Low-risk Pregnancies Research Articles

Trial of labor after caesarean section in low risk pregnancies: is it risky?

To evaluate the influence of a previous caesarean section on adverse composite maternal and perinatal outcome in women who attempted a trial of labor. This historical cohort study analyzed maternal and perinatal outcome in women with otherwise low risk pregnancies at term who underwent a trial of labor after a caesarean section (TOLAC). The primary outcome measure was the adverse composite outcome. Secondary outcome measures were amongst others the caesarean section rate and the mode of vaginal delivery. The adverse composite outcome was more frequently in the previous caesarean section group compared to women with no previous caesarean Sect.(22.3% vs. 15.6%, p < 0.0001). The percentage of caesarean Sect.(15.4% vs. 8.2%, p < 0,0001), uterine rupture (1.0% vs. 0.02%, p < 0.0001), placental abruption (1.1% vs. 0.3%, p = 0.0014), vaginal operative delivery (16.0% vs. 8.6%, p < 0.0001), pH < 7.10 (3.7% vs. 2.5%, p = 0.0151), base excess < -12 (3.2% vs. 2.2%, p = 0.0297), abnormal cardiotocography (22.5% vs. 13.9%, p < 0,0001) and fetal blood analysis (6.2% vs. 2.6%, p < 0.0001) was significantly higher in women with a previous caesarean section. Taking the parity into account, these differences could only been seen in women without a previous vaginal delivery. In parous women with a previous vaginal delivery and a caesarean section in history, the adverse composite did not differ between the groups. Only the rate of pH < 7.1 was higher in women after a caesarean Sect.(4.5% vs. 1.8%, p = 0.0436). Trial of labor after caesarean in otherwise low risk pregnancies is associated with a higher rate of complications especially if there is no history of vaginal delivery.

A Pilot Study of Ultrasound Assessment of Umbilical Cord and Placental Vascular Flow for Cord Accident Stillbirth Prevention.

Our objective was to determine the feasibility and interobserver reliability of umbilical cord and placental arteriolar flow assessment in low-risk pregnancies near term. This was a prospective pilot study in low-risk pregnancies at 36 weeks with anterior placentas. We excluded any with an indication for antenatal testing or delivery before 39 weeks. Each participant underwent two ultrasounds by different examiners, which included arterial and venous velocimetry at three cord sites (fetal, free loop, and placental) in addition to maternal and fetal placental arterioles. The interobserver reliability was quantified using the Pearson correlation coefficient with that of standard clinical parameters serving as a benchmark for interpretation. Among 53 participants scanned at 356/7-371/7 weeks, the mean examination duration was 20.5 ± 4.2 minutes. Ascertainment success was high for measures at the free loop, placental cord insertion, and fetal placental arterioles (range 90.6%-99.1%) and was lower at the fetal cord insertion and maternal spiral arterioles (range 47.2%-87.7%). Interobserver reliability estimates for free-loop systolic/diastolic and pulsatility index ranged from 0.38 to 0.44. Interobserver reliability for experimental parameters varied by measurement site, and all were poor at the fetal insertion and in placental arterioles. Parameters had significant variation across cord sites (range 4.3%-21.7%). In our cohort, flow assessments of the free loop, placental insertion, and placental arterioles are feasible, but interrater reliability varies by measurement type and cord site. Future studies are needed to establish feasibility and reliability in nonanterior placentation and to assess clinical relevance.

Associations between maternal nutritional status, haemodynamic parameters and delivery outcomes in low-risk pregnancies: a prospective observational study

Associations between maternal nutritional status, haemodynamic parameters and delivery outcomes in low-risk pregnancies: a prospective observational study

Longitudinal analysis of body dissatisfaction: the desire to be thinner among women in Japan during low-risk pregnancies.

Body dissatisfaction during pregnancy can significantly impact maternal and child health. Therefore, this longitudinal study investigated changes in body dissatisfaction using two figure rating scales developed from photographic digital data of Japanese pregnant women during the sixth and tenth months of pregnancy. Study participants were recruited at their sixth month prenatal visit at a primary maternity clinic in Japan from October 2014 to March 2015. Body dissatisfaction was estimated based on the perceived and ideal body sizes of 135 pregnant women, expressed as body mass index. Data were collected using self-administered questionnaires. The study found that body dissatisfaction in the tenth month was significantly higher than that in the sixth month. Among the participants, 75 (55.6%) and 79 (58.5%) experienced body dissatisfaction, desiring to be thinner (where perceived body size exceeded ideal body size) during the sixth and tenth months of pregnancy, respectively. Pregnant women who had body dissatisfaction and a desire to be thinner in the sixth month tended to experience an increase in body dissatisfaction by the tenth month compared to those without body dissatisfaction in the sixth month. During the sixth and tenth months, women with body dissatisfaction showed significantly larger perceived body sizes than those without body dissatisfaction. These results indicated that the use of a figure rating scale at the sixth month of pregnancy may help identify women with body dissatisfaction; moreover, perceived body size might be a key factor in preventing an increase in body dissatisfaction from the second to third trimesters.

Soluble fms-like tyrosine kinase-1/placental growth factor ratio at 36 weeks’ gestation: association with spontaneous onset of labor and intrapartum fetal compromise in low-risk pregnancies

Previous evidence showed that placental dysfunction triggers spontaneous preterm or term births and intrapartum fetal compromise and often requires urgent delivery, thereby exposing both the fetus and the mother to significant risks. Predicting spontaneous labor onset and intrapartum fetal compromise could improve obstetrical management and outcomes, but this is currently difficult, particularly in low-risk populations. The objective of this study was to examine whether placental dysfunction, as assessed at 36 weeks' gestation by the soluble fms-like tyrosine kinase-1 to placental growth factor ratio, is associated with the interval to spontaneous onset of labor and intrapartum fetal compromise that requires cesarean delivery in a routinely examined population. This was a retrospective analysis of prospectively collected data of women with singleton pregnancies who underwent routine assessment at 35+0 to 36+6 weeks' gestation at the King's College Hospital (London, England). Using a general linear model, the study examined the outcomes related to the soluble fms-like tyrosine kinase-1/placental growth factor ratio, including the time interval from testing to spontaneous onset of labor and the subsequent rate of fetal compromise that required a cesarean delivery. Patients who underwent induction of labor or prelabor cesarean deliveries were excluded from the study. Competing risks regression and Cox regression models were used to estimate the cumulative incidence and the risk of the outcomes of interest. In the screened population of 45,375 patients, 23,831 (52.5%) had spontaneous onset of labor and were included in the analysis. Cases with an soluble fms-like tyrosine kinase-1/placental growth factor ratio >50 delivered about 1 week earlier than those with a ratio of ≤50 (39.2 vs 40.0 weeks' gestation; P<.001). The general linear model showed that a larger soluble fms-like tyrosine kinase-1/placental growth factor ratio was associated with earlier spontaneous onset of labor (P<.001), particularly among multiparous women. The soluble fms-like tyrosine kinase-1/placental growth factor ratio was significantly associated, as expected, with cases of preeclampsia and advanced maternal age. The cumulative incidence of spontaneous onset of labor was significantly higher in cases with an soluble fms-like tyrosine kinase-1/placental growth factor ratio >50 than in those with a ratio 50 (P<.001). Cox regression showed that the risk for spontaneous onset of labor increased with an soluble fms-like tyrosine kinase-1/placental growth factor ratio >50 (hazard ratio, 1.424; 95% confidence interval, 1.253-1.618; P<.001) and, as expected, the risk was mitigated over time from when the soluble fms-like tyrosine kinase-1/placental growth factor ratio was measured to spontaneous labor onset (P<.001). Cases with intrapartum fetal compromise had a higher mean soluble fms-like tyrosine kinase-1/placental growth factor ratio than those without intrapartum fetal compromise (21.79 vs 17.67; P<.001). Qualitative addition of fetal compromise to the general linear model showed a higher soluble fms-like tyrosine kinase-1/placental growth factor ratio in cases with fetal compromise than in those without fetal compromise (P=.014). Competing risks regression showed a positive dose-response effect for fetal compromise with increasing soluble fms-like tyrosine kinase-1/placental growth factor ratios (P<.001). Above and below the optimal cutoff of 50, the quoted cumulative incidences were 6.7% and 4.7%, respectively (P<.001). The effect of the soluble fms-like tyrosine kinase-1/placental growth factor ratio remained significant even after adjusting for preeclampsia, which is a well-known major risk factor for fetal compromise. Finally, the proportion of cases with intrapartum fetal compromise who had an soluble fms-like tyrosine kinase-1/placental growth factor ratio >50 decreased from 35% to 0% with advancing gestation. This study showed that an increased soluble fms-like tyrosine kinase-1/placental growth factor ratio at 36 weeks' gestation is associated with an earlier gestational age at spontaneous onset of labor and higher rates of intrapartum fetal compromise. There are 2 major implications, namely an soluble fms-like tyrosine kinase-1/placental growth factor ratio >50 indicates imminent labor onset with about a 40% mean risk increase and immediate clinical translation for term pregnancy monitoring. In addition, an increased soluble fms-like tyrosine kinase-1/placental growth factor ratio increases the risk for intrapartum fetal compromise, although outcome variability indicates reassessment within multimarker models.

Risk of hypertensive disorders of pregnancy in electively induced or expectantly managed full-term IVF pregnancies

Research questionAre there differences in the rates of hypertensive disorders of pregnancy among in vitro fertilization (IVF) patients who underwent induction of labor at 39 weeks compared to those who were managed expectantly? DesignThis is a retrospective cohort study of 1,176 low-risk singleton pregnancies conceived following IVF with no contraindications to vaginal delivery. Two groups were constructed: elective induction of labor from 39 weeks 0 days to 39 weeks 6 days (n=234) versus expectant management (n=942). Main outcome measure was the incidence of hypertensive disorders of pregnancy. Secondary outcome was the rate of cesarean delivery. Sub-analyses were performed within fresh and frozen embryo transfer groups. ResultsHypertensive disorders of pregnancy developed in 8.1% of patients in the induction of labor group and in 12.4% in the expectant management group (P=.06). This difference was attenuated after controlling for potential confounders (P=.28). For frozen embryo transfers, the unadjusted odds of hypertensive disorders of pregnancy were significantly lower with induction of labor compared to expectant management (P=.02) and after adjusting for confounders, the odds ratio neared significance (P=.09). For fresh transfers, there was no difference in the odds of hypertensive disorders of pregnancy between the two groups. The odds of delivering via cesarean section were higher in the induction of labor group, in the total population and in sub-analyses. ConclusionOverall, in IVF conceived pregnancies, induction of labor when compared to expectant management was not associated with a lower incidence of hypertensive disorders of pregnancy, it was however, associated with a higher rate of cesarean delivery.

Utilizing Modified Coopland's Scoring System to Identify and Predict the Outcome of High-Risk Pregnancies in Resource-Limited Settings: A Retrospective Review.

Introduction A high-risk pregnancy is associated with adverse maternal and foetal outcomes. Women with high-risk pregnancies are at a greater risk of developing antepartum haemorrhage, miscarriages, and the need for surgical interventions. Neonatal complications include preterm births, low birth weight (LBW), intra-uterine deaths and an increased need for NICU admission. The utilisation of low-cost scoring tools for identifying high-risk women can aid in early diagnosis and timely implementation of therapeutic interventions. Objective The retrospective record-based study sought to calculate the proportion of high-risk pregnancies using modified Coopland's scoring system and compare the maternal and foetal outcomes among high-risk pregnancies. Methods The study retrospectively analysed the records of antenatal women in their third trimester from the years December 2018 to December 2021. Each record was then numerically assessed according to the modified Coopland's scoring system and categorised according to the risk status. Maternal and neonatal outcomes were then compared across the risk groups. Results The data included 300 cases over a three-year period.According to modifiedCoopland's scoring system, we found that the overall proportion of high-risk pregnancies was 18.3%. Adverse maternal and fetal outcomes were increased in high-risk pregnancy groups when compared to low-risk pregnancies, miscarriages (31.6% vs 15.8%) and antepartum haemorrhage (55.6% vs 11.1%). Babies born to high-risk mothers had a higher chance of developing LBW status (52.0%) and respiratory distress (45.5%) when compared to those born to low-risk mothers: 8.0% and 13.6%, respectively. Conclusion A notable portion of pregnant women were classified as high-risk using modified Coopland's scoring tool and would benefit from targeted obstetric care.

Clinical significance of head circumference \ abdominal circumference ratio in low risk pregnancy

Clinical significance of head circumference \ abdominal circumference ratio in low risk pregnancy

Adiponectin and Glucocorticoids Modulate Risk for Preterm Birth: The Healthy Start Study.

Adiponectin is a potent uterine tocolytic that decreases with gestational age, suggesting it could be a maternal metabolic quiescence factor. Maternal stress can influence preterm birth risk, and adiponectin levels may be stress-responsive. We characterized associations between adiponectin and glucocorticoids with preterm birth and modeled their predictive utility. We hypothesized maternal plasma adiponectin and cortisol are inversely related and lower adiponectin and higher cortisol associate with preterm birth. We performed a nested case-control study using biobanked fasting maternal plasma. We included low-risk singleton pregnancies, and matched 1:3 (16 preterm, 46 term). We quantified total, high (HMW), and low molecular weight (LMW) adiponectin using ELISA. We validated an HPLC-MS/MS serum assay for use in plasma, to simultaneously measure cortisol, cortisone, and five related steroid hormones. We used linear/logistic regression to compare group means and machine learning for predictive modeling. The preterm group had lower mean LMW adiponectin (3.07 μg/mL vs. 3.81 μg/mL at 15w0d, P=0.045) and higher mean cortisone (34.4 ng/mL vs. 29.0 ng/mL at 15w0d, P=0.031). The preterm group had lower cortisol-to-cortisone and lower LMW adiponectin-to-cortisol ratios. We found HMW adiponectin, cortisol-to-cortisone ratio, cortisone, maternal height, age, and pre-pregnancy BMI most strongly predicted preterm birth (AUROC=0.8167). In secondary analyses, we assessed biomarker associations with maternal self-reported psychosocial stress. Lower perceived stress associated with a steeper change in cortisone in the term group. Overall, metabolic and stress biomarkers associated with preterm birth in this healthy cohort. We identify a possible mechanistic link between maternal stress and metabolism for pregnancy maintenance.

Neonatal Outcomes after Maternal Biomarker-Guided Preterm Birth Intervention: The AVERT PRETERM Trial.

The AVERT PRETERM trial (NCT03151330) evaluated whether screening clinically low-risk pregnancies with a validated maternal blood biomarker test for spontaneous preterm birth (sPTB) risk, followed by preventive treatments for those screening positive, would improve neonatal outcomes compared to a clinically low-risk historical population that had received the usual care. Prospective arm participants with singleton non-anomalous pregnancies and no PTB history were tested for sPTB risk at 191/7-206/7 weeks' gestation and followed up with after neonatal discharge. Screen-positive individuals (≥16% sPTB risk) were offered vaginal progesterone (200 mg) and aspirin (81 mg) daily, with twice-weekly nurse phone calls. Co-primary outcomes were neonatal morbidity and mortality, measured using a validated composite index (NMI), and neonatal hospital length of stay (NNLOS). Endpoints were assessed using survival analysis and logistic regression in a modified intent-to-treat population comprising screen-negative individuals and screen-positive individuals accepting treatment. Of 1460 eligible participants, 34.7% screened positive; of these, 56.4% accepted interventions and 43.6% declined. Compared to historical controls, prospective arm neonates comprising mothers accepting treatment had lower NMI scores (odds ratio 0.81, 95% CI, 0.67-0.98, p = 0.03) and an 18% reduction in severe morbidity. NNLOS was shorter (hazard ratio 0.73, 95% CI, 0.58-0.92, p = 0.01), with a 21% mean stay decrease among neonates having the longest stays. Sensitivity analyses in the entire intent-to-treat population supported these findings. These results suggest that biomarker sPTB risk stratification and preventive interventions can ameliorate PTB complications in singleton, often nulliparous, pregnancies historically deemed low risk.

Factors associated with depression during pregnancy in women receiving high- and low-risk prenatal care: a predictive model.

Depression during pregnancy can put strain on pregnant women's interpersonal relationships, the formation of emotional bonds with the fetus, and the adaptation to the new routine and social role post-pregnancy. Some studies have associated socioeconomic factors, emotional factors, interpersonal relationships, perceived social support, gestational risk, and the occurrence of certain diseases during pregnancy with higher risk of depression. This study aimed to investigate the prevalence of depression during pregnancy and associated factors in low- and high-risk prenatal patients at a Brazilian university hospital. This study presents a retrospective and prospective cross-sectional design. A total of 684 prenatal psychological analysis records from a Brazilian tertiary university service were retrospectively evaluated to assess depression through the PRIME-MD questionnaire between 2002-2017. Between 2017 and 2018, 76 patients treated at the same service were prospectively evaluated with the aforementioned instrument. Medical records were accessed to obtain labor and birth data. Multivariate analyses assessed the association between sociodemographic, gestational or obstetric, and health variables and the presence of depression during pregnancy. A total of 760 pregnant women were included in the study, with a depression prevalence of 20.66% (n = 157). At the time of assessment, 48 (21.05%) women from the low-risk pregnancy group and 109 (20.49%) from the high-risk pregnancy group were depressed. The mean age was 30.01 ± 6.55 years in the group with depression and 29.81 ± 6.50 years in the group without depression. In the univariate analysis, there was an association of risk for depression with absence of paid work, absence of a partner, low family income and diagnosis of epilepsy, being a protective factor the presence of diabetes during pregnancy. However, in the multivariate analysis, a lower family income, not having a partner at the time of the assessment, and the prevalence of epilepsy were independently associated with an increased risk of depression during pregnancy. This study showed that 1 in 5 women had depression during pregnancy, with no association with obstetric risk, but those women living in unfavorable economic conditions, without a partner, and having epilepsy were at increased risk of depression.

Intrapartum fetal monitoring practices in Norway: A population-based study

ObjectiveTo describe intrapartum fetal monitoring methods used in all births in Norway in 2019–2020, assess adherence to national guidelines, investigate variation by women’s risk status, and explore associations influencing monitoring practices. MethodsA nationwide population-based study. We collected data about all pregnancies with a gestational age ≥ 22 weeks during 2019–2020 from the Medical Birth Registry of Norway. We used descriptive analyses, stratified for risk status, to examine fetal monitoring methods used in all deliveries. Univariable and multivariable logistic regression models were used to determine factors associated with monitoring with cardiotocography (CTG) in low-risk, straightforward births. ResultsIn total, 14 285 (14%) deliveries were monitored with only intermittent auscultation (IA), 46214 (46%) with only CTG, and 33417 (34%) with IA and CTG combined. Four percent (2 067/50 533) of women with risk factors were monitored with IA only. Half (10589/21 282) of the low-risk women with straightforward births were monitored with CTG. Maternal and fetal characteristics, size of the birth unit and regional practices influenced use of CTG monitoring in this group. ConclusionsMost births are monitored with CTG only, or combined with IA. Half the women with low-risk pregnancies and straightforward births were monitored with CTG although national guidelines recommending IA.

Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EPA)-Should They Be Mandatory Supplements in Pregnancy?

Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are essential fatty acids for the human body. Seafood and microalgae are the most important sources of omega-3 fatty acids. Supplementation with 200 mg/day of DHA during pregnancy and breastfeeding has been suggested for women and infants in countries with low seafood consumption. Maternal concentration of DHA and EPA was associated with concentration in cord blood and breast milk. High concentrations of DHA and EPA were identified at the level of retinal photoreceptors and neuronal cell membranes. It was observed that supplementation with DHA and EPA during pregnancy had beneficial effects on the neurological development of the fetus and infant by improving language, memory, attention, and hand coordination, affecting sleep patterns, and improving visual acuity. Beneficial effects on the development of the infant were also associated with the maternal intake of omega-3 fatty acids during breastfeeding. Supplementation with DHA and EPA may reduce the risk of preterm birth but also of preeclampsia in low-risk pregnancies. Women of childbearing age should have an intake of 250 mg/day of DHA + EPA from their diet or supplements. To reduce the risk of premature birth, pregnant women must additionally receive at least 100-200 mg of DHA every day. It is recommended that supplementation with omega-3 fatty acids starts before 20 weeks of pregnancy. Beneficial effects on the mother have been identified, such as the reduction of postpartum depression symptoms, the decrease of cardiovascular risk, and the anti-inflammatory role.

Impact of the midwife-led care model on mode of birth: a systematic review and meta-analysis

Background/Aims Increased rates of caesarean sections globally have potential short- and long-term impacts for mothers and babies. Research on models of care and mode of birth has reported varied results. The aim of this study was to analyse the relationship between the midwife-led model of care and mode of birth. Methods This systematic review and meta-analysis searched PubMed, Scopus and Web of Science. Quantitative full-text open access research articles published between 2010 and 2023 in Indonesian or English were included. Research that assessed the relationship between the model and birth planning were excluded. Results A total of 16 articles were included. Two were experimental, and the remaining 14 were observational, with a total sample of 125 201 people. The midwife-led model supported spontaneous vaginal birth (odds ratio: 1.64, P=0.01) when compared to other models. Conclusions Implementing the midwife-led model of care may increase the likelihood of physiological birth and reduce the incidence of caesarean section, especially in low-risk pregnancies.

Comparison of a Two (32/38 Weeks) versus One (36 Weeks) Ultrasound Protocol for the Detection of Decreased Fetal Growth and Adverse Perinatal Outcome.

Third-trimester ultrasound has low sensitivity to small for gestational age (SGA) and adverse perinatal outcomes (APOs). The objective of this study was to compare, in terms of cost-effectiveness, two routine third-trimester surveillance protocols for the detection of SGA and evaluate the added value of a Doppler study for the prediction of APO. This was a retrospective observational study of low-risk pregnancies that were followed by a two growth scans protocol (P2) at 32 and 38 weeks or by a single growth scan at 36 weeks (P1). Ultrasound scans included an estimated fetal weight (EFW) in all cases and a Doppler evaluation in most cases. A total of 1011 pregnancies were collected, 528 with the P2 protocol and 483 with the P1 protocol. While the two models presented no differences for the detection of SGA in terms of sensitivity (47.89% vs. 50% p = 0.85) or specificity (94.97 vs. 95.86% p = 0.63), routine performance of two growth scans (P2) led to a 35% cost increase. The accuracy of EFW for the detection of SGA showed a noteworthy improvement when reducing the interval to labor, and the only parameter with predictive capacity of APO was the cerebroplacental ratio at 38 weeks. In low-risk pregnancies, the higher costs of a two-scan growth surveillance protocol at the third trimester are not justified by an increase in diagnostic effectivity.

Cohort profile: Improved Pregnancy Outcomes via Early Detection (IMPROvED), an International Multicentre Prospective Cohort

Background Improved Pregnancy Outcomes via Early Detection (IMPROvED) is a multi-centre, European phase IIa clinical study. The primary aim of IMPROvED is to enable the assessment and refinement of innovative prototype preeclampsia risk assessment tests based on emerging biomarker technologies. Here we describe IMPROvED’s profile and invite researchers to collaborate. Methods A total of 4,038 low-risk nulliparous singleton pregnancies were recruited from maternity units in Ireland (N=1,501), United Kingdom (N=1,108), The Netherlands (N=810), and Sweden (N=619) between November 2013 to August 2017. Participants were interviewed by a research midwife at ~11 weeks (optional visit), ~15 weeks, ~20 weeks, ~34 weeks’ gestation (optional visit), and postpartum (within 72-hours following delivery). Findings to date Clinical data included information on maternal sociodemographic, medical history, and lifestyle factors collected at ~15 weeks’ gestation, and maternal measurements, collected at each study visit. Biobank samples included blood, urine, and hair collected at each study visit throughout pregnancy in all units plus umbilical cord/blood samples collected at birth in Ireland and Sweden. A total of 74.0% (N=2,922) had an uncomplicated pregnancy, 3.1% (N=122) developed preeclampsia, 3.6% (N=143) had a spontaneous preterm birth, and 10.5% (N=416) had a small for gestational age baby. We evaluated a panel of metabolite biomarkers and a panel of protein biomarkers at 15 weeks and 20 weeks’ gestation for preeclampsia risk assessment. Their translation into tests with clinical application, as conducted by commercial entities, was hampered by technical issues and changes in test requirements. Work on the panel of proteins was abandoned, while work on the use of metabolite biomarkers for preeclampsia risk assessment is ongoing. Future plans In accordance with the original goals of the IMPROvED study, the data and biobank are now available for international collaboration to conduct high quality research into the cause and prevention of adverse pregnancy outcomes.

The effect of continuous electronic fetal monitoring on mode of delivery and neonatal outcome among low-risk laboring mothers at Debre Markos comprehensive specialized hospital, Northwest Ethiopia.

Electronic fetal heart rate monitoring (EFM) has been widely used in obstetric practice for over 40 years to improve perinatal outcomes. Its popularity is growing in Ethiopia and other sub-Saharan African countries to reduce high perinatal morbidity and mortality rates. However, its impact on delivery mode and perinatal outcomes in low-risk pregnancies remains controversial. This study aimed to assess the effect of continuous EFM on delivery mode and neonatal outcomes among low-risk laboring mothers at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A prospective follow-up study was conducted from November 20, 2023, to January 10, 2024. All low-risk laboring mothers meeting the inclusion criteria were included. Data were collected via pretested structured questionnaires and observation, then analyzed using Epi-data 4.6 and SPSS. The incidences of cesarean delivery and continuous EFM were compared using the chi-squared test and Fisher's exact test. The study found higher rates of instrumental-assisted vaginal delivery (7% vs. 2.4%) and cesarean sections (16% vs. 2%) due to unsettling fetal heart rate patterns in the continuous EFM group compared to the intermittent auscultation group. However, there were no differences in immediate neonatal outcomes between the groups. When compared to intermittent auscultation with a Pinard fetoscope, the routine use of continuous EFM among low-risk laboring mothers was associated with an increased risk of cesarean sections and instrumental vaginal deliveries, without significantly improving immediate newborn outcomes. However, it is important to note that our study faced significant logistical constraints due to the limited availability of EFM devices, which influenced our ability to use EFM comprehensively. Given these limitations, we recommend avoiding the routine use of continuous EFM for low-risk laboring mothers to help reduce the rising number of operative deliveries, particularly cesarean sections. Our findings should be interpreted with caution, and further research with adequate resources is needed to draw definitive conclusions.

Rural-urban and racial differences in cesarean deliveries before and during the COVID-19 pandemic in South Carolina

ProblemUnnecessary cesarean delivery increases the risk of complications for birthing people and infants. BackgroundExamining the intersectionality of rural and racial disparities in low-risk cesarean delivery is necessary to improve equity in quality obstetrics care. AimTo evaluate rural and racial/ethnic differences in Nulliparous, Term, Singleton, Vertex (NTSV) and primary cesarean delivery rates before and during the COVID-19 pandemic in South Carolina. MethodsThis retrospective cohort study used birth certificates linked to all-payer hospital discharge data for South Carolina childbirths from 2018 to 2021. Multilevel logistic regressions examined differences in cesarean outcomes by rural/urban hospital location and race/ethnicity of birthing people during pre-pandemic (January 2018–February 2020) and peri-pandemic periods (March 2020–December 2021), adjusting for maternal, infant, and hospital characteristics among two low-risk pregnancy cohorts: 1) Nulliparous, Term, Singleton, Vertex (NTSV, n = 65,974) and 2) those without prior cesarean (primary, n = 167,928). FindingsBlack vs. White disparities remained for NTSV cesarean in adjusted models (urban pre-pandemic aOR = 1.34, 95 %CI 1.23–1.46) but were not significantly different for primary cesarean, apart from rural settings peri-pandemic (aOR = 0.87, 95 %CI 0.79–0.96). Hispanic individuals had higher adjusted odds of NTSV cesarean only for rural settings pre-pandemic (aOR = 1.28, 95 %CI 1.05–1.56), but this disparity was not significant during the pandemic (aOR = 1.13, 95 %CI 0.93–1.37). Discussion and conclusionObserved rural and racial/ethnic disparities in cesarean delivery outcomes were present before and during the COVID-19 pandemic. Strategies effective in reducing racial disparities in primary cesarean may be useful in also reducing Black vs. White NTSV cesarean disparities.

Statement of retraction: body mass index is linked to cervical length and duration of pregnancy: an observational study in low risk pregnancy

Statement of retraction: body mass index is linked to cervical length and duration of pregnancy: an observational study in low risk pregnancy

The Impact of Midwifery-Led Care on Birth Outcomes in Low-Risk Pregnancies

Purpose: This study aims to investigate the impact of midwifery-led care on birth outcomes in low-risk pregnancies. Research Design and Methodology: Utilizing a qualitative research approach grounded in a comprehensive literature review, this study synthesizes existing knowledge on midwifery-led care. A systematic search and analysis of peer-reviewed articles, clinical reports, and grey literature were conducted to explore the efficacy of midwifery-led care compared to conventional medical care. Findings and Discussion: The findings highlight the significant reduction in medical interventions associated with midwifery-led care, along with the promotion of physiological childbirth and enhanced maternal and neonatal well-being. Key factors such as continuity of care, patient-provider relationships, and cultural competence play crucial roles in optimizing outcomes. Implications: Policy implications include the integration of midwifery care into mainstream healthcare systems, investment in midwifery education, and advocacy for legislative support to ensure equitable access to high-quality maternity care.