Obstetric Interventions Research Articles

Maternal choledochal cysts in pregnancy: A systematic review of case reports and case series.

Choledochal cysts (CC) are cystic dilatations of the biliary tract, usually diagnosed during childhood, with an estimated incidence in the general population of 1:100000. Complications related to CC include rupture, biliary obstruction, and cholangitis. Maternal CC in pregnancy are rarely reported, and there are no guidelines on optimal management. To systematically review maternal CC diagnosed during pregnancy or postpartum with regard to the clinical presentation of CC, the mode of treatment and delivery, and maternal outcomes. A literature search of cases and case series of maternal CC in pregnancy and postpartum was conducted using MEDLINE/PubMed, Web of Science, Google Scholar, and Embase. There were no restrictions on language or publication year. Databases were lastly accessed on September 1, 2022. Overall, 71 publications met the inclusion criteria, reporting 97 cases. Eighty-eight cases were diagnosed during pregnancy and nine in the puerperium. The most common symptoms were abdominal pain (81.2%) and jaundice (60.4%). Interventions for CC complications were required in 52.5% of the cases, and 34% of pregnancies were induced. Urgent cesarean section (CS) was done in 24.7%. The maternal mortality was 7.2%, while fetal mortality was inconsistently reported. Cholangitis, CC > 15 cm, and bilirubin levels > 80 mmol/L were associated with a higher likelihood of urgent CS and surgical intervention for CC. Bilirubin levels positively correlated with CC size. There was no correlation between age and cyst dimension, gestational age at cyst discovery, and CC size. Although rare, maternal CC in pregnancy should be included in the evaluation of jaundice with upper abdominal pain. Symptomatology and clinical course are variable, and treatment may range from an expectative approach to emergent surgical CC treatment and urgent CS. While most cases were managed by conservative measures or drainage procedures, CC > 15 cm and progressive cholangitis carry the risk of CC rupture and septic complications, which may increase the rates of unfavorable maternal and fetal outcomes. Therefore, such cases require specific surgical and obstetric interventions.

The first alongside midwifery unit in Spain: A retrospective cohort study of maternal and neonatal outcomes.

Midwife-led units have been shown to be safer and reduce interventions for women at low risk of complications at birth. In 2017, the first alongside birth center was opened in Spain. The aim of this study was to compare outcomes for women with uncomplicated pregnancies giving birth in the Midwife-led unit (MLU) and in the Obstetric unit (OU) of the same hospital. Retrospective cohort study comparing birth outcomes between low-risk women, depending on their planned place of birth. Data were analyzed with an intention-to-treat approach for women that gave birth between January 2018 and December 2020. A total of 878 women were included in the study, 255 women chose to give birth in the MLU and 623 in the OU. Findings showed that women in the MLU were more likely to have a vaginal birth (91.4%) than in the OU (83.8%) (aOR 2.98 [95%CI 1.62-5.47]), less likely to have an instrumental delivery, 3.9% versus 11.2% (0.25 [0.11-0.55]), to use epidural analgesia, 19.6% versus 77.9% (0.15 [0.04-0.17]) and to have an episiotomy, 7.4% versus 15.4% (0.27 [0.14-0.53]). There were no differences in rates of postpartum hemorrhage, retained placenta, or adverse neonatal outcomes. Intrapartum and postpartum transfer rates from the MLU to the OU were 21.1% and 2.4%, respectively. The high rate of obstetric interventions in Spain could be reduced by implementing midwife-led units across the whole system, without an increase in maternal or neonatal complications.

New Interpretation of Neonatal Outcomes by Phenotypically Classified Preterm Syndrome: A Retrospective Cohort Study.

The global aim to lower preterm birth rates has been hampered by the insufficient and incomplete understanding of its etiology, classification, and diagnosis. This study was designed to evaluate the association of phenotypically classified preterm syndromes with neonatal outcomes; to what extent would these outcomes be modified after the obstetric interventions, including use of glucocorticoid, magnesium sulfate, and progesterone. This was a retrospective cohort study conducted at Tongji Hospital (composed of Main Branch, Optical Valley Branch and Sino-French New City Branch) in Wuhan. A total of 900 pregnant women and 1064 neonates were retrospectively enrolled. The outcomes were the distribution of different phenotypes among parturition signs and pathway to delivery, the association of phenotypically classified clusters with short-term unfavorable neonatal outcomes, and to what extent these outcomes could be modified by obstetric interventions. Eight clusters were identified using two-step cluster analysis, including premature rupture of fetal membranes (PPROM) phenotype, abnormal amniotic fluid (AF) phenotype, placenta previa phenotype, mixed condition phenotype, fetal distress phenotype, preeclampsia-eclampsia & hemolysis, elevated liver enzymes, and low platelets syndrome (PE-E&HELLP) phenotype, multiple fetus phenotype, and no main condition phenotype. Except for no main condition phenotype, the other phenotypes were associated with one or more complications, which conforms to the clinical practice. Compared with no main condition phenotype, some phenotypes were significantly associated with short-term adverse neonatal outcomes. Abnormal AF phenotype, mixed condition phenotype, PE-E&HELLP phenotype, and multiple fetus phenotype were risk factors for neonatal small-for gestation age (SGA); placenta previa phenotype was not associated with adverse outcomes except low APGAR score being 0-7 at one min; mixed condition phenotype was associated with low APGAR scores, SGA, mechanical ventilation, and grade HI-W intraventricular hemorrhage (IVH); fetal distress phenotype was frequently associated with neonatal SGA and mechanical ventilation; PE-E&HELLP phenotype was correlated with low APGAR score being 0-7 at one min, SGA and neonatal intensive care unit (NICU) admission; multiple fetus phenotype was not a risk factor for the outcomes included except for SGA. Not all neonates benefited from obstetric interventions included in this study. Our research disclosed the independent risk of different preterm phenotypes for adverse pregnancy outcomes. This study is devoted to putting forward the paradigm of classifying preterm birth phenotypically, with the ultimate purpose of defining preterm phenotypes based on multi-center studies and diving into the underlying mechanisms.

Let’s talk early labour: The L-TEL randomised controlled trial

BackgroundWomen without complications have lower obstetric intervention if they remain at home in early labour but many women report dissatisfaction in doing this. Using self-efficacy theory as an underpinning framework, a web-based intervention was co-created with women who had previously used maternity services. The intervention provides early labour advice, alongside the videoed, real experiences of women. MethodThe pragmatic, randomised control trial aimed to evaluate the impact of the web-based intervention on women’s self-reported experiences of early labour. Low-risk, nulliparous, pregnant women (140) were randomised. The intervention group (69) received the web-based intervention antenatally to use at their own convenience and the control group (71) received usual care. Data were collected at 7–28 days postnatally using an online version of the Early Labour Experience Questionnaire (ELEQ). The primary outcome was the ELEQ score. Secondary, clinical outcomes such as labour onset, augmentation and mode of birth were collected from the existing hospital system. ResultsThere were no statistically significant differences in the ELEQ scores between trial arms. Women in the intervention group were significantly more likely to progress spontaneously in labour without the need for labour augmentation (39.1 %) compared to the control group (21.1 %) (OR 2.41, CI 95 %; 1.14–5.11). ConclusionAlthough the L-TEL Trial found no statistically significant differences in the primary outcome, the innovative intervention to support women during latent phase labour was positively received by women. Web-based resources are a cost effective, user-friendly and accessible way to provide women with education. A larger trial is needed to detect differences in clinical outcomes.

Diagnostic Imaging during pregnancy of the dog

Diagnostic imaging represents an important part during modern pregnancy management of the dog. Ultrasound has become the modality of choice for an early pregnancy diagnosis, enabling a verification as early as 17-20 days after LH surge. Furthermore an evaluation of fetal viability and development is possible as well as the depiction of malformations and an early assessment of fetal stress. Doppler imaging may also be of supporting value in this context . Using fetal maturity as well as measurements of fetal and extrafetal structures, a calculation of the gestational age and therefore the time of parturition is achievable. Radiographs of the caudal abdomen enable pregnancy diagnosis from the 43rd day after LH surge onward. In addition, an assessment of fetal size as well as litter size is possible. Both modalities allow for complementary statements concerning possible labor complications and possess supporting value concerning the decision of necessary obstetric intervention and further management in patients with dystocia.

Comparison of different resuscitation methods for newborn calves after dystocia

This study aimed to compare the use of hand-powered vacuum pumps and the suspension by the hind legs within the scope of resuscitating newborn dystocial calves. For this study, data were collected from 60 dystocial calves of different breeds. Various reanimation methods were employed to these calves immediately after birth. In group I (n=20), the hand-powered vacuum pump from HK-Rheintechnik (Neuwied, Deutschland) was used to remove mucus and amniotic fluid from the respiratory tract. In group II (n=20), the McCulloch Medical (Elmwood, England) hand-powered vacuum pump was used to remove mucus and amniotic fluid from the respiratory tract. In group III (n=20) 10 to 12 liters of cold water were poured over the neck of 20 calves immediately after birth. In addition, the calves were suspended by the hind legs via a gate or a pole, so that the head hung downwards vertically. The calves' Time to Sternal Recumbency (T-SR) of the calves was measured following the different resuscitation procedures in order to assess their vitality. In addition, the calves were examined segmentally at one-hour post natum. Furthermore, the calves were examined clinically on the seventh day of life. In addition, we investigated whether confounding variables such as calf sex, dam parity, obstetric intervention, and the season affected T-SR. T-SR ranged from 1.5 to 10.5 minutes. There was no difference between the three initial treatment procedures (p=0.07). However, the T-SR of calves treated with a hand-powered vacuum pump tended to be shorter. No statistically significant difference between the pulse rates (p=0.73), respiratory rates (p=0.13), and rectal temperature (p=0.65) of the animals in the three groups on the first and seventh day of life was evident. There was no statistically significant difference in the incidence of the diseases up to the seventh day of life between the individual study groups. The present study was able to show that the use of hand-powered vacuum pumps is at least equivalent to suspending calves. When using hand-powered vacuum pumps, the girth of the muzzle must be taken into account, as this can limit their utility.

Influence of an eCG administration on puerperal involution and fertility in Simmentaler cows

In the literature, various methods aiming for a promotion of uterine involution and ovarian function in post-partum dairy cattle have been described. Recently, successful use of equine choriongonadotropin (eCG) in this context has been repeatedly reported, while other studies have failed to demonstrate positive effects of eCG administration on puerperal involution in cows. Due to the contradictory results described in the literature, the aim of this field study was to verify whether the administration of eCG on day 10 post-partum exerts a positive effect on uterine involution, ovarian activity and fertility indices in Simmental cows. In nine dairy farms, 205 Simmental cows were divided by lot into three groups: Group 1 animals received 500 I.U. eCG, group 2 received 50 µg gonadorelin, and group 3 animals received 250 mg butafosfan and 125 µg cyanocobalamin (control group). Treatment was administered on day 10 post-partum in each case. The animals were examined clinically and ultrasonographically on the 10th, 25th and 42nd day post-partum and the time to insemination and pregnancy were recorded. Group comparison with respect to the recorded parameters was initially performed without considering confounding factors by analysis of variance. In the second step, potential influencing variables (lactation, milk yield, change in backfat thickness, retentio secundarium and serverity of the obstetric intervention) were taken into account, as well as the combination of the random factors "farm" and "individual animal within the farm". The administration of eCG exhibited no significant effect on uterine involution, however, the cervical involution was influenced significantly. In the group of cows with eCG treatment, ovarian cysts were detected significantly more frequently on day 25 post-partum (p=0.04). This difference did not persist on the 42nd day post-partum. Neither voluntary waiting period nor the days open were significantly shortened by eCG administration. Lactation number showed a significant effect on uterine involution. Heifers exhibited more rapid involution by day 42 post-partum than cows. Administration of eCG in Simmentaler cows at day 10 post-partum showed no positive effect. The use of eCG in early puerperium to promote fertility in the cow should be avoided.

Prophylactic Uterine Artery Embolization in Placenta Accreta Spectrum—An Active Intervention to Reduce Morbidity and Promote Uterine Preservation

PurposeTo evaluate the feasibility and safety of early and proactive involvement of interventional radiology (IR) in the management of placenta accreta spectrum (PAS) by performing the cesarean operation and prophylactic uterine artery embolization in the IR angiography suite as a combined procedure. Materials and MethodsThis study evaluated the effectiveness and safety of prophylactic uterine artery embolization prior to placental separation in cases of antenatally proven or suspected abnormal placentation. Over a 5-year period, 16 consecutive patients with PAS underwent combined IR and obstetric intervention. In all cases, cesarean delivery was performed in the IR angiography suite. Vascular access was obtained prior to surgery with balloon placement into both internal iliac arteries. These balloons were inflated after delivery, followed by uterine artery embolization (14 of 16) if there was evidence of active postpartum bleeding or inability to deliver the placenta. ResultsThere was no fetal or maternal mortality and no significant IR or surgical adverse events. Mean blood loss was 1900 mL. Seven patients (44%) underwent hysterectomy. ConclusionsIn patients with PAS, cesarean section in the angiography suite preceded by prophylactic balloon placement and followed by uterine artery embolization was feasible, safe, and effective in preventing massive blood loss, with a 56% uterine sparing rate.

Association between Maternal Neuraxial Analgesia and Neonatal Outcomes in Very Preterm Infants.

Background Although the use of neuraxial analgesia has been shown to improve uteroplacental blood flow and maternal and fetal hemodynamics related to labor pain, possibly improving immediate outcomes in term neonates, the association between neuraxial analgesia use and outcomes in preterm neonates remains unclear. Objective The aim of this article was to evaluate the association between maternal use of neuraxial analgesia and neonatal outcomes in very preterm infants. Methods This is a retrospective cohort study of women delivering singleton neonates between 23 and 32 weeks' gestation at a large academic center between 2012 and 2016. Outcomes of neonates born to women who used neuraxial analgesia for labor and/or delivery were compared to those whose mothers did not. Multivariable logistic regression was utilized to assess the independent associations of neuraxial analgesia use with neonatal outcomes after controlling for potential confounders, including gestational age, mode of delivery, and existing interventions to improve neonatal outcomes of prematurity. Results Of 478 eligible women who delivered singleton very preterm neonates in this study period, 352 (73.6%) used neuraxial analgesia. Women who used neuraxial analgesia were more likely to have delivered at a later preterm gestational age, to have a higher birthweight, to have preeclampsia and/or hemolysis, elevated liver enzymes, low platelet count (HELLP), to have undergone labor induction, to have delivered by cesarean delivery, and to have received obstetric interventions such as magnesium prophylaxis for fetal neuroprotection, antenatal corticosteroids for fetal lung maturity, and antibiotics prior to delivery; they were less likely to have been diagnosed with a clinical abruption. Neuraxial analgesia was associated with decreased incidence of cord umbilical artery pH less than 7.0 (24.7 vs. 34.9%, p = 0.03), as well as decreased incidence of neonatal intensive care unit length of stay over 60 days (35.5 vs. 48.4%, p = 0.01), although these associations did not persist on multivariable analysis. On multivariable analyses, neuraxial analgesia remained independently associated with decreased odds of necrotizing enterocolitis (adjusted odds ratio [aOR]: 0.28, 95% confidence interval [CI]: 0.12-0.62) and grade III/IV intraventricular hemorrhage (aOR: 0.33, 95% CI: 0.13-0.87). These associations remained significant on sensitivity analyses, which were performed between 10 and 90% of the overall cohort in order to control for outliers, as well as between the subgroup of patients who received obstetric interventions. Conclusions Maternal neuraxial analgesia use may be associated with lower odds of adverse outcomes in very preterm infants, even after controlling for existing interventions for prematurity. Prior work has suggested such effects may be due to improved neonatal acid-base status from changes in placental perfusion and maternal pain management, but further work is required to prospectively investigate such associations.

Psychosomatic treatment in gynecology and obstetrics

Psychosomatic treatment in gynecology and obstetrics

The Demographic and Clinical History as Predictors Contributing to the Prevalence of Caesarean Sections in Ghana: A Facility-Based Study

Caesarean section is an essential clinical obstetric intervention used to reduce maternal and foetal death. Several indications contribute to the decision-making to use CS as a delivery in the clinical environment. This study sought to determine the prevalence of CS at LEKMA Hospital in Ghana and the demographic and clinical history of mothers as predictors for the prevalence. Using a retrospective study design, data for all mothers who had previously given birth at the hospital’s obstetric and gynaecological department was used. Multiple logistic regression was applied and a p-value<0.05 with a 95% confidence interval (CI) for results using IBM-SPSS version 25. From the study, the prevalence of CS was 40.6% and the average age for SVD and CS were 28.3±5.94years and CS 29.6±5.50years respectively. The likelihood of those aged 36 years and above undergoing CS was notably higher (AOR; 2.84, 95%CI 1.41-5.3, p-value <0.0001) compared to those aged 26-30 (AOR; 2.45, 95%CI 1.49-4.00, p-value: 0.004) years and 31-35 (AOR; 1.65, 95% CI 0.94-2.90, p-value: 0.080) years. The results further indicated that the risk of undergoing CS was greater among mothers with parity of 1-2 (AOR: 1.56, 95%CI 1.02-2.41, p-value: 0.040). The prevalence of CS in the study is greater than the recommended prevalence per 100 births by the World Health Organization. The sociodemographic and clinical history of a pregnant woman influenced the mode of delivery such that the increase in gestational age and parity decreased the risk of CS. Whiles the educational status and age of the mothers at the time of birth increased the risk of CS delivery. Keywords: Caesarean section, Prevalence, Maternal, Indications.

Maternal mortality and morbidity amongst antenatal patients with and without COVID-19 infection

Background: The aim of our study is to compare the maternal mortality between those who are infected with COVID-19 infection and those who are not. Our study was done at Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, which included 2 groups: group 1- pregnant women with COVID-19 infection, and group 2- pregnant women without COVID-19 infection. Methods: Our study is prospective and comparative study, done over 250 antenatal patients admitted at our centre, with COVID-19 infection status confirmed either by rapid antigen testing, or by reverse transcription polymerase chain reaction (RT-PCR)/TruNaat testing who had signs and symptoms of COVID-19 infection along with those who needed obstetric intervention or had a high-risk pregnancy status. Results: Preterm labor accounted for the maternal complication with a majority in COVID-19 infected maternal group. Maternal mortality did not increase amongst patients affected with COVID-19 infection within our study duration. Conclusions: Maternal mortality thus did not seem to be affected much by the COVID-19 pandemic probably due to the low infectivity and fatality of third wave was low.

Prevalence of gestational diabetes mellitus, maternal obesity and associated perinatal outcomes over 10 years in an Australian tertiary maternity provider

BackgroundThe International Association of Diabetes in Pregnancy Study Groups (IADPSG) gestational diabetes mellitus (GDM) criteria have been heavily scrutinised with concerns that the consequent GDM prevalence increase has not been associated with improved perinatal outcomes. AimsAt a tertiary hospital in Melbourne, Australia we aimed to evaluate prevalence trends for GDM, type 2 diabetes (T2DM), maternal obesity and large-for-gestational age (LGA) and assess changes in perinatal outcomes following IADPSG criteria uptake in 2015. MethodsA retrospective cohort study of singleton births from 20 weeks’ gestation was conducted between 1st January 2011 and 31st December 2020. Maternal characteristics and perinatal outcomes were extracted from medical records. Results52,795 pregnancies were included. GDM prevalence increased 2.7 times from 8.9% in 2011 to 23.7% in 2020 and increased annually by 8.59% (95%CI 7.77, 9.42). The rate of T2DM increased annually by 11.69% (95%CI 7.72, 16.67). Obesity prevalence increased annually by 3.18% (95%CI 2.58, 3.78). Induction of labour (IOL) prevalence increased annually by 8.35% (95%CI 5.69, 11.06). LGA prevalence remained unchanged. Increasing maternal obesity was the major contributing factor for LGA prevalence. ConclusionsFrom 2011 to 2020 GDM, obesity and T2DM prevalence increased significantly, with associated increased IOL, without change in LGA rates. Prospective studies are required to explore interactions between GDM, obesity, LGA and obstetric interventions.

The proposal of the novel fetal shoulder dystocia graduation: a clinical-based opinion.

Shoulder dystocia is a peracute mechanical dystocia and a prepartum, usually unpredictable, life-threatening entity with significant forensic implications due to significantly poor perinatal outcome, especially permanent disability or perinatal death. To better objectify the graduation and to include other important clinical parameters, we believe it is appropriate to present a proposal for a complete perinatal weighted graduation of shoulder dystocia, based on several years of numerous other and our own clinical and forensic studies and thematic biobibliography. Obstetric maneuvers, neonatal outcome, and maternal outcome are three components, which are evaluated according to the severity of 0-4 proposed components. Thus, the gradation is ultimately in four degrees according to the total score: I. degreee, score 0-3: slightly shoulder dystocia with simple obstetric interventions, but without birth injuries; II. degree, score 4-7: mild shoulder dystocia resolved by external, secondary interventions and minor injuries; III. degree, score 8-10: severe shoulder dystocia with severe peripartum injuries; IV. degree, score 11-12: extremely difficult, severe shoulder dystocia with ultima ratio interventions applied and resulting extremely severe injuries with chronic disability, including perinatal death. As a clinically evaluated graduation, it certainly has an applicable long-term anamnestic and prognostic component for subsequent pregnancies and access to subsequent births, as it includes all relevant components of clinical forensic objectification.

The prevalence and associated factors of success of labor induction in Hargeisa maternity hospitals, Hargeisa Somaliland 2022: a hospital-based cross-sectional study

BackgroundThe induction of labor is an artificial initiation of labor and has become one of the most common interventions in modern obstetrics to improve maternal and neonatal health. Understanding the prevalence and pregnancy outcomes following labor inductions is crucial in regions with high rates of maternal mortality and morbidity because of insufficient access to comprehensive emergency obstetric care. Therefore, this study aimed to assess the prevalence and associated factors of the success of induction of labor in Hargeisa maternity hospital Somaliland.MethodsA hospital-based cross-sectional study was employed among 453 women in Hargeisa maternity hospitals, Somaliland from January 1st to March 30th, 2022. Data were entered using Epi data version 4.6 and analyzed by using SPSS version 25. Bivariable and multivariable logistic regression were used to identify the associated factors with the success of labor induction and an odds ratio with a 95% confidence interval was used to measure the strength of the association. A P-value of ≤ 0.05 was considered statistically significant in multivariate analysis.ResultsOf a total of 453 study participants who had undergone induction of labor, 349 (77%) of them had successful induction of labor with a 95% CI: 73%, 81%. Favorable Bishop score (AOR = 3.45, 95% CI: 1.98, 5.99), time from the start of induction to delivery < 12 h (AOR = 4.01, 95% CI: 2.16, 7.450), non-reassuring fetal heart rate pattern (AOR = 0.42, 95% CI: 0.22, 0.78) and amniotic fluid change to meconium (AOR = 0.43, 95% CI: 0.23, 0.79) were significantly associated with the success of labor induction.ConclusionThis study implies that three out of four women who underwent induction had successful induction of labor. Favorable bishop score, time from the start of induction to delivery < 12 h, non-reassuring fetal heart rate pattern, and amniotic fluid change to meconium were significantly associated with the success of labor induction. The hospital should establish a clear bishop scoring system and there should be a strict follow-up on the condition of the fetal heartbeat and take corrective actions as needed. The factors related to healthcare facilities and providers need to be addressed by additional prospective studies.

Birth in the Midwife-Led Delivery Room of a Perinatal Center - Learning Curve, Outcomes and Benchmark

Most births in Germany take place in a clinical setting. Midwife-led units have been offered in Germany since 2003 as an addition to the primarily physician-led obstetric care. The purpose of this study was to analyze differences regarding medical parameters between a midwife-led and a primarily physician-led unit in a level 1 perinatal center. Between 12/2020 and 12/2021, all births begun in the midwife-led unit were retrospectively analyzed and compared to a physician-led control cohort. Outcome measures were defined as obstetric interventions, delivery mode and duration, delivery position, and maternal and neonatal outcome. The percentage of deliveries started in the midwife-led unit out of the total birth rate was 4.8% (n=132). Most transfers were made for more effective analgesia (52.6%). Among medically indicated transfers (n=30, 39.5%), transfers due to CTG abnormalities and failure to progress in labor after rupture of membranes predominated. 43.9% (n=58) of patients gave birth successfully in the midwife-led unit. The rate of episiotomy was significantly higher in the primarily physician-led unit compared to the successful midwife-led unit (p=0.019). Birth in a midwife-led unit within a perinatal center can be considered an equivalent alternative to primarily physician-led birth for low-risk pregnant women.

The Maternal Serum Alpha-Fetoprotein for Congenital Anomalies Screening

Screening examination for maternal, especially serum, is a non-invasive examination of the fetus’s condition. During pregnancy, screening examinations are performed in women recommended for ultrasonography (USG), amniocentesis, or other obstetric interventions. There are three markers for maternal serum screening: alpha-fetoprotein, human chorionic gonadotropin (hCG), and unconjugated estriol. Maternal serum alpha-fetoprotein is useful for screening aneuploidies and neural tube defects. This examination, besides seeing congenital abnormalities, can be used for the risk of pregnancy complications such as placental insufficiency, intrauterine growth restriction, preeclampsia, and intrauterine fetal death. Laboratory methods for examining maternal serum alpha-fetoprotein are radioimmunoassay and microparticle capture enzyme immunoassay.&#x0D; Keywords: Screening, Pregnancy, Alpha-Fetoprotein, Laboratory

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.

Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004-2007 and 2012-2016.

Perinatal management of extremely preterm births in Sweden has changed toward active care from 22-23 gestational weeks during the last decades. However, considerable regional differences exist. This study evaluates how one of the largest perinatal university centers has adapted to a more active care between 2004-2007 and 2012-2016 and if this has influenced infant survival. In this historical cohort study, women admitted with at least one live fetus and delivered at 22-25 gestational weeks (stillbirths included) at Karolinska University Hospital Solna during April 1, 2004-March 31, 2007, and January 1, 2012-December 31, 2016, were compared regarding rates of obstetric and neonatal interventions, and infant mortality and morbidity. Maternal, pregnancy and infant data from 2004-2007 were obtained from the Extreme Preterm Infants in Sweden Study while data from 2012-2016 were extracted from medical journals and quality registers. The same definitions of interventions and diagnoses were used for both study periods. A total of 106 women with 118 infants during 2004-2007 and 213 women with 240 infants during 2012-2016 were included. Increases between the study periods were seen regarding cesarean delivery (overall rate 14% [17/118] during 2004-2007 vs. 45% [109/240] during 2012-2016), attendance of a neonatologist at birth (62% [73/118] vs. 85% [205/240]) and surfactant treatment at birth in liveborn infants (60% [45/75] vs. 74% [157/211]). Antepartum stillbirth rate decreased (13% [15/118] vs. 5% [12/240]) and the proportion of live births increased (80% [94/118] vs. 88% [211/240]) while 1-year survival (64% [60/94] vs. 67% [142/211]) and 1-year survival without major neonatal morbidity (21% [20/94] vs. 21% [44/211]) among liveborn infants did not change between the study periods. At 22 gestational weeks, interventions rates were still low during 2012-2016, most obvious regarding antenatal steroid treatment (23%), attendance of a neonatologist (51%), and intubation at birth (24%). Both obstetric and neonatal interventions at births below 26 gestational weeks increased between 2004-2007 and 2012-2016 in this single center study; however, at 22 gestational weeks they were still at a low level during 2012-2016. Despite more infants being born alive, 1-year survival did not increase between the study periods.

A scoping review of maternal health among resettled refugee women in the United States.

Globally, refugee women continue to face higher maternity-related risks from preventable complications during pregnancy and childbirth, partly due to high health care costs, unfamiliarity with the healthcare system, language barriers, and discrimination. Nevertheless, there is still a paucity of literature that evaluates the available evidence in the US. This scoping review delineated the body of literature on maternal health among refugee women resettled in the US in order to identify knowledge gaps in the literature and highlight future research priorities and directions for maternal health promotion. Electronic databases were searched in PubMed, CINAHL, PsycINFO, and EMBASE from inception through July 2021. We included all peer-reviewed study designs; qualitative, quantitative, and mixed method if they reported on refugee women's perinatal health experiences and outcomes in the US. A total of 2,288 records were identified, with 29 articles meeting the inclusion criteria. Refugee women tend to initiate prenatal care late and have fewer prenatal care visits compared to women born in the US. Some of them were reluctant to get obstetric interventions such as labor induction and cesarean delivery. Despite numerous risk factors, refugee women had generally better maternal health outcomes. Studies have also highlighted the importance of health care providers' cultural competency and sensitivity, as well as the potential role of community health workers as a bridge between refugee women and health care providers. The scoping review emphasizes the need for early prenatal care initiation and more frequent prenatal care visits among refugee women. Furthermore, more needs to be done to mitigate resistance to obstetric interventions and mistrust. The mechanism by which healthy migrant effects occur could be better understood, allowing protective factors to be maintained throughout the resettlement and acculturation process. The scoping review identifies critical gaps in the literature, such as the underrepresentation of different ethnic groups of refugee women in refugee maternal studies in the US. Since this invisibility may indicate unspoken and unaddressed needs, more attention should be paid to underrepresented and understudied groups of refugee women in order to achieve health equity for all.