (RR) with 95% CI. Adjustment was performed for a propensity score based on delivery hospital and baseline characteristics including Bishop score. Vaginal delivery within 24h was significantly lower in the misoprostol group compared with the balloon catheter group (46.5% [346/744] vs 62.7% [294/469]; adjusted RR 0.76 95% CI 0.640.89]). Primary neonatal and maternal safety outcomes did not differ between groups (neonatal composite 3.5% [36/744] vs 3.2% [15/469]; adjusted RR 0.77 [95% CI 0.31-1.89]; maternal composite 2.3% [17/744] vs 1.9% [9/469]; adjusted RR 1.70 [95% CI 0.58-4.97]). Adjusted mean time to vaginal delivery was increased by 3.8h (95% CI 1.3-6.2h) in the misoprostol group. Non-operative vaginal delivery and cesarean delivery rates did not differ. Women's childbirth experience was positive overall and similar in both groups. Induction of labor with oral misoprostol compared with a transvaginal balloon catheter was associated with a lower probability of vaginal delivery within 24h and a longer time to vaginal delivery. However, primary safety outcomes, non-operative vaginal delivery, and women's childbirth experience were similar in both groups. Therefore, both methods can be recommended in women with low-risk postdate pregnancies.

Alterations of Circulating Biomarkers During Late Term Pregnancy Complications in the Horse Part I: Cytokines

Equine abortions are attributed to both infectious and noninfectious causes. Clinical extrapolations are often made from the experimental model for ascending placentitis towards other causes of fetal compromise, including various markers of inflammation, including the cytokines IL-2, 5, IL-6, IL-10, IFNγ, and TNF. It is unknown if these cytokine changes are noted under field conditions, or if they increase preceding other pregnancy related complications. To assess this, Thoroughbred mares (n = 702) had weekly blood obtained beginning in December 2013 and continuing until parturition. Fetal membranes were submitted to the UKVDL for complete gross and pathologic assessment and classified as either ascending placentitis (n = 6), focal mucoid placentitis (n = 6), idiopathic abortion (n = 6) or control (n = 20). Weekly serum samples were analyzed via immunoassay for concentrations of IL-2, IL-5, IL-6, IL-10, IFNγ, and TNF. For both focal mucoid placentitis and ascending placentitis, an increase (P < .05) in the concentrations of IL-2, IL-5, IL-6, IL-10, IFNγ, and TNF was noted preceding parturition in comparison to controls. Cytokine profiles preceding idiopathic abortion did not differ from controls. In conclusion, serum cytokines may be considered potential biomarkers for the prediction of placental infection, while no changes in cytokine profiles were noted when noninfectious causes of abortion occurred. Additionally, this is the first study to report an increase in cytokines during the disease process of focal mucoid placentitis, the etiology of which includes Nocardioform placentitis.

Alterations of Circulating Biomarkers During Late Term Pregnancy Complications in the Horse Part II: Steroid Hormones and Alpha-Fetoprotein

Preterm labor and/or abortion causes considerable economic impact on the equine industry. Unfortunately, few experimental models exist for the induction of various pregnancy-related complications, and therefore extrapolations are made from the experimental model for ascending placentits, although inferences may be minimal. Certain steroid hormones (progestogens, estrogens) and fetal proteins (alpha-fetoprotein; AFP) might improve the diagnostics for abnormal pregnancy, but the utility of these markers in the field is unknown. To assess this, thoroughbred mares (n = 702) were bled weekly beginning in December 2013 until parturition/abortion. Following parturition, fetal membranes were assessed histopathologically and classified as either ascending placentitis (n = 6), focal mucoid placentitis (n = 6), idiopathic abortion (n = 6) or no disease (n = 20). Weekly serum samples were analyzed for concentrations of progesterone, estradiol-17β, and AFP. Samples were analyzed retrospectively from the week of parturition/abortion in addition to the preceding four weeks. For both ascending and focal mucoid placentitis, a significant increase in progesterone and AFP was noted, alongside a significant decrease in estradiol-17β and the ratio of estradiol-17β to progesterone in comparison to controls. In contrast, idiopathic abortions experienced a decrease in progesterone concentrations alongside an increase in AFP, and this was only noted in the week preceding parturition/abortion. In conclusion, spontaneous placental infection in the horse altered both endocrine and feto-secretory markers in maternal circulation, while minimal changes were noted preceding noninfectious idiopathic abortion. Additionally, this is the first study to report an alteration in steroid hormones and AFP during the disease process of focal mucoid placentitis, the etiology of which includes Nocardioform placentitis.

862 Implementation and evaluation of an elective induction protocol at a regional tertiary obstetric care center

Elective induction of labor aids in managing timing of delivery and reducing risks associated with late-term pregnancy. Results of a recent randomized controlled trial showed that rates of cesarean section and hypertensive disorders were lower with elective induction compared to expectant management. The primary objective of this study was to determine the safety of elective induction at or beyond 39 weeks gestation by comparing incidence of maternal and neonatal outcomes among women who did and did not opt for elective induction. This was a prospective cohort study of low-risk pregnant women delivering at a regional tertiary obstetric care center. The study group was composed of low-risk pregnant women who opted for elective induction at or beyond 39 weeks gestation between May 1, 2019 and November 30, 2019 and between February 15, 2020 and August 15 2020. The comparison group included low-risk pregnant women who opted for expectant management and delivered during the same timeframes. Outcomes were compared between groups. For categorical variables, relative risks with confidence intervals were determined. For continuous variables, differences between means were determined. Significance levels of 0.05 (two-sided) were used. There were 228 participants with 112 (49.1%) in the elective induction group and 116 (50.9%) in the comparison group. Patient characteristics are described in Table 1. There was no significant difference in maternal and neonatal outcomes (Table 2). The use of ripening agents was significantly greater in the elective induction group (p < 0.0001). Length of stay on antepartum and labor and delivery units were significantly greater among the elective induction group (p < 0.0001 and p = 0.0015, respectively). Length of stay on postpartum was significantly greater in the comparison group (p = 0.0368). Elective induction does not have increased maternal or neonatal risks compared to expectant management. It can be offered to patients, although they should be counseled on the increased time and amount of cervical ripening needed for elective induction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

994 Concurrent use of prostaglandin E2 and acetaminophen is associated with longer duration of labor induction

Acetaminophen (APAP) is widely used for pain management during pregnancy with a mechanism known to selectively suppresses peripheral prostaglandin E2 (PGE2) release. Dinoprostone is a naturally occurring PGE2 used for induction of labor. This study sought to determine if acetaminophen's suppressive activity on peripheral PGE2 effects the efficacy of dinoprostone for induction of labor. We conducted a 5 year retrospective cohort study and reviewed charts on women who received dinoprostone for induction of labor at term. Term pregnancies were defined as pregnancies between 40-42 weeks gestational age without onset of labor and a bishop score of 6 or less. Patients were included in the study if there received dinoprostone vaginally in doses of 10mg every 12 hours as needed for induction for a late term pregnancy and received between 2000-4000mg of APAP per day over the course of their induction. Patients receiving magnesium sulfate in the context of preeclampsia with severe features excluded. The study included 631 patients, with 303 receiving at least 2000mg of acetaminophen and 328 who did not. Baseline characteristics were not significantly different between treatment groups. Patients receiving acetaminophen experienced a longer duration of induction of labor 9.2±0.9 (1.6-13.7) hours as compared with those not receiving acetaminophen 6.3±1.1 (0.8-10.3), p = 0.02. In crude analysis, compared to those not receiving acetaminophen, receiving acetaminophen was associated with a 32% increased risk of requiring a second dose of dinoprostone (RR 1.78, 95% CI 1.42-1.93, p = 0.04.) After adjusting for BMI, initial cervical dilation at presentation, bishop score, diabetes mellitus, gestational blood pressure >140/90, race, advanced maternal age ( >34 y), and parity, this risk remained significant. APAP use ranging between 2000-4000mg over the course of a patient's labor induction with vaginal dinoprostone appears to be associated with a longer duration of induction. In such cases, other methods of cervical ripening may be a more suitable choice.

Sublethal, sex-specific, osmotic, and metabolic impairments in embryonic and adult round stingrays from a location exposed to environmental contamination in southern California, USA

Organic contaminants are known to affect a suite of physiological processes across vertebrate clades. However, despite their ancient lineage and important roles in maintaining healthy ecosystems, elasmobranchs (sharks, skates, and rays) are understudied with regard to sublethal effects of contaminant exposure on metabolic processes. Perturbations resulting from contaminant exposure can divert energy away from maintaining physiological homeostasis, particularly during energetically challenging life stages, such as pregnancy and embryonic development. Using the round stingray (Urobatis halleri) as a model elasmobranch species, we captured adult males and pregnant females (matrotrophic histotrophy) and their embryos from two populations differing in their environmental exposure to organic contaminants (primarily polychlorinated biphenyls (PCBs)). Pregnant females from the PCB-exposed population experienced significant decreases from early- to late-pregnancy in tissue mass and quality not seen in reference females. PCB-exposed pregnant females also failed to maintain plasma urea concentrations as pregnancy progressed, which was accompanied by a loss in muscle protein content. Despite the energetic demands of late-term pregnancy, females had significantly greater liver lipid content than reproductively inactive adult males. PCB-exposed adult males also had high metabolic capacity (i.e., enzyme activity) for most substrate groupings of all sex-site groups, suggesting that males may be even more negatively impacted by contaminant exposure than pregnant females. Evidence that in utero exposure to PCBs via maternal offloading impairs embryo outcomes is accumulating. Embryos from the PCB-contaminated site had lower tissue quality measures and indications that sex-based differences were manifesting in utero as males had higher metabolic capacities than females. This study indicates that accumulated PCB contaminants are not physiologically inert in the stingray.

Comparison of fetal Doppler blood flow characteristics of late-term and post-term pregnancies

Amaç: Çalışmanın amacı, 41 hafta ve üzeri komplike olmayan geç-term ve post-term gebeliklerde fetal Doppler akım özelliklerini karşılaştırmak ve bunların doğum sonrası sonuçlara etkisini değerlendirmektir. Gereç ve Yöntem: Ümraniye Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Polikliniği’ne başvuran düşük risk grubundaki toplam 98 geç-term ve post-term tekiz gebe çalışma grubuna alındı. Tüm gebelerin gebelik haftası, son adet tarihi ve erken dönem ultrasonografi verileri ile teyit edilerek hesaplandı. Hastalara sonografik değerlendirme ile tahmini fetal kilo, amniyotik sıvı hacmi, biyofizik profil ve Doppler (fetal umbilikal arter, orta serebral arter ve maternal uterin arter) incelemeleri yapıldı. Orta serebral ve umbilikal arterlerde pulsatilite ve rezistans indeksleri ile serebroplasental oran Doppler ultrasonografi ile günlük olarak değerlendirildi. Bu gebelerin doğum şekli, yenidoğan doğum kilosu, doğumda mekonyumlu amniotik sıvı varlığı, NST’de fetal distres bulgusu varlığı, yenidoğan 5. dakika Apgar skoru, fetal distres varlığında kordon kan gazı pH değeri ve yenidoğan yoğun bakım ünitesi ihtiyacı olup olmadığı kayıt altına alındı. Bulgular: Her iki grubun ortalama uterin arter ve ortalama umbilikal arter pulsatilite indeksleri ile orta serebral arter rezistans indeksi değerleri arasında fark gösterilememiştir. Post-term grupta ortalama umbilikal arter rezistans indeksi ve orta serebral arter pulsatilite indeksi değerleri anlamlı olarak daha düşük bulunmuştur. Geç-term grupta serebroplasental oran daha düşük olsa da bu farklılık istatistiksel olarak anlamlı değildir. Her iki grupta, bebeklerin yeni doğan yoğun bakım ünitesine yatma oranları arasında anlamlı bir fark saptanmadı. Sonuç: Anormal ve normal serebroplasental oran sonucuna göre yenidoğanın iyilik hali ve yoğun bakım ünitesinde yatma ihtiyacı açısından anlamlı ilişki saptanmamasına rağmen daha geniş serili çalışma gruplarına ihtiyaç olduğu düşünülmektedir

UNUSUAL PRESENTATION OF ACUTE INTESTINAL OBSTRUCTION DUE TO TRANSVERSE COLON VOLVULUS IN LATE PREGNANCY

Transverse colon volvulus is the rarest type of colonic volvulus, with a higher morbidity and mortality rate. In pregnancy, intestinal obstruction due to transverse colon volvulus is rare and seldom reported, and its timely diagnosis can be difficult. We report an unusual case of transverse colon volvulus in a young female at late-term pregnancy. A 28-years-old, pregnant woman, gravida 2, para 1, at 34 weeks of gestation, presented with progressive abdominal pain and distention, commencing about 12 hours prior to admission, associated with vomiting and obstipation. Vital signs were stable. However, the abdomen was asymmetrically hugely distended. The initial abdominal ultrasound showed a single viable intrauterine fetus and dilated loops of bowels. As fetal distress progressed throughout the admission, a laparotomy was performed, which revealed an unexpected transverse colonic volvulus. Resection of the twisted segment and primary anastomosis were performed, followed by a cesarean section to deliver the baby. The mother made a satisfactory recovery. Although this patient’s preoperative clinical findings suggested colonic obstruction, the diagnosis of transverse colonic volvulus was only made intraoperatively and has seldom been previously described. Chronic constipation, the enlarging uterus, and the anatomical redundancy of the transverse colon may have been contributing factors. Transverse colon volvulus in late pregnancy is uncommon. Early diagnosis and prompt surgical intervention can significantly minimize maternal and fetal mortality.

Association of Summer Heat Waves and the Probability of Preterm Birth in Minnesota: An Exploration of the Intersection of Race and Education

Preterm birth (PTB) is common and has negative impacts on infant health. While some maternal risk factors have been identified, including age under 20 or over 40, substance abuse, low BMI, and racism, less is known about the impact of environmental exposures like high heat. We combined 154,157 records of live births occurring in Minnesota between 2009 and 2015 with hourly weather records collected from the Minneapolis–St. Paul airport. We tested if maternal heat wave exposure (a seven-day period with a mean daily high temp of 37 °C) immediately prior to birth leads to a higher risk of preterm birth. Additional covariates included maternal age, race/ethnicity, educational status, and residence in the seven-county Minneapolis–St. Paul metro area. Pregnant women exposed to a seven-day heat wave of 37 °C or higher experienced a higher relative risk of PTB compared to women who did not experience a heat wave (1.14 risk ratio (RR), 1.0–1.3 95% confidence interval (CI)). The result is robust to controls for a woman’s age, race/ethnicity, educational attainment, place of residence, and year of the birth. Children born to Black women with college degrees who are exposed to heat waves experience a higher relative risk of PTB compared to White women with college degrees in a heat wave (2.97 RR, 1.5–6.1 95% CI). Summer heat waves are associated with higher risk of PTB in late-term pregnancies in Minnesota.

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection during late pregnancy: a report of 18 patients from Wuhan, China

BackgroundCompared with Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), Corona Virus Disease 2019(COVID-19) spread more rapidly and widely. The population was generally susceptible. However, reports on pregnant women infected with SARS-CoV-2 were very limited. By sharing the clinical characteristics, treatments and outcomes of 18 patients with COVID-19 during late pregnancy, we hope to provide some references for obstetric treatment and management.MethodsA total of 18 patients with COVID-19 treated at Renmin Hospital of Wuhan University were collected. The epidemiological characteristics, clinical manifestations, laboratory tests, chest CT and pregnancy outcomes were performed for analysis.Results1. 18 cases of late pregnancy infected with SARS-CoV-2 pneumonia were delivered at 35 + 5 weeks to 41 weeks. According to the clinical classification of COVID-19, 1 case was mild type, 16 cases were ordinary type, and 1 case was severe type. 2. According to imaging examinations: 15 (83%) cases showed unilateral or bilateral pneumonia, 2 (11%) cases had pulmonary infection with pleural effusion, and 1 (6%) case had no abnormal imaging changes. 8 (44%) cases were positive and 10 (56%) cases were negative for nasopharyngeal-swab tests of SARS-CoV-2. 3. Among the 18 newborns, there were 3 (17%) premature infants, 1 (6%) case of mild asphyxia, 5 (28%) cases of bacterial pneumonia, 1 (6%) case of gastrointestinal bleeding, 1 (6%) case of necrotizing enteritis, 2 (11%) cases of hyperbilirubinemia and 1 (6%) case of diarrhea. All the newborns were negative for the first throat swab test of SARS-CoV-2 after birth. 4. Follow-up to Mar 7, 2020, no maternal and neonatal deaths occurred.ConclusionsThe majority of patients in late term pregnancy with COVID-19 were of ordinary type, and they were less likely to develop into critical pneumonia after early isolation and antiviral treatment. Vertical transmission of SARS-CoV-2 was not detected, but the proportion of neonatal bacterial pneumonia was higher than other neonatal diseases in newborns.

Polymorphism of the Oxytocin Receptor (OXTR) Gene Affects the Circulating Oxytocin Receptor Levels in Late-Term Pregnancy in a Turkish Population

Introduction: Postterm and late-term pregnancies still remain a serious health problem, and underlying exact mechanisms are not fully elucidated. These mechanisms are influenced by many factors. Objective: The aim of this study was to investigate the relationship between plasma oxytocin and oxytocin receptor levels and oxytocin receptor polymorphisms in term and late-term pregnant women. Methods: Sixty-eight singleton pregnant women with late-term pregnancy and 83 singleton pregnant women with term parturition were included in this study. A comparison was performed between pregnancies and neonates born at term (37 0/7 and 41 6/7 weeks’ gestation). Plasma oxytocin, oxytocin receptor, estradiol, and progesterone levels were measured by using enzyme-linked immunosorbent assay kits. TaqMan® SNP Genotyping Assays and qPCR ProbesMaster were used to investigate the polymorphisms of rs237911, rs2228485, rs53576, and rs2254298. Results: There was not any difference in gene distributions of 4 common single-nucleotide polymorphisms of oxytocin receptor of rs237911, rs2228485, rs53576, and rs2254298 between subjects in late-term and term pregnancy groups. With rs53576 of the GG genotype, serum oxytocin levels were 21.50 ± 10.69 (ng/L) in the late-term group and 62.71 ± 18.01 (ng/L) in the term group (p = 0.049). Oxytocin receptor levels in the late-term and term pregnancy groups of the GG genotype were 17.92 ± 8.15 (pg/mL) and 45.77 ± 11.66 (pg/mL), respectively (p = 0.046). Conclusion: Our findings suggest that the rs53576 oxytocin receptor single-nucleotide polymorphism is associated with late-term pregnancy through acting by direct modulation of oxytocin and oxytocin receptor levels.

What women want and why. Women's preferences for induction of labour or expectant management in late-term pregnancy

BackgroundBoth induction of labour at 41 weeks and expectant management until 42 weeks are common management strategies in low-risk pregnancy since there is no consensus on the optimal timing of induction in late-term pregnancy for the prevention of adverse outcomes. Our aim was to explore maternal preference for either strategy and the influence on quality of life and maternal anxiety on this preference. MethodsObstetrical low-risk women with an uncomplicated pregnancy were eligible when they reached a gestational age of 41 weeks. They were asked to fill in questionnaires on quality of life (EQ6D) and anxiety (STAI-state). Reasons of women's preferences for either induction or expectant management were explored in a semi-structured questionnaire containing open ended questions. ResultsOf 782 invited women 604 (77.2%) responded. Induction at 41 weeks was preferred by 44.7% (270/604) women, 42.1% (254/604) preferred expectant management until 42 weeks, while 12.2% (74/604) of women did not have a preference. Women preferring induction reported significantly more problems regarding quality of life and were more anxious than women preferring expectant management (p<0.001). Main reasons for preferring induction of labour were: “safe feeling” (41.2%), “pregnancy taking too long” (35.4%) and “knowing what to expect” (18.6%). For women preferring expectant management, the main reason was “wish to give birth as natural as possible” (80.3%). ConclusionWomen's preference for induction of labour or a policy of expectant management in late-term pregnancy is influenced by anxiety, quality of life problems (induction), the presence of a wish for natural birth (expectant management), and a variety of additional reasons. This variation in preferences and motivations suggests that there is room for shared decision making in the management of late-term pregnancy.

Uzamış ve Term Gebeliklerde Primer Sezaryen Oranları: Bir Retrospektif Çalışma

Uzamış ve Term Gebeliklerde Primer Sezaryen Oranları: Bir Retrospektif Çalışma

“I guess baby was just too comfy in there…”: A qualitative study of women's experiences of elective late-term induction of labour

BackgroundThe frequency of induction of labour (IOL) in late-term pregnancy has increased significantly, but little is known about how women with uncomplicated pregnancies experience IOL for late-term indication alone. AimTo explore how women with uncomplicated pregnancies experienced late-term IOL. MethodsQualitative interviews were conducted with 23 women who all had labour induced on late-term indication only. Participants were recruited from two Danish hospitals who offered an outpatient induction regime. The women were interviewed 4–8 weeks after birth. Data were analysed using thematic analysis. ResultsAll women had hoped for a spontaneous birth. Prolonged pregnancy was understood as the body/baby “not being ready”, but generally, the women were not worried at that point. Most women felt adequately informed about the reasons for IOL, but some requested more information and time to consider their options. The majority considered IOL to be both an offer and a recommendation. One-third of the participants were initially hesitant but chose/accepted IOL because of weariness from pregnancy and the impatience to deliver a healthy child. The opportunity of outpatient induction was generally appreciated as it allowed the women to continue everyday activities while waiting for labour to begin. Nineteen women reported having a good birthing experience. Two women felt that negative birthing experiences were partly related to IOL. ConclusionsMost women considered the late-term IOL to be a positive experience. Some women requested more information and time to consider alternatives. These women should be provided with supported opportunities to consider the options.

Spontaneous abortion in cattle after consumption of Hesperocyparis (Cupressus) macrocarpa (Hartw.) Bartel and Cupressus arizonica (Greene) needles in Uruguay

An outbreak of cattle abortion associated with the consumption of Hesperocyparis (Cupressus) macrocarpa and Cupressus arizonica needles has been reported in Uruguay. Twenty-five of 125 pregnant heifers in late-term pregnancy aborted after being introduced into a paddock containing numerous H. macrocarpa, C. arizonica and Casuarina cunninghamiana trees. There were no significant macroscopic or histological findings in the two fetuses analyzed. Abortifacient labdane acids were detected in the needles of H. macrocarpa (1.68%, D.W.) and C. arizonica (0.36%, D.W.) but none were found in C. cunninghamiana.

Induction of Labour at 41 Weeks Versus Expectant Management and Induction of Labour at 42 Weeks (SWEdish Post-Term Induction Study, SWEPIS): Multicentre, Open Label, Randomised, Superiority Trial

(Abstracted from BMJ 2019;367:l6131) Adverse perinatal outcomes such as stillbirth and maternal complications have been shown to gradually increase postterm (≥42 weeks [≥294 days]). Despite this, no international agreement exists on how to manage late-term pregnancies (although the World Health Organization does recommend induction of labor at 41 weeks).

The risk of meconium aspiration syndrome (MAS) increases with gestational age at term

Objective To examine the risk of meconium aspiration syndrome (MAS) by the week of gestational age in pregnancies with meconium-stained amniotic fluid (MSAF). Methods This is a retrospective cohort study derived from term pregnancies at a single tertiary institution over an 18-year period. Outcomes analyzed included MAS, acidemia, and Apgar scores. Univariate analysis was performed using chi-square and multivariable logistic regression was used to adjust for potential confounders. Results A total of 34,303 deliveries ≥37 weeks were included; 23.7% were complicated by MSAF. Of the total study cohort, 272 (0.7%) neonates were diagnosed with MAS; this represented 3% of all deliveries complicated by MSAF. In the presence of MSAF, the risk of MAS increased with gestational age, from 1.3% at 38 weeks to 4.8% at 42 weeks (p < .001). Similarly, the risk of acidemia increased from 3.0% at 38 weeks to 7.0% at 42 weeks (p < .001). These findings were also demonstrated in patients with MAS in the absence of MSAF. The risk for both MAS and acidemia in the presence of MSAF persisted after controlling for potential confounders (aOR 1.31 [95% CI 1.18–1.46] and 1.20 [95% CI 1.05–1.37], respectively). Conclusion In women with MSAF, as gestational age increases, the risk of meconium aspiration syndrome also increases. Other factors with late-term and post-term pregnancy besides the presence of meconium may contribute to the evolution of MAS.

86. Late-Term Pregnancy in Adolescents and its Impact on Perinatal Outcomes: Is Maternal Age a Risk Factor?

86. Late-Term Pregnancy in Adolescents and its Impact on Perinatal Outcomes: Is Maternal Age a Risk Factor?