Low-risk Pregnancies Research Articles

Midwife-Led Versus Obstetrician-Led Perinatal Care for Low-Risk Pregnancy: A Systematic Review and Meta-Analysis of 1.4 Million Pregnancies

Background: The optimum model of perinatal care for low-risk pregnancies has been a topic of debate. Obstetrician-led care tends to perform unnecessary interventions, whereas the quality of midwife-led care has been subject to debate. This review aimed to assess whether midwife-led care reduces childbirth intervention and whether this comes at the expense of maternal and neonatal wellbeing. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for relevant studies. Studies were checked for eligibility by screening the titles, abstracts, and full texts. We performed meta-analyses using the inverse variance method using RevMan software version 5.3. We pooled data using the risk ratio and mean difference with the 95% confidence interval. Results: This review included 44 studies with 1,397,320 women enrolled. Midwife-led care carried a lower risk of unplanned cesarean and instrumental vaginal deliveries, augmentation of labor, epidural/spinal analgesia, episiotomy, and active management of labor third stage. Women who received midwife-led care had shorter hospital stays and lower risks of infection, manual removal of the placenta, blood transfusion, and intensive care unit (ICU) admission. Furthermore, neonates delivered under midwife-led care had lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission. Postpartum hemorrhage, perineal tears, APGAR score < 7, and other outcomes were comparable between the two models of management. Conclusions: Midwife-led care reduced childbirth interventions with favorable maternal and neonatal outcomes in most cases. We recommend assigning low-risk pregnancies to midwife-led perinatal care in health systems with infrastructure allowing for smooth transfer when complications arise. Further research is needed to reflect the situation in low-resource countries.

Added value in low-risk pregnancies of longitudinal changes in uterine Doppler and circulating angiogenic factors during the third trimester in predicting term preeclampsia.

To assess the relationship between longitudinal changes in the uterine Doppler velocimetry and the maternal profile of angiogenic factors in the third trimester of pregnancy and to assess their ability to predict term preeclampsia. A cohort of low-risk pregnant women was constructed at second trimester routine scan and scheduled for a uterine Doppler evaluation and measurement of the circulating levels of angiogenic factors at ~30 and ~36 weeks. The performance of both parameters at both time-points and their change over time from the first to the second measurement in predicting term preeclampsia was evaluated by logistic regression and receiver operating characteristic curve (ROC) analyses. A total of 1172 women were analyzed, of which 28 (2.4%) women developed term preeclampsia. At ~30 weeks, a model including the ratio sFlt-1/PlGF (fms-like tyrosine kinase-1/placental growth factor) and the uterine Doppler explained 16.2% of the uncertainty of developing term preeclampsia, while at ~36 weeks the same variables explained 25.2% [p<0.001]. A model including the longitudinal changes of both predictors had an R2 of 26.8%, which was not significantly different from that of the ~36 weeks evaluation [p=0.45]. The area under the curve (AUC) of the ~36 weeks sFlt-1/PlGF ratio was significantly higher than at ~30 weeks (0.86 [0.77-0.94] vs. 0.81 [0.73-0.9]; p=0.043). The AUC of the 30-to-36 week change of the sFlt-1/PlGF ratio (0.85 [0.77-0.94]) did not significantly differ from that of at ~36 weeks (p=0.82). At ~36 weeks, for a 10% of false positives, the sFlt-1/PlGF ratio had a detection rate of 71.4%, with positive and negative likelihood ratios of 7.3 and 0.32, respectively. A cross-sectional measurement of the sFlt-1/PlGF ratio outperforms uterine Doppler in predicting term preeclampsia. The combination of both markers does not improve such prediction, nor the evaluation of the longitudinal changes between ~30 and ~36 weeks.

Effect of topical magnesium sulfate on labor duration and childbirth experience: a randomized controlled trial

BackgroundMagnesium sulfate is used topically to reduce the duration of labor in some regions of the country. However, there is insufficient evidence about its effectiveness. This study aimed to determine whether topical magnesium sulfate reduces labor duration and improves childbirth experience (primary outcomes).MethodsIn this randomized controlled trial, the participants were 98 women with low-risk, singleton, and full-term pregnancies admitted to a teaching hospital in Iran. They were randomly assigned to the intervention group (receiving 50% magnesium sulfate) or the control group (receiving distilled water) stratified by parity and onset of labor. The participants, interventionists, and data collectors were blinded. During the vaginal examination at the beginning of the active phase of labor, 10 mL of magnesium sulfate or distilled water was poured on the cervix of the uterus. Data collection was performed by the researcher with continuous monitoring up to two hours post-delivery and follow-up at 4–5 weeks postpartum. The Childbirth Experience Questionnaire 2.0 was used to examine childbirth experience. We performed a modified intention-to-treat analysis, excluding those whose outcome of interest could not be assessed. Independent-samples t-tests were used to compare the groups in terms of the mean of the primary outcomes.ResultsParticipant recruitment took place between December 2021 and December 2022. Thirty-three percent were primiparous and 37% had induced labor. Three women in the intervention group and seven in the control group underwent emergency cesarean sections. All 49 women assigned to each group were included in the analysis of labor duration outcome, while one and two women were excluded from the analysis of childbirth experience score due to loss to follow-up. In the intervention group, compared to the control group, the mean duration of the intervention until delivery was significantly shorter (1.59 vs. 2.93 h; MD -1.34, 95% CI [-1.88 to -0.79]) and the childbirth experience score was higher (3.1 vs. 2.3, MD 0.84; 95% CI [0.59 to 1.08]).ConclusionsAccording to the results of this trial, pouring 10 mL of 50% magnesium sulfate on the cervix at the beginning of the active phase of labor probably reduces labor duration and improves the childbirth experience.Trial registrationEthics Committee of Tabriz University of Medical Sciences: IR.TBZMED.REC. 1400.726. Iranian Registry of Clinical Trials: IRCT20100414003706N40 Registration date: 21/11/2021 (https://en.irct.ir/trial/58323).

Early Supraspinal Influences on Human Embryonic Posture.

Knowledge of embryonic body posture as a reflection of neurodevelopment is limited. Here, we investigate embryonic body posture, preference, symmetry, and lateralization during periods of rest using virtual reality (VR) and four-dimensional (4D) ultrasound techniques to enhance our knowledge of neurodevelopment. It is hypothesized that lateralization and asymmetry in embryonic posture are absent. Embryos from low-risk pregnancies at 9 weeks gestational age (GA) were analyzed using a 30-min 4D ultrasound and VR techniques. In the middle of an embryonic resting period, the total body posture was determined by combining joint positions. Interindividual and intraindividual postures were analyzed over time to identify posture preferences, asymmetry, and lateralization. Sixteen embryos (N=210 middle frames out of 210 resting periods) displayed 27 different embryonic body postures. Interindividual and intraindividual variations in postures were seen. Asymmetry was noted in upper extremities, whereas lateralization of the head and spine was observed in nine embryos. Intraindividual and interindividual variation in embryonic posture at 9 weeks' GA is seen, suggesting the presence of supraspinal influences on body posture this early. Future interdisciplinary longitudinal studies on embryonic posture may provide further insights into embryonic central nervous system development, contributing to our understanding of embryonic health.

Is confidence in knowledge related to childbirth fear and mode of birth among Polish women?

Abstract Background In Poland, cesarean section (CS) rate is 48% what means that it is one of the highest rate among OECD countries and the highest in the European Union. WHO has considered that CS rates higher than 15% at the population level are not associated with reductions in maternal and newborn mortality rates. Fear and attitudes towards childbirth are shaped years before the first pregnancy. Yet, little is understood about how young people’s knowledge, attitudes and fears concerning the birth process shape their healthcare preferences around birth. Thus, the aim of the study was to examine whether confidence in knowledge was associated with childbirth fear prior to pregnancy and preference for CS. Methods We recruited 782 women aged 18 - 35 (mean 24.7, sd = 3.19) who had never been pregnant but wished to have at least one child in the future. The women answered questions about: (i) socio-economic situation, (ii) confidence in knowledge and educational needs related to pregnancy and childbirth; (iii) fear of childbirth prior to pregnancy; (iv) preferred mode of birth in the hypothetical pregnancy in which there are no medical indications for cesarean section. Results Almost one in four women (22.1%) preferred CS in a hypothetical low-risk pregnancy. In addition, most often young women gained knowledge on pregnancy and birth from experiences and stories of family members (62.3%). Women with moderate and high level of confidence in knowledge had respectively lower odds of high level of childbirth fear prior to pregnancy comparing to women with low level of confidence in knowledge (OR = 0.57, 95% CI: 0.39-0.83 and OR = 0.54, 95% CI: 0.33-0.88, respectively). Conclusions Increasing knowledge about pregnancy and childbirth among young women might lower childbirth fear and thus, indirectly, lower rates of CS in the future. Key messages • The results of this study may solve very important public health problem i.e. the growing rates of cesarean section. • Confidence in knowledge may be an important factor associated with the level of childbirth fear.

Obstetric and neonatal outcomes of immune thrombocytopenic purpura in pregnancy and the role of delta hemoglobin index: A case-control study from a tertiary center.

To evaluate the effect of idiopathic thrombocytopenic purpura (ITP) on pregnancies and the role of the delta hemoglobin indices in the evaluation of treatment effectiveness. This case-control study was conducted with 23 ITP and 115 low-risk pregnancies. Obstetric outcomes (fetal growth retardation (FGR), preterm delivery) and neonatal outcomes (weights, APGAR scores, NICU admissions, thrombocytopenia) were recorded. ITP group was subgrouped based on the platelet ratio at the admission for delivery and evaluated the impact of platelet ratios on blood loss amounts at delivery by using delta hemoglobin indices. Eleven patients received treatment during pregnancy. The gestational age at birth and fetal APGAR scores were lower, and the preterm delivery and FGR rates were higher in the ITP group. Four newborns (17.4%) had thrombocytopenia. There were two postpartum hemorrhages. Newborn platelet counts did not correlate with maternal platelet counts. The study showed no difference in delta hemoglobin counts between the ITP and control groups. ITP is associated with an increased risk of maternal and fetal complications. The presented study showed by using the delta hemoglobin indices that, hemorrhagic complications could be prevented with appropriate management. Neonatal thrombocytopenia should be considered for all ITP patients.

Maternity Care Sustainability in Rural Australia

Introduction: In recent years there has seen significant closure of small maternity units particularly in rural regions of Australia. Those small maternity units that do continue to care for childbearing women may only provide antenatal and postnatal care with women giving birth in a larger maternity unit often some distance away. There are some small maternity units that continue to provide complete care to childbearing women which is the focus of this research. The issue here is that these small rural maternity units tend to only cater for women who are having a low-risk pregnancy. When the women is deemed ‘high risk’ they will need to transfer to a larger maternity unit for their ongoing antenatal visits and to birth. These larger maternity units are often some distance away requiring women to travel for each antenatal care visit and for birth. This research aims to explore women’s experience of having to transfer their care to a larger maternity unit due to being deemed at risk through interview of 40 women deemed at risk. Methods: Focus of the research was women’s experiences of needing to transfer their maternity care and used a qualitative descriptive phenomenology approach. To date seven women have been interviewed. Results: This paper presents the preliminary findings from the interviews that have been undertaken to date on seven women. The data is presented under emerging themes which will be refined with further interviews. The emerging themes are ‘women had no agency’, ‘the hidden cost’ and ‘the journey continues’. Conclusion: The paper presents the preliminary findings from these interviews. Ultimately the aim is to assess how care can be improved for these women and potential options/models of care and make these small rural maternity units sustainable.

Serial Multiple Mediation of the Marital Satisfaction and Parenting Competence in the Relationship Between Postpartum Depression and Parent-Infant Attachment in First-Time Parents With Low- and High-Risk Pregnancy Experiences: A Cross-Sectional Study.

Little is known regarding the effects of postpartum depression on parent-infant attachment in high-risk parents. Based on Mercer's theory of becoming a mother, this study aimed to (1) examine the mediating effects of marital satisfaction and parenting competence in the relationship between postpartum depression and parent-infant attachment using a serial mediation model in first-time parent couples during the first 6 months postpartum, and (2) compare the serial mediation models between parents who had experienced low-risk and high-risk pregnancies. In this cross-sectional study, a total of 194 first-time parent couples at 1 to 6 months postpartum were included. Participants completed an online survey on postpartum depression, marital satisfaction, parenting competence, and parent-infant attachment. In both low- and high-risk groups, parenting competence was a common mediator of the impact of postpartum depression on parent-infant attachment. A sequential mediation effect involving both marital satisfaction and parenting competence was observed in high-risk mothers. Our findings suggest that the adverse impacts of postpartum depression on parent-infant attachment can be mitigated by boosting parenting competence or improving the marital satisfaction in couples experiencing first high-risk pregnancy.

Evaluation of an Outpatient Cervical Ripening Program Using Osmotic Dilators and Foley Balloon Catheters.

This study aimed to describe patient characteristics, satisfaction, and outcome measures for patients undergoing outpatient cervical ripening. A retrospective cohort study using electronic health record data from March 2020 to March 2022 from a large health system. The sample included patients with a low-risk singleton pregnancy undergoing outpatient cervical ripening with either an osmotic dilator or Foley balloon catheter. A subset of patients completed satisfaction surveys. Frequencies and means were used to describe the population and conduct comparisons by device type. Inverse probability of treatment weighted estimates were generated to address baseline differences between patients in the two device groups. Outpatient cervical ripening was completed by 120 patients (80 osmotic dilators and 40 Foley balloon catheters). The mean time from insertion to inpatient admission was 16.2 ± 4.8 hours. The mean change in simplified Bishop score (SBS) was 1.8 ± 1.4 and the mean change in dilation was 1.8 ± 1.1 cm. There were no differences in the amount of cervical change by device type. Patients returned earlier than planned 16.7% of the time, primarily for contractions or rupture of membranes. Following outpatient cervical ripening, the time from admission to delivery was 19.9 ± 10.3 hours, with no difference by device type. Vaginal delivery occurred for 74.8% of patients. Patients reported overall satisfaction with the outpatient cervical ripening experience, with the highest satisfaction among those with osmotic dilators. Patients with both device types stated they would recommend outpatient cervical ripening to others, and experienced low levels of stress and discomfort at home prior to hospital admission. Patients participating in outpatient cervical ripening with osmotic dilators or Foley balloon catheters experienced clinically meaningful changes in dilation and SBSs while at home and reported general satisfaction with the outpatient program experience. · Outpatient use of osmotic dilators or Foley balloon catheters improved Bishop scores.. · Patient and device complications were comparable to other research findings.. · Patients reported overall satisfaction with outpatient cervical ripening..

Study protocol of a breathing and relaxation intervention included in antenatal education: A randomised controlled trial (BreLax study).

Antenatal education is part of antenatal care in many countries. Physical and mental preparation for childbirth and information on pain management are considered key elements of antenatal education classes. Evidence suggests that women who participate in antenatal education classes appear to benefit in terms of self-efficacy and childbirth experience. In particular, women with increased fear of childbirth benefit from trained breathing and relaxation techniques in antenatal education. However, little is known about the effect of breathing and relaxation techniques on the outcomes of healthy pregnant women without fear of childbirth or who do not have medical or obstetric risks, or on neonatal outcomes. The aim of this study is to test whether including a breathing and relaxation technique in an antenatal education class will improve self-efficacy towards birth compared to a standard antenatal education class. The study will be a two-armed randomised controlled trial (RCT). Healthy pregnant women between the 12th and 30th week of gestation with singleton low-risk pregnancies and who are receiving routine antenatal care will be recruited in a hospital in Switzerland. All women included will attend an 8-hour antenatal education class. The intervention group will additionally practise a breathing and relaxation technique, receive a handbook to guide their exercise practice at home, and be provided with access to an online brochure with video and audio recordings for guidance. Data on maternal and neonatal outcomes will be collected after recruitment, in the 37th week of pregnancy, and two to four weeks postpartum. The effectiveness of including a breathing and relaxation technique in antenatal education classes on women's self-efficacy is discussed as a means to improving women's pregnancy and childbirth outcomes. NCT06003946, SNCTP000005672.

Efficacy and Safety of Oral Mifepristone as a Cervical Ripening Agent for Labor Induction in Low-Risk Full-Term Live Pregnancies Beyond 40 Weeks of Gestation: A Randomized Controlled Study

Efficacy and Safety of Oral Mifepristone as a Cervical Ripening Agent for Labor Induction in Low-Risk Full-Term Live Pregnancies Beyond 40 Weeks of Gestation: A Randomized Controlled Study

The biomechanical evolution of the uterus and cervix and fetal growth in human pregnancy

The coordinated biomechanical performance of maternal tissues facilitates healthy pregnancy. Quantifying uterine and cervical biomechanical function has been challenging due to minimal data on the anatomy’s shape, size, and material properties across gestation. Addressing this challenge, this study quantifies structural features of human pregnancy by assessing maternal reproductive tissues and estimated fetal weight in 47 low-risk pregnancies at four gestation times. Uterocervical size and estimated fetal weight were measured via ultrasound, and cervical stiffness was measured via mechanical aspiration. Patient-specific uterocervical solid models were built for each time point, and uterocervical dimensions and cervical stiffness rate changes were assessed between time points. We found that uterine growth rates are time- and direction-dependent, with cervical softening occurring fastest in early gestation and cervical shortening fastest in late gestation. In conclusion, this work enables computational modeling platforms (i.e., digital twins) to explore the structural performance of the uterus and cervix in pregnancy.

Routine third-trimester ultrasonography and child neurodevelopmental outcomes: a follow-up of a pragmatic cluster-randomised controlled trial

ABSTRACT Aims/Background Routine third-trimester ultrasonography is increasingly conducted to screen for foetal growth restriction (FGR) and reduce adverse perinatal and child neurodevelopmental outcomes using timely obstetric management. While it did not reduce adverse perinatal outcomes in previous trials, evidence regarding its association with child neurodevelopmental outcome is absent. We examined whether routine third-trimester ultrasonography is positively associated with child developmental and behavioural/emotional outcomes compared to usual care. Design/Methods Dutch mothers with a low-risk pregnancy participating in a subsample (n = 1070) of a nationwide cluster-randomised trial reported infant (age 6 months) and toddler (age 28 months) developmental milestones (Ages and Stages Questionnaire) and toddlers’ internalising and externalising problems (Child Behavior Checklist). Usual care (n = 380) comprised selective ultrasonography. The intervention strategy (n = 690) included two routine third-trimester ultrasounds next to usual care. Both strategies applied the same interdisciplinary protocol for FGR detection and management. Results Adjusted linear mixed-level regressions revealed that routine third-trimester ultrasonography was positively but modestly related to z-standardised infant developmental milestones at 6-month follow-up, B = 0.20, 95%CI [0.07; 0.32], p = 0.003, compared to usual care. At 28-month follow-up, these strategies did not differ in child developmental outcome and internalising and externalising problems. Conclusion Routine third-trimester ultrasonography was positively but modestly associated with infant development. In toddlerhood, routine ultrasonography was not related to child developmental and behavioural/emotional outcomes. Overall, these findings do not support the implementation of routine third-trimester ultrasonography for low-risk pregnant women for reasons concerning children’s early neurodevelopmental outcomes.

Novel, Group-Based Trajectories of Labor Progress in Nulliparous Women With Low-Risk Pregnancies

ObjectiveTo characterize labor progress among nulliparous women by applying group-based trajectory analysis and examining predictors of group membership. DesignRetrospective observational. SettingAn existing biobank and database from a birth hospital in Western Pennsylvania. ParticipantsNulliparous women with low-risk pregnancies at term gestation with singleton fetuses in vertex presentation (N = 401). MethodsWe characterized labor progress by applying group-based trajectory analysis. We conducted a multinomial logistic regression analysis to examine the relationships among labor trajectory groups and various demographic and clinical variables. ResultsWe identified three trajectories of labor in the group-based trajectory analyses: precipitously progressing (n = 76, 20.1%), average (n = 245, 59.1%), and slow progress (n = 80, 20.7%). Only gestational age at birth significantly predicted trajectory group membership, and an increased gestational age was associated with greater odds of belonging to the slower progress group (OR = 1.43, 95% CI [1.06, 1.92]). ConclusionWe identified multiple trajectories of labor progress in a sample of nulliparous women with low-risk pregnancies at term gestation. Gestational age may help predict the trajectory of labor.

The Impact of Shiatsu Massage on Labour Pain and Anxiety: A Randomized Controlled Trial.

Labour pain experienced by women during childbirth can significantly affect the mother's psychological condition and birthing process. This study aimed to determine the effect of shiatsu massage on pain and anxiety during labour. This randomized controlled trial was conducted on 80 nulliparous pregnant women who gave birth in four low-risk maternity clinics in Samarinda, Indonesia, from February to May 2022. The women were randomized into intervention (N=40) and control (N=40) groups based on random allocation. Certified midwives performed shiatsu massages following standard protocols. Pain was assessed using the Numeric Rating Scale, and anxiety was assessed using the Hamilton Anxiety Rating Score at three times including before the intervention (T0), the latent phase (T1), and at transition phase (T2). The impact of the intervention was analyzed using repeated measures analysis of variance by SPSS 26. A p-value less than 0.05 was considered statistically significant. The intervention group showed a significant reduction in labour pain scores from 6.85±1.00 (T0) to 6.13±0.88 (T1) and 4.78±0.83 (T2) (P<0.001), while the control group showed an increase from 6.85±1.00 (T0) to 8.05±0.64 (T1) and 8.85±0.48 (T2) (P<0.001). Anxiety scores in the intervention group decreased from 28.53±4.41 (T0) to 26.15±3.59 (T1) and 20.65±2.69 (T2) (P<0.001), whereas the control group experienced an increase from 25.55±3.16 (T0) to 27.05±3.36 (T1) and 31.73±3.27 (T2) (P<0.001). The between-subject effects in time levels for labour pain and anxiety in the two study groups had a significant impact (P<0.001). Findings showed that shiatsu massage was effective and safe for relieving pain and reducing anxiety during childbirth of nulliparous women. This research suggests that shiatsu massage can be used as an effective alternative method to relieve pain and anxiety during labour in low risk pregnancies, particularly in settings with limited access to pharmaceutical analgesics.Trial Registration Number: IRCT20220317054316N1.

Cost-effectiveness of exome sequencing and chromosomal microarray for low-risk pregnancies

ObjectiveTo investigate the cost -effectiveness of exome and genome sequencing (ES), compared to Chromosomal microarray (CMA) Methodscosts, utility and quality adjusted life years (QALYs) were modeled for prenatal testing with CMA or CMA+ES. Average costs and utilities were discounted at 3%. Two strategies for screening were compared using Markovian decision analysis model: (1) CMA only- abnormal result culminating in termination of pregnancy and normal test has with 1/160 chance for severe disorders. (2) ES after a normal CMA, for positive result a termination of pregnancy (TOP) was conducted. One - way sensitivity analysis for all variables. Outcome measures included the QALYs after abortion, cost of CMA and ES test and the health expenses of a critically ill infant. The time horizon of the model was 20 years. ResultsTotal costs were $1,348 and $3,108 for CMA and CMA+ES strategies respectively. The QALYs with time horizon of 20 years were 14.15 and 14.19 QALYs for CMA and CMA+ES strategies respectively with incremental cost-effectiveness ratio (ICER) of 46,383$/QALYs. Sensitivity analysis revealed that the time horizon and the dis-utility of moderate/severe disability of the genetic disorder has an impact on the ICER. For example, with a relatively small disutility of moderate/sever disability, the ICER is 84,291$/QALYs and for a shorter time horizon of 10 years, the ICER is 94,148$/QALYs. ConclusionExome has the potential to be cost-effective compared with CMA alone. Our research provides data regarding the cost-effectiveness of ES without specific indication that will become increasingly important in the near future as whole exome sequencing becomes the first-tier test in prenatal diagnosis.

Facilitating home birth in perinatal palliative care: A case report.

Perinatal palliative care can offer compassionate support to families following diagnosis of a life-limiting illness, to enable them to make valued choices and the most of the time that they have with their newborn. However, home birth is usually only offered in low-risk pregnancies. A couple who received an antenatal diagnosis of hypoplastic left heart syndrome and who had made a plan to provide palliative care to their baby after birth requested the option of a home birth. Recommend birth at hospital or explore the possibility of a home birth with perinatal palliative care support. Multidisciplinary discussion and collaboration enabled a plan for home birth to be made which anticipated potential complications. The baby was born at home and died on day 5 of life receiving outreach nursing, paediatric and palliative care support and buccal and oral opioids for symptom management. We include reflections from the family on the importance of this experience. We provide a list of potential criteria for considering home birth in the setting of perinatal palliative care. Facilitating a home birth in the setting of perinatal palliative care is an option that can be hugely valued by families, but this service may be practically difficult to deliver in many contexts. Further research is needed to understand the preferences of women and families receiving perinatal palliative care.

Factors Influence Breastfeeding Duration after High Risk and Low Risk Pregnancies.

Breastfeeding provides vital nutrients and fosters maternal-infant bonding, benefiting both mother and child. However, breastfeeding duration is influenced by various factors, especially in women of high-risk pregnancy. This study aims to identify predictors of breastfeeding duration among women of high-risk and low-risk pregnancy, focusing on exclusive and mixed feeding practices. Conducted at a public hospital in Attica, Greece, this 20-month prospective cohort study (May 2020-January 2022) included 380 pregnant women, divided into high-risk and low-risk groups. The final sample of 157 women, after excluding non-breastfeeding participants, was assessed across five phases from prenatal to six months postpartum using interviews, calls, and surveys. Multiple linear regression identified key predictors, with statistical methods applied. Results revealed birth weight as a consistent significant predictor of breastfeeding duration. For women with high-risk pregnancy, additional factors like infant gender, jaundice, and early introduction of solid foods influenced breastfeeding duration. The mixed breastfeeding model for women with high-risk pregnancy explained 72.9% of the variance. Exclusive and mixed breastfeeding models for women with low-risk pregnancy also highlighted birth weight's influence. The findings highlight the important role of birth weight and other specific factors in determining breastfeeding duration among women of high-risk and low-risk pregnancy. Further research is needed to validate these findings across diverse populations.

Association of in vitro fertilization with severe maternal morbidity in low-risk patients without comorbidities

To determine whether an association exists between invitro fertilization (IVF) and severe maternal morbidity among low-risk pregnant patients. Retrospective cohort study. Academic healthcare system. Low-risk pregnant patients who delivered between January 2019 and December 2022. Low-risk was defined as having an obstetric comorbidity index score of 0. Invitro fertilization. The primary outcome (dependent variable) was any severe maternal morbidity. The secondary outcome was the need for a cesarean delivery. A modified Poisson regression with robust error variance was used to model the probability of severe maternal morbidity as a function of IVF. Risk ratios and their associated 95% confidence intervals (CIs) were computed. An α value of 0.05 was considered statistically significant. A total of 39,668 pregnancies were included for analysis, and 454 (1.1%) were conceived by IVF. The overall severe maternal morbidity rate was 2.4% (n = 949), with the most common indicator being blood transfusion. The overall cesarean delivery rate was 18.8% (n = 7,459). On modified Poisson regression, IVF-conceived pregnancies were associated with 2.56 times the risk of severe maternal morbidity (95% CI, 1.73-3.79) and 1.54 times the risk of having a cesarean delivery (95% CI, 1.37-1.74) compared with non-IVF pregnancies. Invitro fertilization is associated with higher rates of severe maternal morbidity, primarily the need for a blood transfusion, and cesarean delivery in low-risk pregnancies without major comorbidities. Recognizing this association allows healthcare providers to implement proactive measures for better monitoring and tailored postpartum care.

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.