Maternal Postpartum Hemorrhage Research Articles

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

BackgroundMaternal mortality in sub‐Saharan Africa is approximately 500 to 1000 per 100 000 births (vs. approximately 5‐20 in developed countries). Postpartum hemorrhage (PPH) is deemed responsible for 30% to 50% of the deaths. ObjectiveTo study PPH, risk factors, and mortality in metropolitan Mozambique to inform future studies and intervention strategies. Materials/MethodsRetrospective cross‐sectional data extraction from all charts available to us (n = 495) recording deliveries between January and June 2018 at Maputo Central Hospital. Data included age, maternal survival, HIV status, parity, delivery mode, complications, vital signs, laboratory values, and maternal/fetal data. PPH was determined by charted diagnosis, interventions for hemorrhaging, placental abruption, transfusion, or blood loss. Autopsy reports from all deceased patients (n = 35) were examined. ResultsMedian age was 29 years with 17% HIV prevalence. Risk factors for PPH (frequency, 12%) included parity (adjusted odds ratios (AORs) for 3+ versus nulliparity, 7.20 (95% confidence interval [CI], 2.46‐21.10), gestation length (AOR, 0.86; CI, 0.81‐0.92 per week), and body temperature (AOR, 1.10; CI, 1.04‐1.16 per 0.1°C). Maternal mortality was strongly associated with PPH (AOR, 5.22; 95% CI, 2.26‐12.08) and HIV (AOR, 11.66; 95% CI, 4.72‐28.78). Laboratory values (n = 241) were available from mothers experiencing complications (approximately 50%). Anemia (prevalence 54%) was a strong predictor of PPH with an inverse relationship between hemoglobin levels on admission (AOR, 0.62; 95% CI, 0.50‐0.77 per g/dL higher hemoglobin) and the probability of later suffering from PPH. Mothers who died following PPH had lower median hemoglobin (6.2 g/dL) than mothers who survived (9.2 g/dL). Protocols to estimate peripartum blood loss were not used; antifibrinolytics and/or cryoprecipitate were unavailable. ConclusionPostpartum hemorrhage is a serious problem even in metropolitan areas of sub‐Saharan Africa, and anemia influenced bleeding and death substantially. To address this problem, it is critical to raise awareness and region‐specific prevention and intervention protocols.

Pregnancy with pancytopenia: An Observational Study

Background: Pancytopenia is the reduction in all three major cellular elements of the blood; hence it is the simultaneous presence of anemia, leukopenia and thrombocytopenia. Pancytopenia is associated with many maternal and fetal complications during pregnancy like maternal sepsis, postpartum hemorrhage, pre-eclampsia and preterm labor, IUGR and intrauterine fetal demise. Methods: The study was conducted at BLDE (Deemed to be) University, Shri B. M. Patil Medical College Hospital, and Research Centre. It's an observational study done from November 2019-April 2020. The participants enrolled in the study were subjected to further clinical and laboratory evaluation and followed for a feto-maternal outcome. Results: The incidence of pancytopenia with pregnancy in this study was 3% and all the patients were vegetarian by diet along with vitamin B12 and folic acid deficiency. They were associated with different maternal and fetal complications. Conclusions: Proper dietary counseling and well-balanced dietary plans even with plant originate food can prevent micronutrients deficiency and avoid deleterious consequences like pancytopenia.

Interventions to reduce the cesarean delivery rate in a tertiary hospital in China

Introduction High cesarean delivery rate has been a global public health concern. This study assesses the effect of medical interventions and societal changes on cesarean delivery rates in a Chinese tertiary hospital. Material and methods A retrospective study including all live births ≥34-week gestation between 2008 and 2016 from Guangzhou Women and Children’s Medical Center was divided into 5 stages: (1) no interventions; (2) patient-controlled epidural analgesia; (3) episiotomy restriction; (4) new labor management; (5) universal two-child policy. An interrupted time series design was used to measure the effect of interventions on overall cesarean rate, primary cesarean rate, maternal and neonatal outcomes. Results There were 126,609 deliveries including 49,092 cesarean deliveries and 77,517 vaginal deliveries in this period. Overall cesarean delivery rate declined after implementing patient-controlled epidural analgesia, episiotomy restriction and universal two-child policy. Primary cesarean rate decreased after implementing episiotomy restriction. Cesarean rate with previous cesarean dramatically increased, and maternal request cesarean rate decreased gradually. Low Apgar rate (score ≤7 at 5 min) increased after episiotomy restriction and maternal postpartum hemorrhage rate increased after new labor management. Conclusions Patient-controlled epidural analgesia, episiotomy restriction and the universal two-child policy showed the most significant effects to reducing the cesarean rate.

Maternal characteristics and outcomes affected by hypothyroidism during pregnancy (maternal hypothyroidism on pregnancy outcomes, MHPO-1)

BackgroundHypothyroidism in pregnancy is an arena of ongoing research, with international conflicts regarding screening, management, and outcomes. Various studies have described the outcomes depending on geographical and international diagnostic criteria. No study has been conducted in this regard from the region of Pakistan. Therefore, we aim to report the clinical features and maternal outcomes of hypothyroid pregnancies and compare the maternal outcomes between uncontrolled and controlled TSH levels in the preconception as well as the gestational period.MethodsWe conducted a cross-sectional retrospective study on 718 cases in the Aga Khan University Hospital after ethical approval. We collected information on pregnant females who have diagnosed hypothyroidism before conception or during their antenatal period. We noted the maternal characteristics and maternal comorbidities. Laboratory data were recorded for thyroid stimulating hormone levels before conception and during gestation. We recorded maternal outcomes as pregnancy loss (including miscarriage, stillbirth/intrauterine death, medical termination of pregnancy and ectopic pregnancy), gestational hypertension, pre-eclampsia, postpartum hemorrhage, placental abruption, and modalities of delivery. Data analysis was performed on Statistical Package for the Social Sciences version 20.0.ResultsAmong 708 hypothyroid women 638 had live births. Postpartum hemorrhage was the most frequent maternal outcome (38.8%). The emergency cesarean section occurred in 23.4% of cases. We determined TSH levels in 53.2, 56.7, 61.7 and 66.6% of cases in preconception, 1st, 2nd, and 3rd trimester periods. A significant association existed between cesarean section and preconception thyrotropin levels > 2.5 mIU/L, whereas postpartum hemorrhage was significantly associated with thyrotropin levels > 2.5 mIU/L in the preconception and third trimester.ConclusionSuccessful live births in our patients were complicated by maternal postpartum hemorrhage and a frequent number of emergency cesarean section.

ANALISIS FAKTOR RISIKO ATONIA UTERI

Maternal mortality rate in Indonesia is still relatively high. The biggest cause of maternal mortality in Indonesia is bleeding. Most bleeding in the puerperium (75-80%) is uterine atony. Uterine atony is the most frequent cause of the occurrence of bleeding postpartum. This study aimed to analyze the risk factors for uterine atony in Cut Meutia General Hospital and Health Center PONED in North Aceh district. This study uses a case control design, as a case group, maternal postpartum hemorrhage with uterine atony and control group, maternal postpartum hemorrhage without uterine atony. The sample size for each selected group 69 (the number of cases during the period from 2015 to 2017) while the control selected at random with the same number as many as 69 cases. Data analysis using chi square and multiple logistic regression. The results of the research bivariable indicates a meaningful associated with uterine atony is preeclampsia with OR 10,30 (CI 95%: 2,91-36,41), twin pregnancy with OR 17,31 (CI 95%: 2,21-135,76), induction of labor with an OR 4,39 (CI 95%: 1,0-21,45), grande multipara with OR 4,52 (CI 95%: 1,61-12,73) compared with primipara. Multivariable those associated with uterine atony is the age of the mother with OR 2,98 (CI 95%: 0,56-15,82), preeclampsia with OR 20,27 (CI 95%: 4,66-88,20), induction of labor with an OR 6,69 (CI 95%: 1,12-39,95), twin pregnancy with OR 52,39 (CI 95%: 5,65-486,03), anemia with OR 3,06 (CI 95%: 1,07-8,69). This study concluded that parity, preeclampsia, twin pregnancy and labor induction were risk factors for the incidence of uterine atony with twin pregnancy as the most dominant factor in the incidence of uterine atony.
 
 Keywords : Risk factors; Uterine Atony.

Development and Effect of Nurse-Centered Doula Support Program for Mothers with Natural Childbirth: PILOT TEST

Purpose The present study is to develop a Nurse-Centered Doula Support Program (NDSP) for the management of pain and childbirth support in natural births and to evaluate its effect. Methods Sixty items were derived by 5 experts and the final contents of program were confirmed with the verification of 58 items with content validity index of 0.8 or more, by an expert group consisting of 2 obstetricians and 3 maternity nurses. Twenty-four pregnant women admitted for maternity care at Mediflower hospital in Seoul were included in the evaluation of NDSP efficacy. Pain, anxiety, postpartum hemorrhage, type of birth, and the birth satisfaction of the newborn were assessed for the evaluation. Results This study showed that compared to non-NDSP-applied group, NDSP-applied group had lower pain scores during transitional phase and lower postpartum anxiety score. Also, postpartum hemorrhage was less frequently found in NDSP-applied group, with higher birth satisfaction, when compared to the non-NDSP-applied group. Conclusion These results suggest that the NDSP developed by the present researcher is effective in reducing maternal pain, anxiety, postpartum hemorrhage, and birth satisfaction in natural births, and thereby, is expected to be used as nursing intervention in maternal care. Key Words: Anxiety, Labor pain, Natural childbirth, Midwifery

Effectiveness and feasibility of early essential newborn care during term cesarean section

Objective To explore the effects of early essential newborn care (EENC) on short-term maternal and neonatal health and to evaluate the satisfaction and acceptability of both patients and medical staff in the operating room regarding the implementation of EENC during term cesarean section(CS). Methods Two hundred gravidas who underwent CS in Wenzhou Medical University Affiliated Women and Children Hospital from January 2018 to April 2018 were recruited in this prospective study. According to the odd or even number of their medical records, these women were randomly divided into EENC or control group, 100 in each. EENC was offered to those in the EENC group immediately after birth, including drying the newborn immediately and thoroughly, mother–infant skin-to-skin contact at least 90 min and initiating the first breastfeeding, and delayed cord clamping until l-3 min after birth. Routine neonatal care was provided to the control group, including regular drying, insufficient skin-to-skin contact and cord clamping within 1 min after birth. Differences were compared between the two groups in the incidence of abnormal pulse, low oxygen saturation, hypothermia and mild asphyxia from the neonatal aspect and the incidence of postpartum hemorrhage and early initiation of breastfeeding from the maternal aspect. The acceptability and satisfaction of all the participants and the medical staff were also analyzed. t-test and Chi-square test were used as statistical methods. Results All of the 200 participants were finally analyzed. In the EENC group, the incidence of neonatal hypothermia [2% (2/100) vs 13% (13/100), χ2=8.721, P=0.003] and maternal postpartum hemorrhage [1% (1/100) vs 6% (6/100), χ2=5.701, P=0.035] were lower comparing to the control group, while the initiation rate of early breastfeeding was higher [56% (56/100) vs 5% (5/100), χ2=61.352, P 0.05). The scores of maternal satisfaction (24.6±0.4 vs 23.4±1.9, t=6.443, P=0.001) and acceptability (24.3±0.5 vs 23.5±1.4, t=5.436, P=0.001) in the EENC group were also significantly higher than those in the control. For the obstetric operation team, the acceptability scores among obstetricians (22.6±0.8 vs 21.6±1.3, t=2.379, P=0.019), instrument nurses (23.2±0.9 vs 21.3±1.1, t=13.592, P<0.001) and anesthetists (22.6±0.9 vs 21.5±1.7, t=5.625, P=0.001) in the EENC group were higher than those in the control group. However, no significant difference was observed in the acceptability among rounding nurses between the two groups (P=0.086). Conclusions EENC during CS could stabilize the neonatal temperature, reduce postpartum hemorrhage, promote early breastfeeding and improve the maternal satisfaction as well as the acceptability of both obstetric operation team and puerperae. There is a clinical significance to promote EENC during CS. Key words: Cesarean section; Maternal-child nursing; Neonatal nursing; Feasibility studies

A local risk score model for venous thromboembolism prophylaxis for caesarean section in Chinese women and comparison with international guidelines

ObjectiveRecommendations for venous thromboembolism (VTE) prophylaxis from authoritative guidelines for women undergoing caesarean delivery differed significantly and may not be applicable to Chinese populations. We aim to formulate a local risk model for VTE prophylaxis for caesarean section women. Material and methodsA local risk score model based on demographic, obstetric and medical parameters was used to assess the risk of VTE in women undergoing caesarean delivery from May 2017 to April 2018 in a regional obstetric unit. Women with increased risk (VTE Score ≥ 2) are given mechanical prophylaxis with pneumatic cuff and those with high risk (VTE Score ≥ 3) are additionally prescribed low molecular weight heparin (LMWH) as pharmacological prophylaxis in the early postpartum period. The risk scores obtained by applying other major guidelines were then compared. ResultsOf 859 patients were included for analysis, overweight (15.3%), advanced maternal age (9.7%), multiple pregnancy (5.1%), obesity (4.7%), and primary postpartum haemorrhage (4.1%) were the most common risk factors. Overall, 109 (12.7%) patients required mechanical prophylaxis and 28 (3.3%) patients required additional pharmacological prophylaxis. No patient had postpartum VTE events nor serious haemorrhage after receiving LMWH prophylaxis. In contrast, applying the Royal College of Obstetricians and Gynaecologists guidelines to our cohort, 649 (75.6%) patients would receive LMWH after caesarean section, compared with no patients under the American College of Obstetrics and Gynaecology guidelines. ConclusionsOur local risk score model avoided the need for large proportions of women to be subjected to pharmacological prophylaxis, and appeared safe and practical.

Postpartum use of oxytocin and volume of placental transfusion: a randomised controlled trial

ObjectiveTo assess whether oxytocin administered before clamping the umbilical cord modifies the volume of placental transfusion.DesignRandomised controlled trial.MethodsMothers of term infants born vigorous by vaginal delivery with informed consent provided...

Rates of Neonatal Sepsis by Maternal Race, Education, and Insurance [22F

INTRODUCTION: Given the dearth of current data comparing sepsis rates among infants based on maternal demographics, clinicians have little with which to evaluate a neonate's chances of developing sepsis. This study aims to characterize the rates of sepsis stratified by maternal race, education level, and insurance status. METHODS: This is a retrospective cohort study of 9,676,773 non-anomalous, singleton and twin deliveries in the United States. We conducted a chi-squared analysis comparing rates of sepsis among infants stratified by maternal race, education level, and insurance status. Multivariate analysis controlled for maternal age, diabetes, chronic hypertension, preeclampsia, chorioamnionitis, postpartum hemorrhage, cesarean section, nulliparity, and gestational age. RESULTS: Within our cohort, rates of neonatal sepsis were significantly higher among infants born to women with Medicaid insurance than those born to women without Medicaid insurance (2.00% vs. 1.27%; p<0.001). Infants with mothers who had no college education exhibited higher rates of neonatal sepsis than infants with mothers who had some college education (1.84% vs. 1.35%; p<0.001). Additionally, multivariate analysis showed that non-Hispanic Black race and Hispanic race were predictive for neonatal sepsis (OR 1.22, 95% CI 1.16-1.29; OR 1.17, 95% CI 1.13-1.21). CONCLUSION: In our cohort, Hispanic and non-Hispanic Black mothers exhibited an increased risk of giving birth to an infant who developed neonatal sepsis. Rates of sepsis were also significantly higher among infants born to mothers with Medicaid and to mothers with no college education. This research highlights a need for further investigation into the association between sepsis rates and demographic factors.

Effect of Maternal Body Mass Index on Postpartum Hemorrhage

(Anesthesiology. 2018;128:774–783) While postpartum hemorrhage is a leading cause of maternal morbidity and has been on the rise, only a small portion of its incidence can be explained by well-known risk factors including placenta previa, multiple gestation, and polyhydramnios. To improve risk assessment, other risk factors should be identified. Maternal obesity has also become more prevalent, and some data suggest obese women may have an increased risk of postpartum hemorrhage. This study aimed to investigate the possible link between maternal obesity and postpartum hemorrhage. In addition, the effect of maternal body mass index (BMI) and delivery mode on risk of hemorrhage was examined.

Determinants of Breast-Feeding Initiation Time among Newborns Delivered in a Tertiary Baby Friendly Health Facility in Enugu, Nigeria

Background: The importance of early breastfeeding initiation to both the mother and infant is enormous as it reduces the likelihood of neonatal mortality as well as maternal postpartum haemorrhage. The objectives of the study were to assess the prevalence and determinants of correct breastfeeding initiation time among newborns delivered at the University of Nigeria Teaching Hospital, Enugu. Methods: This was a cross sectional descriptive study. Relevant maternal and new-born birth characteristics were obtained using a pretested semi-structured questionnaire. Data were analyzed using SPSS version 20.0. Multivariate logistic regression was used to determine the factors that are significantly associated with correct breastfeeding initiation time with the level of significance set at p < 0.05. Results: A total of 321 mother-newborn pairs were studied. 86 (26.8%) of the respondents correctly initiated breastfeeding within 1 hour of delivery. Planned pregnancy, pre-pregnancy decision on infant feeding options, primiparity, vaginal delivery and breast milk as first food given to the neonate post-delivery were associated with increased likelihood of correct breastfeeding initiation time. Conclusion: Correct breastfeeding initiation time among respondents is low. Planned pregnancy, pre-pregnancy decision on infant feeding option before pregnancy, primiparity, vaginal delivery and breast milk as first food given to the neonate after delivery were associated with having correct breastfeeding initiation time among respondents. Efforts should be made to complement Baby Friendly Hospital Initiative with baby friendly community initiative in order to improve the rate of correct breastfeeding initiation time in our setting.

MRI Distinguish the Types of Placental Accrete Ability and Finding: 27 Patients Results

The placenta accrete is a kind of emergency and it leads to maternal postpartum hemorrhage, and one of the causes of death. Its aims is to evaluate diagnostic ability and findings of MRI in placental accrete of different types. This study included 27 pregnant women who were all histologically confirmed placental accrete after operation. According to the Maldjia diagnostic MRI criteria. The sensitivity and accuracy of MRI imaging were compared, and the MRI features of placental accrete were also described. The results showed a statistically significant difference among the three radiologists in MRI classification (P 0.05), chi square test (c2) showed no difference between the two types diagnostic capabilities (P>0.05). ADC and high b value DWI both showed slightly high signal of placental accrete. Residual placenta demonstrated flower braid or mushroom inhomogeneous enhancement. Comparison of MRI and US, 0 and 1 type are no obviously difference between US and MRI (P>0.05), but there are statistical difference (P<0.05) for distinguishing type 2 and type 3. MRI has a high diagnostic accuracy in placental implantation and the location, extent and depth of its invasion, displaying the condition of blood supply, and the drawing the typing diagnosis based on them. Moreover, MRI was more useful than US in distinguishing type 2 and type 3 of placental accrete.

Management of Immune thrombocytopenic purpura during pregnancy: A single center experience

Background: Immune thrombocytopenic Purpura (ITP) is the second most common cause of an isolated low platelet count during pregnancy. It account for about 3% of thrombocytopenic cases during delivery. Treatment is indicated, if there is an evidence of bleeding or platelet count is less than 30,000/µl. Herein, we presented a medical record of twenty-four pregnant women, who were diagnosed with ITP during pregnancy.&#x0D; Method: A total number of twenty four pregnant women diagnosed with primary ITP and having platelet count of less than 30000/µl were enrolled in the study. Oral prednisolone (1mg/kg) was started in all patients with an aim to keep the platelet count above 50000/µl during delivery. Steroid was continued for 21 consecutive days and were tapered (10 mg) every week, if platelet counts were above 30000/µl.&#x0D; Data pertaining to the ITP during pregnancy was recorded for age, platelet count, mode of delivery and complications related to steroid therapy and were analyzed by simple statistical analysis.&#x0D; Result: ITP was observed in about 58%, 25% and 17% of the cases during first, second and third trimester respectively. About, 63% of patients presented with purpuric rash, 18% presented with mucosal bleed, one present presented with hematuria and others were asymptomatic. More than two third of cases responded to the steroid and in those cases platelet counts were above 50,000/µl at the time of delivery. All subjects delivered a healthy child. There was no maternal mortality and post-partum hemorrhage was absent in all patients.&#x0D; Conclusion: Steroid is the treatment of choice for all cases of ITP. ITP is no longer a contraindication to the continuation of pregnancy, the tradition and tendency to advice for abortion in these pregnant mothers, may not be justifiable.

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

Background: Delayed cord clamping (DCC) improves placental transfusion and increases blood volume in preterm infants when compared with immediate cord clamping (ICC). However, evidence to support DCC in multiple-birth preterm infants is still lacking. Objective: To compare the outcomes of ICC versus DCC in preterm infants of multiple births. Study Design: Women with a multiple pregnancy, including twins and triplets with a gestational age of 28–36 weeks, were randomized to receive ICC (23 women and 50 infants) or DCC for 30–60 s (24 and 51 infants). The infants’ hematocrit on admission, superior vena cava (SVC) flow measured within 24 h, and hematocrit at 8 weeks of age were compared. The use of uterotonic agents during delivery was not controlled in this study. Result: All infants were delivered by cesarean section (CS) except for 2 sets of twins, 1 in each group. Maternal and infant baseline characteristics in both groups were comparable. There were no significant differences between the groups in admission hematocrit, SVC flow measured within 24 h, hematocrit at 8 weeks of age, or any other neonatal outcomes. The incidence of maternal postpartum hemorrhage (PPH) was higher in the DCC group (4.3% in ICC vs. 25% in DCC, p = 0.04). Conclusion: DCC for 30–60 s did not improve placental transfusion or increase systemic blood flow in multiple-birth infants born preterm, mostly by CS, when compared with ICC. The finding of a higher PPH rate in the DCC group raises concerns about the maternal safety of this procedure in this patient population.

Impact of Resident Overnight Duty Hour Changes on Obstetrical Outcomes: A Population-Based Cohort Study.

To determine whether obstetrical patient outcomes have changed following the introduction of restricted resident work hours. A population-based retrospective cohort study of the effects of restricted duty hours for residents in July 2013 at three academic hospitals in Toronto, ON using linked health care databases. The study included 6763 deliveries in the 2 years pre-exposure and 5548 deliveries in the 2 years post-exposure. The primary outcome, planned prior to data collection, was a composite index of 29 maternal/fetal outcomes including maternal transfusion/postpartum hemorrhage, maternal infection, fetal mortality, NICU admissions, and surgical/obstetrical complications. There were seven secondary outcomes analysed: NICU admissions; neonatal death; maternal transfusion or postpartum hemorrhage; maternal infection; and three composite measures. A generalized estimating equation model, clustered by institution, was utilized to assess for differences post-intervention. We found no significant differences in baseline demographics between groups. After the implementation of duty hour restrictions, no significant difference was seen in the primary outcome. However, an increased incidence of composite maternal surgical/obstetrical outcomes (OR 1.191; 95% CI 1.037-1.367, P = 0.013) and transfusion/postpartum hemorrhage (OR 1.232; 95% CI 1.074-1.413, P = 0.003) was found. There were no significant differences in other secondary outcomes. Since the implementation of resident duty hour restrictions, there was no overall change in patient outcomes. However, there was an increase in surgical/obstetrical complications and transfusion/postpartum hemorrhage. This suggests that duty hour restrictions may not be beneficial to patient outcomes. It highlights the need to further investigate the clinical impact of a change in resident duty hours.

Is Gestational Weight Gain below That Recommended by IOM for Obese Women with Insulin Treated Gestational Diabetes Safe?

The Institute of Medicine (IOM) recommends gestational weight gain (GWG) of 5-9 kg in women with a body mass index of &amp;gt;/=30. Debate continues as to whether GWG less than that recommended is safe. Concern relates to whether this would result in an increase in small for gestational age (SGA) infants, or an increase in rates of prematurity. We examined pregnancy outcomes for mothers with a BMI &amp;gt;/=30 and their offspring in 473 women. All women recorded on our Atlantic DIP database with a singleton pregnancy treated with insulin and a BMI&amp;gt;/=30 were included. Women were categorised into 3 groups as follows (1) those with weight loss, N = 97 (2) weight gain 0-5kg, N = 49 (3) weight gain &amp;gt;5kg N = 327, from first antenatal visit to delivery. Rates of maternal outcomes (pregnancy induced hypertension (PIH), preeclampsia (PET), antepartum (APH) and postpartum haemorrhage (PPH), week of delivery, caesarean section (CS) delivery) and neonatal outcomes (birth weight, large for gestational age (LGA), SGA, macrosomia, prematurity, neonatal morbidities) were compared. Mean maternal booking BMI was 38, 37.6 and 36 kg/m2 (p&amp;lt;0.01) and mean maternal age was 34.7, 34.1 and 33.3 years in groups 1,2 and 3 respectively (p=0.04). Rates of PIH PET APH PPH and CS were similar between groups. Glycaemic control prior to delivery was better in women in group 1 compared to groups 2 and 3 (HbA1C 37.2 vs. 38.4 vs. 39 mmol/mol; p = 0.02). Infant birth weight was lower in group 1 compared to groups 2 and 3 (3545g vs. 3645g vs. 3703g; p&amp;lt;0.01) Rates of LGA, macrosomia. SGA and prematurity (&amp;lt;37 gestational weeks) were similar between groups. Rates of neonatal hypoglycaemia were less in group 1 compared to groups 2 and 3; (2.1% vs. 14.3% vs. 4%; p&amp;lt;0.01), while all other morbidities were similar between groups. Gestational weight change for GDM women treated with insulin below that recommended by the IOM appears safe. In addition, it is associated with better maternal glycaemic control and lower infant birth weight. Disclosure D. Bogdanet: None. P.M. O'Shea: None. F.P. Dunne: None.

Delayed Cord Clamping in Term Neonates: Attitudes and Practices of Midwives in Irish Hospitals

Background:At the time of birth, the baby is attached to its mother’s placenta via the umbilical cord. A delay in cord clamping is physiologically beneficial to the neonate as they receive an increase in blood volume (30%–40%), increased iron stores (20–30mg/kg), and an easier transition to extrauterine life. Active management of the third stage of labor, in order to prevent maternal postpartum hemorrhage, may contribute to early cord clamping practices in Ireland. Objective:To describe the current practices and attitudes of midwives in Irish hospitals toward delayed cord clamping in term neonates. Methods:A cross-sectional descriptive survey was distributed to three maternity hospitals and two Irish online midwifery groups. Results:One hundred and fifty-three valid responses were received. One hundred and eleven midwives (72.4%) defined delayed cord clamping as “clamping after the cord ceases to pulsate.” One hundred and forty (91.5%) respondents practiced delayed cord clamping. Moreover, 62.7 % (98/153) of participants routinely clamp the umbilical cord &gt;1 minute when practicing active management of the third stage, with 49.1% (48/98) of those waiting until cord pulsations have ceased. Awareness of research, practice guidelines advising delayed cord clamping, and experience of practicing physiological third stage are associated with increased delayed cord clamping practices. Early cord clamping is influenced by a deteriorating neonatal or maternal condition and the cultural context within clinical sites. Delayed cord clamping times during active management of the third stage differ significantly between clinical sites and maternity care pathways.Conclusion:A variety of midwifery practices were identified with differing attitudes toward cord clamping practices. Diverse influences included the practice environment, awareness of research, and availability of adjunct resuscitation supports. Recommendations for future practice include a synchronized approach to delayed cord clamping in the third stage of labor, including the provision of a national guideline.

33: Postpartum maternal administration of oxytocin and volume of placental transfusion, an RCT

Background: Delayed umbilical cord clamping is recommended in vigorous infants to allow for passage of blood from the placenta to the infant. Oxytocin is administered to mothers soon after birth to decrease the risk of postpartum hemorrhage. It is not known whether oxytocin administered postpartum influences placental transfusion. Objective: To assess the volume of placental transfusion when oxytocin is administered immediately after birth (group A) compared with oxytocin given after clamping the umbilical cord at 3 minutes (group B). Randomised control trial. Study population: Healthy term infants born vigorous by vaginal delivery with informed consent provided in early labor. Methods: Random numbers were generated by computer program and allocation concealment was performed by opaque, sealed, sequentially numbered envelopes. Oxytocin (10 IU) was given IV within 15 sec. of birth in Group A and after clamping the umbilical cord 3 minutes after delivery in Group B. Soon after birth all infants were weighed at the level of the vagina using a 1g precision scale and subsequently placed on the mother's abdomen or chest. At 3 minutes, in both groups, the cord was clamped and cut and weight was obtained again on the same scale. The primary outcome (volume of placental transfusion) was estimated by the difference in weights (1cc of blood equals 1.05g).T-test and chi-square test were used for group comparison A total of 144 patients were included from May 2016 to November 2016. There were no differences in the primary outcome: infants in group A (n: 70) gained 86g (SD 48), 95% CI 74-97 and in group B (n: 74) 87g (SD 50), 95% CI 75-98, p=0.92. Hematocrit was 57% (SD 5) in group A and 56.8% (SD 6) in group B. No differences were found in any secondary outcomes including jaundice, polycythemia and maternal postpartum hemorrhage. No clinically relevant adverse events in mothers or infants were recorded. When umbilical cord clamping is delayed for 3 minutes infants receive a clinically significant placental transfusion which is not modified by the administration of IV oxytocin immediately after birth.

Double-balloon versus single-balloon catheter for cervical ripening and labor induction: A systematic review and meta-analysis.

We searched Embase, PubMed and the Cochrane Library for randomized or quasi-randomized controlled trials to compare the use of single-balloon to double-balloon catheters. The risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) was calculated using fixed-effects or random-effects models. Four studies involving a total of 793 pregnant women were included. There were no significant differences in the rate of cesarean (RR 1.09, 95% CI 0.86, 1.38; P = 0.48), or vaginal deliveries within 24 h (RR 0.94, 95% CI 0.82, 1.09; P = 0.42), the mean time to delivery (MD 0.39, 95% CI -0.90, 1.68 h; P = 0.55) or Bishop score improvement (MD 0.62, 95%CI -0.18, 1.42; P = 0.13) between the groups. Women who received the double-balloon catheter had a similar risk of maternal intrapartum fever and post-partum hemorrhage. Pain during ripening was only reported in one trial and was significantly higher with the double balloon, whereas pain during device insertion was measured in two trials: one reported no difference while the other reported significantly increased pain with the double balloon. The double-balloon and single-balloon (Foley) catheters had similar effectiveness and safety. The Foley catheter is significantly cheaper, widely available and accessible, has a longer history of use and remains the logical choice over the double-balloon catheter for cervical ripening.