Longer Pregnancy Duration Research Articles

Wellbeing of Breastfeeding Women in Australia and New Zealand during the COVID-19 Pandemic: A Cross-Sectional Study.

During the COVID-19 pandemic, breastfeeding women have experienced restricted access to support, placing them at increased risk of mental health concerns and limited breastfeeding assistance. This study investigated the effect of the pandemic on feeding choices and maternal wellbeing amongst breastfeeding mothers living in Australian and New Zealand. We conducted a cross-sectional online survey that examined feeding methods, maternal mental wellbeing, worries, challenges, and positive experiences during the pandemic. Most women were exclusively breastfeeding (82%). Partial breastfeeding was associated with perceived low milk supply and longer pregnancy duration during the pandemic. Reduced mental health and wellbeing was associated with lower levels of family functioning, increased perceived stress, and perinatal anxiety. Longer pregnancy duration during the pandemic was associated with lower mental health wellbeing scores, while higher perceived stress scores were reported for regions with higher COVID-19 infection rates and women with perceived low milk supply. Women reported that the pandemic resulted in less pressure and more time for family bonding, while worries about the pandemic, family health, and parenting challenges were also cited. Mental health concerns of breastfeeding women appear to be exacerbated by COVID-19, highlighting a critical need for access to mental health and broader family support during the pandemic.

Geçirilmiş multipl sezaryen öyküsü bakımından Suriyeli mülteci ve yerleşik Türk vatandaşı gebelerin karşılaştırılması

Aim: To compare pregnancy outcomes between pregnant Syrian refugees and Turkish citizens with a history of multiple cesarean sections.Material and Methods: The pregnant women included in this retrospective cohort study were Syrian refugees and resident Turkish citizens with a history of multiple cesarean sections who were admitted between January 1 2017 and August 1 2018 in a tertiary hospital. All data about the demographics, multiple cesarean numbers, emergent/elective cesarean numbers, hematocrit values, and neonatal birth weights were comparatively analyzed between the two groups.Results: The Syrian refugee group had a higher ratio of women with a history of >2 cesarean sections than the Turkish citizen group (23.2% vs 11.1%, p<0.05). The ratio of urgent cesarean section operations were higher in the Syrian refugee group than in the Turkish citizen group (69.6% vs 55.4%, p<0.05). The Syrian refugee group had longer pregnancy duration (39.08±1.01 vs 38.46±1.50 weeks, p<0.001) and lower neonatal birth weights (3117.83±363.36 g vs 3230.93±472.67 g, p<0.05).Conclusion: Our data suggested a significant relationship between a history of >2 cesarean sections and the pregnant Syrian refugees. The Syrian refugees had longer pregnancy duration, lower neonatal birth weights, and a higher rate of emergency cesarean sections. Therefore, we think that complications related to caesarean section may increase gradually over time in Syrian refugee pregnant women.

Suture thickness and transvaginal cervical cerclage outcomes

Cervical cerclage placement has been shown to benefit women who have cervical insufficiency, however, the best type of suture to use for transvaginal cerclage placement is unknown. To evaluate the association between transvaginal cerclage suture thickness and pregnancy outcomes. Retrospective cohort study of women with a singleton, non-anomalous gestation who underwent history-, ultrasound- or physical exam-indicated transvaginal cerclage at a single tertiary care center (2013-2016). The primary outcome was gestational age at delivery. Secondary outcomes included preterm birth less than 34 weeks, chorioamnionitis, neonatal intensive care unit admission and composite neonatal morbidity. Baseline characteristics and outcomes were compared by thickness of suture material: thick 5mm braided polyester fiber (Mersilene® tape) versus thin polyester braided thread (Ethibond®) or polypropylene non-braided monofilament (Prolene®) with selection of suture type at the discretion of the provider. The association between thick suture and gestational age at delivery was estimated using Cox proportional hazard regression. Multivariable logistic regression was used to estimate the association between thick suture and the secondary outcomes. Effect modification of cerclage indication was also assessed. A total of 203 women met inclusion criteria: 120 (59%) with thick suture and 83 (41%) with thin suture. Of these, 130 women had history-indicated, 35 had ultrasound-indicated, and 38 had exam-indicated cerclages. Compared to women who had thin suture, women with thick suture were more likely to have had a history- or ultrasound-indicated cerclage, rather than exam-indicated cerclage, and more likely to have had a Shirodkar or cervico-isthmic approach, rather than McDonald. Women with thick suture were also more likely to have received progesterone and had placement at earlier gestational age, but there were no differences in cervical exam at placement. After adjusting for confounding factors, thick suture was associated with longer pregnancy duration among women with ultrasound-indicated cerclage (aHR 0.61, 95%CI 0.41-0.91) and exam-indicated cerclage (aHR 0.30, 95%CI 0.15-0.58), but not with history-indicated cerclage (aHR 1.27, 95%CI 0.83-1.94). Thick suture was also associated with lower odds of preterm birth < 34 weeks, chorioamnionitis and neonatal intensive care unit admission, compared to thin suture. Thick, compared to thin suture, for transvaginal cervical cerclage was associated with longer duration of pregnancy among women with ultrasound- and exam-indicated cerclages and lower odds of chorioamnionitis and neonatal intensive care unit admission among all women regardless of cerclage indication.

Associations of Trimester-Specific Exposure to Bisphenols with Size at Birth: A Chinese Prenatal Cohort Study.

Background:Bisphenol A (BPA) is an endocrine disruptor that affects fetal growth in experimental studies. Bisphenol F (BPF) and bisphenol S (BPS), which have been substituted for BPA in some consumer products, have also shown endocrine-disrupting effects in experimental models. However, the effects of BPF and BPS on fetal growth in humans are unknown.Objectives:Our goal was to investigate trimester-specific associations of urinary concentrations of BPA, BPF, and BPS with size at birth.Methods:The present study included 845 pregnant women from Wuhan, China (2013–2015), who provided one urine sample in each of the first, second, and third trimesters. Linear regressions with generalized estimating equations were applied to estimate trimester-specific associations of urinary bisphenol concentrations with birth weight, birth length, and ponderal index. Linear mixed-effects models were used to identify potential critical windows of susceptibility to bisphenols by comparing the exposure patterns of newborns in the 10th percentile of each birth anthropometric measurement to that of those in the 90th percentile.Results:Medians (25th–75th percentiles) of urinary concentrations of BPA, BPF, and BPS were 1.40 (0.19–3.85), 0.65 (0.34–1.39), and 0.38 (0.13–1.11) ng/mL, respectively. Urinary BPA concentrations in different trimesters were inversely, but not significantly, associated with birth weight and ponderal index. Urinary concentrations of BPF and BPS during some trimesters were associated with significantly lower birth weight, birth length, or ponderal index, with significant trend p-values () across quartiles of BPF and BPS concentrations. The observed associations were unchanged after additionally adjusting for other bisphenols. In addition, newborns in the 10th percentile of each birth anthropometry measure had higher BPF and BPS exposures during pregnancy than newborns in the 90th percentile of each outcome.Conclusions:Prenatal exposure to BPF and BPS was inversely associated with size at birth in this cohort. Replication in other populations is needed. https://doi.org/10.1289/EHP4664

Hydroxychloroquine Use in Lupus Patients during Pregnancy Is Associated with Longer Pregnancy Duration in Preterm Births.

Objective To investigate the effect of hydroxychloroquine (HCQ) in pregnant women with systemic lupus erythematosus (SLE). Methods In SLE pregnancies of a single Dutch center (2000–2015), lupus activity and flares before and during pregnancy and postpartum were assessed using the SLE Disease Activity Index (SLEDAI)/SLEPDAI (SLEDAI adjusted for pregnancy). The association between HCQ use and pregnancy outcomes (early spontaneous abortion, fetal death, and preterm and term live birth) was analyzed using generalized estimating equations (GEE) accounting for the occurrence of multiple pregnancies per patient. Analyses were adjusted for antiphospholipid antibody (aPL) status. Results 110 pregnancies (63 mostly Caucasian patients) were included, of which, in 30, HCQ was used; overall occurrence of flares was low (non-HCQ group: 5 mild (6.4%) and 2 severe (2.6%); HCQ group: 2 mild (6.7%) and no severe flares). The HCQ group showed a trend towards lower dosage of prednisone (OR 0.2 (95% CI 0.0–1.4); p = 0.10). Pregnancy outcomes were comparable between groups. Among preterm live births, pregnancy duration was significantly longer in HCQ users (2.4 weeks (95% CI 1.0–3.8; p ≤ 0.001)). Conclusion HCQ use was associated with longer pregnancy duration in the vulnerable preterm birth population, underscoring the beneficial effect of HCQ use during pregnancy.

Maternal plasma cholesterol and duration of pregnancy: A prospective cohort study in Ghana.

Low plasma cholesterol may be associated with preterm birth; however, results are mixed and limited primarily to high-income countries. Our objective was to determine whether maternal plasma lipid concentrations are associated with pregnancy duration. We performed a nested cohort (n=320) study of pregnant Ghanaian women enrolled in a randomized controlled trial. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and triglyceride concentrations were analyzed in plasma at ≤20and 36weeks gestation as continuous variables and also categorized into low, referent, or high (<10th, 10th-90th, >90th percentile). At ≤20weeks, plasma lipid concentrations were not associated with pregnancy duration. At 36weeks, total cholesterol and triglyceride concentrations were not associated with pregnancy duration. Higher HDL-C at 36weeks was associated with a longer pregnancy duration (adjusted β-coefficient±standard error: 0.05±0.02daysmg-1 /dL, p=.02); pregnancy duration was 5.9±2.0 (mean±standard error)days shorter among women with low HDL-C compared with the referent group (10th-90th percentile) (p=.02) and 8.6±2.6days shorter when compared with the high HDL-C group (p=.003). Pregnancy duration was 4.9±2.1days longer among women with low low-density lipoprotein cholesterol at 36weeks gestation when compared with the referent group (p=.051). Our data suggest that low HDL-C in the third trimester of pregnancy is associated with a shorter duration of pregnancy in this study population but do not support the hypothesis that low total cholesterol is associated with a shorter pregnancy duration.

Delivery at Term: Impact of University Education by Week of Gestation.

Data on risk factors for early term delivery are scant despite greater complications in infants born at 37 and 38 weeks' gestation. We determined the probability of delivery by gestational week at term according to level of maternal education, an established risk factor for preterm birth. We analyzed 2 319 697 live singleton births at term (≥37 weeks) in Quebec from 1981 to 2010. We estimated hazard ratios with 95% confidence intervals (CI) of delivery according to level of maternal education, adjusting for individual characteristics. The main outcome measure was the probability of delivery at term by week of gestation for women with university education versus high school education. Early term birth at 37 and 38 weeks of gestation was less common for university-educated women (23.1%) than for high school-educated women (25.8%; P < 0.001). Compared with women with a high school education, university-educated women had a 15% lower probability of delivery at 37 to 38 weeks (95% CI: 0.84 to 0.86), a 4% lower probability of delivery at 39 weeks (95% CI: 0.96 to 0.97) and a 2% lower probability of delivery at 40 weeks (95% CI: 0.97 to 0.98). University-educated women were, however, more likely to deliver at 41 weeks. A higher level of education was associated with longer duration of pregnancy at term. Women who were university-educated had a lower chance of delivery at 37, 38, 39, and even 40 weeks of gestation. Clinicians should be aware that women with lower levels of education are more likely to deliver earlier at term.

Assessment of iron deficiency and anemia in pregnant women: an observational French study.

We explored the prevalence and management of iron deficiency and anemia among pregnant women in France. In this prospective, observational, multicenter registry study, randomly selected investigators (gynecologists/obstetricians/midwives registered in the CEGEDIM(®) database) assessed pregnant women presenting for a consultation. Participants completed a questionnaire at study inclusion. A total of 1506 patients were enrolled by 95 investigators. Overall, investigators estimated a moderate or significant risk of iron deficiency in almost 60% of women. The overall prevalence of anemia (15.8%) increased with longer pregnancy duration. Medication (mainly iron-based) was prescribed to 57.3% of patients. In French clinical practice, the estimated risk of iron deficiency and prevalence of anemia during pregnancy align with expectations and are managed according to national/international recommendations.

O22. Correlation of sFlt-1/PlGF ratio with time to delivery or preterm birth in PROGNOSIS (prediction of short-term outcome in pregnant women with suspected preeclampsia study)

Introduction PROGNOSIS reported a negative predictive value of 99.3% (95% CI 97.9–99.9) for ruling out preeclampsia/eclampsia/HELLP syndrome within 1week using a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio cut-off of 38 in women with suspicion of the syndrome. The sFlt-1/PlGF ratio may also help identify women likely to deliver preterm. Objectives Correlation of the sFlt-1/PlGF ratio with (a) time to delivery and (b) preterm delivery ( Methods PROGNOSIS (prospective/non-interventional) enrolled pregnant women ( ⩾ 18 years; gestational age 24wk+0d–36wk+6d at visit 1) with suspected preeclampsia (having clinical features of the syndrome). Maternal serum sFlt-1 and PlGF were measured (fully automated Elecsys ® sFlt-1 and PlGF assays; cobas e electrochemiluminescence platform; Roche Diagnostics, Mannheim, Germany) and analyzed at the study end. Assessment points: Visit 1; Visit 2 (7+2d); Visits 3, 4, and 5 (each 7 ± 2 d after previous visit); delivery; postpartum. Early and late gestational phases were defined as 24wk+0d–33wk+6d and 34wks to delivery, respectively. Cox-regression analysis was adjusted for gestational age and preeclampsia status. Results sFlt-1/PlGF ratio >38 at Visit 1 was associated with shorter time to delivery, particularly in the early gestational phase (Figure). With a median 15 (SD 11) day difference the immediate risk for delivery was higher for women with sFlt-1/PlGF ratio >38 versus ⩽ 38 (HR 2.9 [95% CI 2.5–3.5]), independent of preeclampsia status/gestational age. Women with sFlt-1/PlGF ratio ⩽ 38 had longer pregnancy duration (no preeclampsia [ n =720]: median 270 days, interquartile range [IQR] 262–279; preeclampsia [ n =91]: median 262 days, IQR 248–269) than in women with a ratio >38 (no preeclampsia [ n =159]: median 255 days, IQR 224–266; preeclampsia [ n =108]: median 251 days, IQR 232–262). These trends were consistent when the sFlt-1/PlGF ratio at any pre-delivery visit was examined (not shown). Women without preeclampsia, who had iatrogenic preterm delivery had a higher Visit 1 median sFlt-1/PlGF ratio (35.3 [IQR 6.8–104], n =171), than women with non-iatrogenic preterm delivery (8.4 [IQR 3.4–30.6], n =25) or term delivery (4.3 [IQR 2.4–10.9], n =584). For women who developed preeclampsia and delivered preterm, the median sFlt-1/PlGF ratio at Visit 1 was 121 (IQR 66.2–231, n =53). Conclusions The maternal sFlt-1/PlGF ratio gives further information on preterm delivery risk. Women with high sFlt-1/PlGF ratios (>38) should be closely monitored, regardless of preeclampsia.

Shorter mothers have shorter pregnancies

We assessed whether maternal height was associated with gestational age in a cohort of 294 children born at term. Increasing maternal height was associated with longer pregnancy duration (p = 0.002). Stratified analyses showed that the main effect on pregnancy length appears to occur among shorter mothers (<165 cm tall), whose pregnancies were ∼0.6 and ∼0.7 weeks shorter than pregnancies of mothers 165–170 cm (p = 0.0009) and >170 cm (p = 0.0002) tall, respectively. Further, children of shorter mothers were more likely to be born early term than those of average height (p = 0.021) and taller (p = 0.0003) mothers. Maternal stature is likely to be a contributing factor influencing long-term outcomes in the offspring via its effect on pregnancy length.

Reproductive and productive performances of the stress-negative Piétrain pigs in the tropics: the case of Vietnam

The objective of the present study is to investigate the reproduction, production and semen traits of the stress-negative Piétrain line of pigs in the north of Vietnam, as well as to identify various factors (halothane genotype, generation-origin, parity, sex and month of the year) acting on these traits. The experiment was carried out on a purebred nucleus on Dong Hiep farm, Haiphong province in Vietnam. The reproduction performances and the sperm quality measures were based on 12 sows and 5 boars imported from Belgium as well as on 29 sows and 14 boars born in Vietnam, while the production performances were recorded only from 251 animals born in Vietnam. No significant differences were observed between halothane genotypes of sows for reproduction traits (P &gt; 0.0578). At the age of 7.5 months, bodyweight, backfat thickness and longissimus depth (7.5) of homozygous-dominant pigs were higher (P &lt; 0.05) than in heterozygotes. Homozygous-dominant boars had higher total number of spermatozoa than heterozygote boars (P &lt; 0.05); similarly, Vietnam boars also presented higher total number of spermatozoa values than Belgium boars (P &lt; 0.001). Vietnam sows had longer duration of pregnancy, more piglets born alive and heavier litter weight of weaning than Belgium sows (P &lt; 0.01). Bodyweight at birth, at weaning, at 2, 5.5 and 7.5 months of age increased from the first to third parity (P &lt; 0.05). Gilts had more lean meat than intact boars (P &lt; 0.01). Compared with observations made in temperate countries, the reproduction and production performances, sperm concentration and total number of spermatozoa of stress-negative Piétrain pigs were reduced, whereas lean meat percentage was not affected. This might be due to the different climate, although improving values for animals born in Vietnam might indicate adaptation of the animals and/or of the technicians with that breed. The results support the interest of the use of this new Piétrain line in tropical countries with ecological and climatic conditions similar to Vietnam.

Effects of a low–glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial

The optimal diet for pregnancy that is complicated by excessive weight is unknown. We aimed to examine the effects of a low-glycemic load (low-GL) diet in overweight and obese pregnant women. We randomly assigned 46 overweight or obese pregnant women to receive a low-GL or a low-fat diet. Participants received carbohydrate-rich foods, fats, and snack foods through home delivery or study visits. The primary outcome was birth weight z score. Other endpoints included infant anthropometric measurements, gestational duration, maternal weight gain, and maternal metabolic parameters. There were no significant differences in birth weight z score or other measures of infant adiposity between groups. However, in the low-GL compared with the low-fat group, gestational duration was longer (mean ± SD: 39.3 ± 1.1 compared with 37.9 ± 3.1 wk; P = 0.05) and fewer deliveries occurred at ≤ 38.0 wk (13% compared with 48%, P = 0.02; with exclusion of planned cesarean deliveries: 5% compared with 53%; P = 0.002). Adjusted head circumference was greater in the low-GL group (35.0 ± 0.8 compared with 34.2 ± 1.3 cm, P = 0.01). Women in the low-GL group had smaller increases in triglycerides [median (interquartile range): 49 (19, 70) compared with 93 (34, 129) mg/dL; P = 0.03] and total cholesterol [13 (0, 36) compared with 33 (22, 56) mg/dL, P = 0.04] and a greater decrease in C-reactive protein [-2.5 (-5.5, -0.7) compared with -0.4 (-1.4, 1.5) mg/dL, P = 0.007]. A low-GL diet resulted in longer pregnancy duration, greater infant head circumference, and improved maternal cardiovascular risk factors. Large-scale studies are warranted to evaluate whether dietary intervention during pregnancy aimed at lowering GL may be useful in the prevention of prematurity and other adverse maternal and infant outcomes. This trial is registered at clinicaltrials.gov as NCT00364403.

Early signs of maternal iron deficiency do not influence the iron status of the newborn, but are associated with higher infant birthweight

To investigate the associations between maternal iron status, pregnancy outcome and newborn iron status using sensitive and specific red blood cell indices reflecting iron-deficient erythropoiesis. Cross-sectional study in Kuopio University Hospital, Finland. One hundred and ninety-two pregnant women and their full-term newborns (cord blood). Quartile analysis and Spearman correlations were used to investigate the associations of the iron status of pregnant women with that of their newborns, and with pregnancy outcome. Maternal and cord blood analysis including indices reflecting the hemoglobin (Hb) content of red blood cells as well as serum iron, transferrin saturation, transferrin receptor and ferritin. Gestational age, birthweight and placental weight. The highest quartile of the maternal percentage of hypochromic red blood cells (%HYPOm) indicating the lowest iron status was associated with a high birthweight and a long duration of pregnancy. The newborns in this group did not show any signs of iron deficiency even though the maternal %HYPOm was elevated. In a well-nourished maternal population, lower maternal iron status did not affect the iron accumulation on the fetal side. However, longer duration of pregnancy and growth of the fetus appeared to be associated with a lower amount of iron for Hb synthesis in maternal red blood cells, as reflected by the increased maternal %HYPOm, birthweight and length of gestation.

Chorioamnionitis

SummaryChorioamnionitis is an inflammation of the placental membranes induced by microorganisms which reach the endometrial cavity from the vagina and uterine cervix. Premature labor frequently depends on infections. In patients with premature rupture of membranes (PROM) antibiotic treatment can prevent intra-amniotic inflammation if it is absent at admission. In spite of antibiotic treatment started immediately after the PROM in 218 patients, the chorioamnionitis did not prevent delivery in 41 patients within 48 hours of PROM. In the presence of a previous chorioamnionitis, antibiotic treatment cannot prevent premature labor, whereas it can prevent infection and lead to a longer duration of pregnancy if PROM does not depend on a previous infection.

A retrospective study of the success, safety and effectiveness of external cephalic version without tocolysis in a specialised midwifery centre in the Netherlands

Background to evaluate the effectiveness of external cephalic version (ECV) without tocolysis or epidural analgesia, the complications associated with the procedure and the association between the number of ECV attempts and cephalic presentation at birth and caesarean section. Methods retrospective cohort study of all ( n = 924 ) ECVs carried out between 1996 and 2000 in a specialised midwifery centre in the Netherlands. After bivariate analysis, those variables with a p value under 0.05 were considered statistically significant and were tested in a logistic regression model using backward stepwise selection. Analyses were carried out separately for first ECV attempts and second ECV attempts. Findings in total, 958 ECVs were analysed, 889 first attempts and 69 repeat attempts. Seventy per cent of all first ECVs were carried out before 37 weeks, but half of those were carried out between 36 and 37 weeks. The success rate for first ECV was 41% and for the second ECV 29%. Bivariate analysis showed that the success of the first ECV was positively influenced by parity, non-Dutch origin, higher birth weight, higher age and longer duration of pregnancy. After logistic regression, parity (odds ratio [OR] 2.8, 95% CI 2.1 to 3.7), non-Dutch origin (OR 1.8, 95% CI 1.2 to 2.8) and birth weight (OR 1.7, 95% CI 1.4 to 2.0) remained factors that independently influenced the success of ECV. The odds ratio for duration of pregnancy at first ECV was borderline significant: OR 1.2 (1.0 to 1.4). After an unsuccessful first ECV, only 13% of the women received a second ECV. The prevalence of cephalic presentation at birth increased with 3% after a second ECV. Three cases of complications were reported during or very shortly after the first ECV, and these did not result in serious complications. No complications were reported after a second ECV. Conclusion ECV without tocolysis is a safe procedure for pregnant women and their babies. Repeat ECV increases the number of cephalic presentations at birth and should be considered after an unsuccessful ECV.

Supplementary calcium in prevention of pre-eclampsia

Objective: To study the effect of calcium supplementation on reduction of pre-eclampsia in Iranian women at high risk of pre-eclampsia. Methods: Thirty pregnant women at high risk of developing pre-eclampsia were randomized to 2 g of daily calcium and placebo. Subjects and investigators were blinded to treatment allocation. The inclusion criteria were positive rollover test, having at least one risk factor for pre-eclampsia, between 28 and 32 weeks of pregnancy, and blood pressure less than 140/90 (mmHg). Exclusion criteria were having any chronic condition. Pre-eclampsia was defined as systolic/diastolic blood pressure over 140/90 plus proteinuria. All the subjects were followed up to delivery. Result: A sevenfold reduction in the occurrence of pre-eclamsia were seen among the calcium group compared with the placebo group (7 out of 15 developed pre-eclampsia in control group vs. 1 out of 15 in calcium group, P=0.014). No major effect on pregnancy induced hypertension was seen (66% in placebo and 76% in calcium group developed hypertension) but the onset of hypertension was delayed 3 weeks in the calcium group. A longer duration of pregnancy was seen in calcium than placebo (mean±S.D.=37±2 for calcium and 34±2 for placebo, P<0.05). Infants born to the calcium group, on average, were 552 g heavier than infants born to the placebo group, P<0.05. Conclusion: Calcium supplementation is beneficial for preventing pre-eclampsia among Iranian women at high risk of developing pre-eclampsia.

Maternal Hematocrit and Albumin as Predictors of Intrauterine Growth Retardation and Preterm Delivery

Objective: To determine if maternal hematocrit and serum albumin can predict intrauterine growth retardation and/or preterm delivery. Methods: Analyses were performed during each trimester of pregnancy to evaluate the predictive value of these two common laboratory parameters as predictors of intrauterine growth retardation and/or prematurity. Results: 1468 women participated in the study. Intrauterine growth retardation occurred in 9.9% and preterm delivery in 6.1%. A significant inverse correlation between hematocrit and albumin and birth weight was found ( r= -0.005, p = 0.04, and r= -0.07, p = 0.007, respectively), albumin being a stronger predictor as demonstrated by multiple regression. Low hematocrit at the third visit was associated with a longer pregnancy duration ( r= -0.06, p = 0.02). Women with higher serum albumin levels at the second visit, had a longer pregnancy duration, possibly reflecting a better nutritional status ( r= 0.057, p= 0.03). To determine the predictive value of hematocrit and serum albumin, the prevalence of intrauterine growth retardation and premature delivery in the highest quartiles were compared with the lowest, and no significant differences were observed ( p > 0.1). Conclusion: Maternal hematocrit and serum albumin concentation cannot be used as useful predictors of intrauterine growth retardation or preterm delivery.

Determining the clinical efficacy and cost savings of successful external cephalic version

OBJECTIVE: The aim of this study was to determine predictors of successful external cephalic version and to calculate the associated cost savings achieved with success. STUDY DESIGN: A retrospective study of 203 women with singleton gestations who underwent external cephalic version was performed. Descriptive, univariate, and multivariate analyses were performed on patient-specific risk data to predict successful version. National claims data were used for the cost simulation. RESULTS: Higher parity ( p = 0.02), transverse-oblique presentation ( p = 0.001), posterior placenta ( p = 0.001), and a longer duration of pregnancy ( p = 0.001) significantly increased the likelihood of a successful version. Heavier maternal weight was negatively associated with successful version ( p = 0.05). The cost simulation revealed an average savings of $2462 for each successful version. CONCLUSION: This study identifies clinical variables associated with an increased external cephalic version success rate. If, in fact, successful external cephalic version reduces both maternal and fetal morbidity associated with cesarean delivery and, as demonstrated in this analysis, the costs associated with the delivery, then greater effort should be made to maximize the success rate of external cephalic version. (Am J Obstet Gynecol 1996;175:1639-44.)