Maternal Position Research Articles

Longitudinally assessed maternal sleep position, measures of breathing during sleep, and fetal growth in high-risk pregnancies.

Subjective recall of supine sleep during pregnancy has been linked to increased risk of stillbirth, but longitudinal, objective data are lacking. We aimed to examine how sleep position and breathing parameters change throughout pregnancy, and investigated associations between maternal supine sleep, assessed objectively in early and late gestation, and fetal growth velocity in high-risk women. Women with singleton pregnancies and body mass index (BMI) ≥27 kg/m2 underwent level-III sleep apnea testing. Sleep position was assessed by accelerometry. We derived percentiles of estimated fetal weight and birthweight using FetalGPSR software, then calculated growth velocity as change in percentile/week between the second-trimester anatomy scan and birth. In total, 446 women were included, with N = 126 in the longitudinal sleep pattern analysis and N = 83 in the fetal growth analysis. Sleep-onset position and predominant sleep position were significantly correlated in both early (p = 0.001) and late (p < 0.01) pregnancy. However, supine going-to-bed position predicted predominant supine sleep in only 47% of women. Between early and late pregnancy there was a reduction in predominant supine sleepers (51.6% to 30.2%). Percent of sleep spent supine and oxygen desaturation index, in the third trimester, were significantly associated after BMI adjustment (B = 0.018, p = 0.04). Models did not suggest significant effects of early or late pregnancy supine sleep on growth velocity (p > 0.05). Going-to-bed position predicts predominant supine sleep in less than half of women with overweight and obesity. Time spent supine throughout pregnancy correlates with measures of sleep-disordered breathing. Maternal sleep position patterns did not affect fetal growth velocity in this high-risk population, but the study was not powered to detect differences.

Feasibility of MRI assessment of maternal-fetal oxygen transport and consumption relative to maternal position in healthy late gestational pregnancies.

Late gestational supine positioning reduces maternal cardiac output due to inferior vena caval (IVC) compression, despite increased collateral venous return. However, little is known about the impact of maternal position on oxygen (O2 ) delivery and consumption of the gravid uterus, fetus, placenta and lower limbs. We studied the effects of maternal positioning on these parameters in 20 healthy pregnant subjects at 36±2weeks using magnetic resonance imaging (MRI); a follow-up MRI was performed 6-months postpartum (n=16/20). MRI techniques included phase-contrast and T1/T2 relaxometry for blood flow and oximetry imaging, respectively. O2 transport was measured in the following vessels (bilateral where appropriate): maternal abdominal descending aorta (DAoabdo ), IVC, ovarian, paraspinal veins (PSV), uterine artery (UtA) and external iliacs, and umbilical. Maternal cardiac output was measured by summing DAothoracic and superior vena cava flows. Supine mothers (n=6) had lower cardiac output and O2 delivery in the DAoabdo , UtA and external iliac arteries, and higher PSV flow than those in either the left (n=8) or right (n=6) lateral positions during MRI. However, O2 consumption in the gravid uterus, fetus, placenta and lower limbs was unaffected by maternal positioning. The ratio of IVC/PSV flow decreased in supine mothers while ovarian venous flow and O2 saturation were unaltered, suggesting a major route of pelvic venous return unaffected by maternal position. Placental-fetal O2 transport and consumption were similar between left and right lateral maternal positions. In comparison to non-pregnant findings, DAoabdo and UtA O2 delivery and pelvic O2 consumption increased, while lower-limb consumption remained constant , despite reduced external iliac artery O2 delivery in late gestation. KEY POINTS: Though sleeping supine during the third trimester is associated with an increased risk of antepartum stillbirth, the underlying biological mechanisms are not fully understood. Maternal cardiac output and uteroplacental flow are reduced in supine mothers due to inferior vena caval compression from the weight of the gravid uterus. This MRI study provides a comprehensive circulatory assessment, demonstrating reduced maternal cardiac output and O2 delivery (uteroplacental, lower body) in supine compared to lateral positioning; however, O2 consumption (gravid uterus, fetus, placenta, lower limbs) was preserved. Unlike other mammalian species, the ovarian veins conduct substantial venous return from the human pregnant uterus that is unaffected by maternal positioning. Lumbar paraspinal venous flow increased in supine mothers. These observations may have important considerations during major pelvic surgery in pregnancy (i.e. placenta percreta). Future studies should address the importance of maternal positioning as a potential tool to deliver improved perinatal outcomes in pregnancies with compromised uteroplacental O2 delivery.

The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester-A primary cohort study with a scoping review.

Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental perfusion. Evidence for the effects of prone position in pregnancy is less clear. This study aimed to determine the effect maternal prone position on maternal haemodynamics and fetal heart rate, compared with left lateral position. Twenty-one women >28 weeks' gestation underwent non-invasive CO monitoring (Cheetah) every 5 minutes and continuous fetal heart rate monitoring (MONICA) in left lateral (20 minutes), prone (30 minutes), followed by left lateral (20 minutes). Anxiety and comfort were assessed by questionnaires. Regression analyses (adjusted for time) compared variables between positions. The information derived from the primary study was used in an existing mathematical model of maternal circulation in pregnancy, to determine whether occlusion of the inferior vena cava could account for the observed effects. In addition, a scoping review was performed to identify reported clinical, haemodynamic and fetal effects of maternal prone position; studies were included if they reported clinical outcomes or effects or maternal prone position in pregnancy. Study records were grouped by publication type for ease of data synthesis and critical analysis. Meta-analysis was performed where there were sufficient studies. Maternal blood pressure (BP) and total vascular resistance (TVR) were increased in prone (sBP 109 vs 104 mmHg, p = 0.03; dBP 74 vs 67 mmHg, p = 0.003; TVR 1302 vs 1075 dyne.s-1cm-5, p = 0.03). CO was reduced in prone (5.7 vs 7.1 mL/minute, p = 0.003). Fetal heart rate, variability and decelerations were unaltered. However, fetal accelerations were less common in prone position (86% vs 95%, p = 0.03). Anxiety was reduced after the procedure, compared to beforehand (p = 0.002), despite a marginal decline in comfort (p = 0.04).The model predicted that if occlusion of the inferior vena cava occurred, the sBP, dBP and CO would generally decrease. However, the TVR remained relatively consistent, which implies that the MAP and CO decrease at a similar rate when occlusion occurs. The scoping review found that maternal and fetal outcomes from 47 included case reports of prone positioning during pregnancy were generally favourable. Meta-analysis of three prospective studies investigating maternal haemodynamic effects of prone position found an increase in sBP and maternal heart rate, but no effect on respiratory rate, oxygen saturation or baseline fetal heart rate (though there was significant heterogeneity between studies). Prone position was associated with a reduction in CO but an uncertain effect on fetal wellbeing. The decline in CO may be due to caval compression, as supported by the computational model. Further work is needed to optimise the safety of prone positioning in pregnancy. This trial was registered at clinicaltrials.gov (NCT04586283).

Exploring the impact of maternal supine position on placental perfusion in late gestation fetal growth restriction by magnetic resonance imaging.

Exploring the impact of maternal supine position on placental perfusion in late gestation fetal growth restriction by magnetic resonance imaging.

Maternal Cardiovascular Responses to Position Change in Pregnancy.

The maternal cardiovascular-circulatory system undergoes profound changes almost from the conception of a pregnancy until the postpartum period to support the maternal adaptions required for pregnancy and lactation. Maintenance of cardiovascular homeostasis requires changes in the cardiovascular autonomic responses. Here, we present a longitudinal study of the maternal cardiovascular autonomic responses to pregnancy and maternal position. Over a normal gestation, in the left lateral position there are significant changes in both time and frequency domain parameters reflecting heart rate variability. We show that cardiovascular autonomic responses to physiological stressors (standing and supine positions in late pregnancy) became significantly different with advancing gestation. In the third trimester, 60% of the subjects had an unstable heart rate response on standing, and these subjects had a significantly reduced sample entropy evident in their heart rate variability data. By 6 weeks, postpartum function returned to near the non-pregnant state, but there were consistent differences in high-frequency power when compared to nulligravid cases. Finally, we review complementary evidence, in particular from magnetic resonance imaging, that provides insights into the maternal and fetal impacts of positioning in pregnancy. This demonstrates a clear relationship between supine position and maternal hemodynamic parameters, which relates to compression of the inferior vena cava (p = 0.05). Together, these studies demonstrate new understanding of the physiology of physiological stressors related to position.

Prevalence and association of musculoskeletal disorders among breastfeeding women in Saudi Arabia.

To investigate the prevalence of musculoskeletal disorders, and to explore the association between maternal positioning and musculoskeletal pain among lactating women. The cross-sectional survey-based study was conducted from January to May 2022 at buraidah, Saudi Arabia, and comprised Arabic-speaking women aged 18-49 years who were breastfeeding. Sociodemographic and clinical data related to musculoskeletal disorders was collected using a redesigned questionnaire through Twitter and WhatsApp platforms. Data was analysed using SPSS 28. Of the 474 women who responded, 192(40.7%) were excluded because they did not meet the eligibility criteria. The sample comprised 281(59.3%) women. The median age was 33 years with an interquartile range of 10 years 71(25.3%). Overall, 163(58%) subjects reported musculoskeletal pain caused by breastfeeding, 78(27.8%) experienced musculoskeletal pain with breastfeeding, 43(15.3%) considered discontinuing breastfeeding, and 59(21%) reported that musculoskeletal pain prevented them from performing their activities of daily living. The most painful segments reported were the back 6.24±3.21, nipple 5.51±3.43, shoulders 4.88±3.40, and neck 4.10±3.13. Sitting on a mat was the commonly adopted maternal positioning 2.38±1.41. Cradle hold was the most convenient baby-holding positioning during breastfeeding reported by 170(60.5%). The prevalence of musculoskeletal disorders was found to be high among breastfeeding women in Saudi Arabia, and an association was found between musculoskeletal disorders and maternal breastfeeding positioning.

Midwives’ experiences using a peanut ball for women during labour: A qualitative study

ObjectiveTo gain insight into the benefits, shortcomings, and practical considerations when using the peanut ball for women during labour. Design & settingWe used a descriptive qualitative approach using semi-structured, in-depth interviews to explore the experiences of eight midwives working in a tertiary hospital birth unit in New South Wales, Australia when using the peanut ball for women during labour. ParticipantsParticipants were recruited from the birthing unit of a tertiary hospital in New South Wales. The final sample included eight midwives working in the birth unit. FindingsThree overarching themes were identified: ‘Education and encouragement’, ‘benefits and disadvantages of peanut ball’ and ‘techniques’. The ‘Education and encouragement’ theme included three sub-themes: ‘selling it to the woman’, ‘educating midwives’ and ‘becoming usual practice and improving confidence’. The ‘Benefits and disadvantages of peanut ball’ theme included two sub-themes: ‘facilitates labour and birth’ and ‘discomfort’. The ‘Techniques’ theme included three subthemes: ‘positioning’, ‘sizing’ and ‘using alternative techniques’. Midwives are confident in their practice with the peanut ball and acknowledge the importance of educating midwives and women to promote its use. Midwives also discussed favoured techniques when using the ball, especially relating to size and maternal positioning. ConclusionOur study provides insight into midwives’ experiences about using a peanut ball for women during labour. The midwives reported that the peanut ball encourages vaginal births and shortens labour times, whilst enabling women to participate actively in the birth. Education for midwives and women is vital for using peanut balls. Implications for practicePeanut balls are not usual practice in birthing units in Australia and they are a novel intervention to improve labour and birthing outcomes for women, especially when using an epidural.

Role of Fetal Cardiac MRI in Assessment of Congenital Heart Diseases in Comparison to Fetal Echocardiography

Introduction •Abnormalities of the cardiovascular system are the most common congenital diseases in the fetus and the first cause of infant mortality (Johnson et al. 2014). •Without a doubt, Echocardiography is the method of choice to visualize the fetal cardiac cardiovascular abnormalities. Unlike fetal echocardiography imaging, cardiovascular magnetic resonance (CMR) is relatively unaected by maternal and fetal conditions such as maternal obesity, uterine myoma, twins, oligohydramnios, fetal position and rib calcification, which particularly impair sonographic visualization of the fetal heart (Donofrio et al. 2014; Wielandner et al. 2013). •Fetal cardiac MR imaging is a novel MRI technique which can provide valuable information that could add to the prenatal diagnosis and evaluation of cardiac and most of extra-cardiac anomalies. The evaluation of pre-natal congenital cardiac anomalies is important for postnatal management. Aim of the work To highlight the advantage of MRI over fetal echocardiography in assessment of fetal congenital cardiac anomalies. Methods and material Twenty-six feti with suspected or diagnosed congenital cardiac anomalies. All cases underwent detailed history taking, fetal echocardiography and fetal cardiac MR. Study is approved by the ethics review board of Ain Shams University Hospital. Fetal echocardiography was done according to standard protocol and performed by suitable curvilinear probe. Then MRI of the fetal heart was done with uterine SURVEY_BFFE (balanced fast field echo), Black blood single shot -BH, white blood Cine, sBFFE_RLT DYN 3D(real time 3Ddynamic). Images were acquired in the transverse, four-chamber, shortaxis, coronal and oblique sagittal views. Findings of fetal echocardiography were compared with that of cardiac MRI. Results •Regarding the diagnostic performance of prenatal Echo and fetal cardiac MRI showed significant moderate agreement between the two modalities in the detection of different congenital cardiac anomalies, Kappa test: 0.500; p-value 0.021*. •Qualitative analysis: All cardiac structures were delineable by echocardiography and cardiac MRI. There was full agreement(κ = 1) between fetal echocardiography and cardiac MRI in evaluating the cardiac situs(24normal,1 levocardia, 1 ectopia cordis), aorta (20normal, 3 hypoplastic aorta,1 aortic stenosis,1 rt. Sided aortic arch and 1 small sized aorta), transverse cardiac diameter (22 normal, 4 cardiomegaly), foramen ovale (25 normal, 1 large single atrium), Good agreement was found between echocardiography and cardiac MRI for detection of position of the cardiac apex (23 normal, 2 dextrocardia and 1 mesocardia) •Fetal MRI had a significant role in detection of additional extracardiac anomalies in 13 cases. Conclusion fetal cardiac MR imaging as an adjunct to fetal echocardiography may provide valuable information that could add to the prenatal diagnosis and evaluation of cardiac and most of extra cardiac anomalies.

Midwives’ practice of maternal positions throughout active second stage labour: an integrative review

Background/Aims Extensive research focuses on the advantages and disadvantages of various positions throughout active second stage labour, but there is limited focus on midwives’ practice. This study aimed to explore midwives’ practice of maternal positions throughout the active phase of second stage labour. Methods An integrative review of three databases was carried out for research papers published between 2015 and 2022. Thematic analysis was used for data analysis and synthesis. Results Five eligible research papers were included. There were four key findings: maternal positions practised by midwives, midwives as the prime decision maker, midwives’ personal convenience and comfort, and barriers to practising maternal positions. Conclusions Midwives were seen as prime decision makers, who hindered informed decision making on maternal positions during active second stage labour. Inadequate knowledge, skills and confidence were barriers to practice and attributed to midwives adopting positions that were convenient and comfortable for themselves. Strategies are needed to enhance practice through review and evaluation of current clinical settings, regular updates to evidence-based practice and refreshing essential midwifery skills.

Improving Nurse Management of the Second Stage of Labor

ObjectiveTo develop, implement, and evaluate an educational program to improve nurses’ management of the second stage of labor. DesignEvidence-based practice project guided by the Iowa Model–Revised. SettingAcute care teaching hospital in central California averaging 2,100 births/year with 12 labor, delivery, and recovery rooms and a Level III nursery. ParticipantsEighteen registered nurses participated in the educational intervention. InterventionAn instructional course addressed contemporary labor management guidelines and delayed and open/closed glottis pushing. Assessment/documentation of maternal–fetal status, progress/fetal descent, and nurse/provider communication were discussed. Participants engaged in an interactive experience regarding maternal positions. MeasurementsData collected from the electronic health record included the number of position changes, nurse/provider communication interactions, and minutes from 10 cm to birth and minutes in delayed pushing. ResultsSecond-stage labor outcomes for nulliparous patients at term with a singleton in vertex presentation improved with more position changes and percentage of spontaneous vaginal births. Patients of nurses who participated in the educational intervention (n = 18) had a vaginal birth rate of 87.5% and a surgical birth rate of 6.2%. Patients of nurses who did not participate in the educational intervention (n = 31) had a vaginal birth rate of 81.8% and a surgical birth rate of 9.1%. ConclusionBased on the positive response to the intervention and improved clinical outcomes, regularly scheduled interactive nursing education focused on strategies to improve the second stage of labor may be beneficial.

The effect of maternal position on placental blood flow and fetoplacental oxygenation in late gestation fetal growth restriction: a magnetic resonance imaging study.

Fetal growth restriction (FGR) and maternal supine going-to-sleep position are both risk factors for late stillbirth. This study aimed to use magnetic resonance imaging (MRI) to quantify the effect of maternal supine position on maternal-placental and fetoplacental blood flow, placental oxygen transfer and fetal oxygenation in FGR and healthy pregnancies. Twelve women with FGR and 27 women with healthy pregnancies at 34-38weeks' gestation underwent MRI in both left lateral and supine positions. Phase-contrast MRI and a functional MRI technique (DECIDE) were used to measure blood flow in the maternal internal iliac arteries (IIAs) and umbilical vein (UV), placental oxygen transfer (placental flux), fetal oxygen saturation (FO2 ), and fetal oxygen delivery (delivery flux). The presence of FGR, compared to healthy pregnancies, was associated with a 7.8% lower FO2 (P=0.02), reduced placental flux, and reduced delivery flux. Maternal supine positioning caused a 3.8% reduction in FO2 (P=0.001), and significant reductions in total IIA flow, placental flux, UV flow and delivery flux compared to maternal left lateral position. The effect of maternal supine position on fetal oxygen delivery was independent of FGR pregnancy, meaning that supine positioning has an additive effect of reducing fetal oxygenation further in women with FGR, compared to women with appropriately grown for age pregnancies. Meanwhile, the effect of maternal supine positioning on placental oxygen transfer was not independent of the effect of FGR. Therefore, growth-restricted fetuses, which are chronically hypoxaemic, experience a relatively greater decline in oxygen transfer when mothers lie supine in late gestation compared to appropriately growing fetuses. KEY POINTS: Fetal growth restriction (FGR) is the most common risk factor associated with stillbirth, and early recognition and timely delivery is vital to reduce this risk. Maternal supine going-to-sleep position is found to increase the risk of late stillbirth but when combined with having a FGR pregnancy, maternal supine position leads to 15 times greater odds of stillbirth compared to supine sleeping with appropriately grown for age (AGA) pregnancies. Using MRI, this study quantifies the chronic hypoxaemia experienced by growth-restricted fetuses due to 13.5% lower placental oxygen transfer and 26% lower fetal oxygen delivery compared to AGA fetuses. With maternal supine positioning, there is a 23% reduction in maternal-placental blood flow and a further 14% reduction in fetal oxygen delivery for both FGR and AGA pregnancies, but this effect is proportionally greater for growth-restricted fetuses. This knowledge emphasises the importance of avoiding supine positioning in late pregnancy, particularly for vulnerable FGR pregnancies.

Cow and management factors and their association with estimates of uterine size and position at the time of insemination of dairy cattle.

This study examines factors affecting uterine size and position determined at 30-36 days postpartum in dairy cattle. The final study population consisted of 328 dairy cows, all calving during the warm season. Uterus position (pelvic, pelvic-abdominal, abdominal) and uterus size (small, medium, large) was measured by ultrasound on Day 30-36 postpartum. Multiparous cows had a larger uterus positioned in the abdominal cavity (p = .03) and a male newborn was associated with a larger uterus (p = .022). The number of cows with the uterus in the abdominal cavity was higher among multiparous and high producer (p < .0001) cows. High producers were 0.41 times more likely to have a small uterus in a pelvic position. The most important finding of this study was that the delivery of a male dairy, rather than beef, calf was related to the least optimal maternal uterus size and position.

Pregnant Prisoners in Shackles

Pregnant Prisoners in Shackles

The Impact of Maternal Position in Labor on Occiput-Posterior Position of Fetus and Pregnancy Outcomes in Pregnant Women Without Epidural Analgesia.

Fetal occiput posterior (OP) position is associated with more maternal and neonatal complications. This study aimed to investigate the effect of maternal position during labor on fetal OP position and pregnancy outcomes. This randomized clinical trial study included 180 primigravida women in labor with a single fetus and approved OP position. Participants were randomly allocated into three groups: semi-prone position (n=45), knee-chest position (n=45), and supine position (n=90). All participants were placed in the defined positions 15-30 min in labor until delivery. Data collected using Visual Analogue Scale and researcher made checklist. The ANOVA, Tukey post hoc, and the chi-square test were used to analyze. Among all participants who had OP, after intervention 16.3% in the semi-prone position, 14/3 % in the knee-chest position, and 33.7% of the control groups remained with OP at birth (X3=7/87, P=0.019). The rate of natural delivery was significantly higher in the semi-prone position and knee-chest position. The duration of active phase of labor and low back pain were significantly reduced in the semi-prone and knee-chest position compared to the control groups (P<0.05). There were no differences in the duration of the third stage of labor, APGAR score, and the rate of neonatal addition to neonatal intensive care unit, using oxytocin, and perineal tears (P>0.05). The semi-prone and knee-chest positions increase the spontaneous rotation of occiput to the anterior position, vaginal delivery rates as well as a reduction in duration of active phase of labor and low back pain after delivery.

Effects of Right Lateral Position on Changes of Fetal Hemodynamics in Late Pregnancy.

We aim to evaluate the effect of right lateral position on fetal hemodynamics (including umbilical artery [UA] and middle cerebral artery (MCA) blood flow-velocity waveform). In total, 150 low-risk singleton full-term pregnant women were included in the study from November 2021 to January 2022. Doppler flow velocity waveforms of the fetal UA and MCA tested by ultrasound were collected in gestation of 37-40 weeks. Computational analysis was performed using the one-way ANOVA test. Compared with the maternal left lateral position, there was a significant increase in Doppler indices of UA-RI (P = .033), UA-S/D (P = .019) and MCA-PSV (P = .021) and a significant decrease in MCA-RI (P = .030) in the supine position group. There was no statistical significance in all Doppler indices between the left and right lateral position (P > .05). Among the Doppler indices of three different maternal positions, there was no significance in both UA-PI and MCA-PI (P > .05). There were no significant differences on changes of the fetal hemodynamics between left and right lateral positions. Pregnant women could adopt to lie in the left or right lateral position alternately to relieve the discomfort in late pregnancy.

Correlation between bituberous diameter and mode of delivery in a cohort of low-risk nulliparous women

ObjectiveThe aim our study was to evaluate the association between the antepartum clinical measurement of the Bituberous Diameter (BTD) and the occurrence of unplanned obstetrical intervention (UOI) due to labor dystocia, including either operative vaginal delivery or caesarean section in a cohort of low-risk, nulliparous at term. DesignRetrospective analysis of prospectively collected data. SettingTertiary maternity care. InterventionsWith the women lying in lithotomic the distance between two ischial tuberosities was assessed using a tape measure during the routine antenatal booking between 37 and 38 weeks of gestation. Measurements and findingsOverall, 116 patient were included, and of these 23(19.8%) were submitted to an UOI due to labor dystocia. Compared to women that had a spontaneous vaginal delivery, women submitted to an UOI had a shorter BTD (8.25 + 0.843 vs 9.60 + 1.12, p < 0.001), a higher frequency of epidural analgesia (21/23 or 91.3% vs 50/93 or 53.8%; p = 0.002) and of augmentation of labor (14/23 or 60.9% vs 19/93 or 20.4%; p < 0.001) as well as a longer first [455 (IQR 142–455 min vs 293 (IQR 142–455) min] and second stages of labor [129 (IQR 85–155) min vs 51 (IQR 27–78) min]. Multivariable logistic regression showed that the BTD (aOR 0.16, 95% CI 0.04–0.60; p = 0.007) and the length of the second stage of labor (aOR 6.83, 95% CI 2.10–22.23; p = 0.001) were independently associated with UOI. When evaluating the diagnostic accuracy of the BTD for the prediction of UOI due to labor dystocia, the BTD showed an AUC of 0.82 (95 %CI 0.73–0.91; p < 0.001) with an optimal cut-off value of 8.6 cm (78.3% (95 %CI 56.3–92.5) sensitivity, 77.4% (95 %CI 67.6–85.4) specificity, 46.2% (95% CI 30.1–62.8) PPV, 93.5% (95% CI 85.5–97.9) NPV, 3.5 (95% CI 2.3–5.4) positive LR, and 0.28 (95% CI 0.13–0.61) negative LR. A significant inverse correlation between the length of the second stage of labour and the BTD in patients that had a vaginal delivery was also demonstrated (Spearman’s rho = -0.24, p = 0.01). Key conclusionsOur study suggests that antepartum clinical assessment of the BTD might be used as a reliable predictor of UOI due to labor dystocia in low-risk, nulliparous women at term gestation. Implications for practiceAntenatal identification of women at higher risk for labor dystocia might trigger some interventions during the second stage of labor, such as maternal position shifting, to increase the pelvic capacity and potentially improve outcomes or might prompt a referral of the patient to a district hospital prior to the onset of labor.

Neurosurgical emergencies during pregnancy - Management dilemmas.

Neurosurgical emergencies in the obstetric setting pose considerable challenges. Decision-making involves deliberations on the gestational age, critical nature of the illness, timing of surgery, maternal positioning during neurosurgery, anesthesiologic strategies, monitoring of the pregnancy during surgery, and the mode of delivery. The present study discusses the management and ethical dilemmas encountered during the management of six obstetric patients with neurosurgical emergencies. A retrospective review of all neurosurgical operations performed between January 2016 and December 2022 were included in the study. This study includes a series of six pregnant women who presented with neurosurgical emergencies, secondary to freshly diagnosed pathologies in the period 2016-2022. The mean maternal age was 31.33 years. Four of the six patients were in the third semester and two were in the second trimester. The underlying etiologies were as follows: spontaneous intracerebral hypertensive hemorrhage (1), obstructive hydrocephalus due to shunt malfunction (1), brain tumor (02), and compressive spinal cord myelopathy due to tumors (02). Three patients who were near term underwent lower cesarean section followed by emergency neurosurgical procedure in the same sitting. Two second trimester patients continued their pregnancy after the emergency neurosurgical operation. In one patient, in whom a brain tumor was diagnosed near term, underwent neurosurgery 1 week after successful cesarean section. All the six mothers and fetus recovered well, ex3cept two patients who have persisting residual deficits. Treatment of neurosurgical emergencies during pregnancy needs to be customized depending on the clinical condition of the pregnant woman, prognosis of the disease, gestational age and the status of the pregnancy. With careful planning, timely intervention, consultative decision making and it is possible to achieve the ultimate goal - which is to protect and safeguard the mother and preserve and deliver a viable fetus.

Long-term Risk of Epilepsy Following Invasive Group B Streptococcus Disease in Neonates in Denmark

The risk of epilepsy after neonatal invasive Group B Streptococcus (iGBS) disease, particularly iGBS sepsis, is poorly understood. To examine the association between neonatal iGBS (sepsis or meningitis) and long-term risk of epilepsy, stratified by sex, prematurity, and maternal socioeconomic position (SEP). This population-based cohort study was conducted in Denmark with an inclusion period from 1997 through 2017 and follow-up until the end of 2018. A general population comparison cohort was randomly sampled and matched up to 10:1 to the exposed cohort. Linkage between Danish national registers were applied for data collection. Participants were infants aged 0 to 89 days. The general population comparison cohort was matched by sex, the child's year and month of birth, and gestational age. SEP was defined by maternal income and education. Hospital-diagnosed iGBS (sepsis or meningitis) during the first 89 days after birth. Epilepsy was defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and/or prescription codes for antiepileptic drugs using Danish medical registry data. Cumulative risk (CR) of epilepsy was calculated by treating death as a competing event. Cox proportional hazards regression was used to estimate hazard ratios with 95% CIs. Effect modification by sex, prematurity, and maternal SEP was assessed on an additive scale. A total of 1432 children (792 [55.3%] boys; 1126 [78.6%] with gestational age ≥37 weeks) were identified with iGBS disease: 1264 with sepsis and 168 with meningitis. In the comparison cohort, there were 14 211 children (7869 [55.4%] boys; 11 260 [79.2%] with gestational age ≥37 weeks). The overall (0 to 22 years) CR of epilepsy was 3.6% (95% CI, 2.6%-5.0%) in children with iGBS disease and 2.3% (95% CI, 1.9%-2.7%) in the comparison cohort. The overall CR of epilepsy for iGBS meningitis was 15.1% (95% CI, 8.9%-22.8%) and 2.2% (95% CI, 1.4%-3.4%) for iGBS sepsis. The adjusted hazard ratio for epilepsy in children with iGBS disease was 2.04 (95% CI, 1.46-2.85). Being a boy, born premature, or born to a mother belonging to a low SEP group was associated with an increased risk of epilepsy in later childhood. In this population-based cohort study of 1432 neonates, iGBS disease was associated with a higher incidence of epilepsy in later childhood, notably after meningitis. Premature birth, sex, and low maternal SEP modified the association.

Intrapartum ultrasound in maternal lateral versus semi-recumbent posture. A repeated measures study

ObjectiveThis study aimed to assess whether intrapartum ultrasound (ITU) measurements in maternal lateral posture are superimposable to ITU measurements in semi-recumbent position. Study designA single-center, repeated measures design was used. Women in the second stage of labor were randomized to ITU first in semi-recumbent followed by ITU in side-lying posture without and with contraction, or inversely.The angle of progression (AOP) and the head-perineum distance (HPD) between contractions (AOP1 and HPD1) and with contraction (AOP2 and HPD2) were measured in each maternal posture. The differences between AOP1 and AOP2 (dAOP), and between HPD1 and HPD2 (dHPD) were calculated. Results and conclusionsForty-two women participated in the study. A generalized estimating equation model showed that AOP1 (-3.00°; 95 % CI −5.77 to −0.23; p = 0.03) and AOP2 (-4.14°; 95 % CI −7.20 to −1.08; p = 0.008) were lower in semi-recumbent compared to maternal lateral posture. HPD1 (+1.43 mm; 95 % CI 0.05–2.81; p = 0.042) and HPD2 (+1.53 mm; 95 % CI 0.17–2.89; p = 0.03) were higher in semi-recumbent position.Differences in the ITU measurements in maternal lateral posture compared to semi-recumbent position are small. Monitoring the second stage of labor with ITU in lateral maternal posture is possible.

Influence of maternal position during combined spinal-epidural anesthesia for labor analgesia on technical difficulties and complications.

Generally, combined spinal-epidural anesthesia (CSEA) for labor analgesia is performed in the lateral or sitting position; however, only few studies have investigated the effect of maternal position on labor analgesia induction. We aimed to retrospectively assess the influence of maternal position on induction time and complications. We retrospectively analyzed anesthetic and medical records regarding labor analgesia in 201 parturients treated between January 2019 and November 2019. Patients were classified into 2 groups based on their position (sitting or lateral) during induction. The primary outcome was the time required for CSEA induction. We compared 2 groups on the primary outcome and the occurrences of other complications during CSEA induction using hyperbaric bupivacaine. Moreover, we performed multiple linear regression analysis to identify independent factors associated with induction time. There was no significant between-group difference in the time required for induction. Multiple linear regression analysis revealed an independent association of the distance from the skin to the epidural space with the time required for induction. The lateral group had a significantly higher incidence of paresthesia than the sitting group (P = 0.028). The lateral group had a significantly higher ephedrine requirement (P < 0.001) than the sitting group. Maternal position was not associated with the time required for CSEA induction. However, the sitting group had a lower paresthesia occurrence and ephedrine requirement than the lateral group. Other technical complications were not associated with maternal position during CSEA induction.