Obstetric Risk Factors Research Articles

Psychological profiles of risk for antenatal depression and anxiety in Iranian sociocultural context.

BACKGROUND AND AIM:Mental health issues including depression and anxiety are common in pregnancy worldwide. This study aimed to identify factors associated with mental disorders in a sample of Iranian pregnant women.MATERIALS AND METHODS:A cross-sectional study was conducted among pregnant women referred to a prenatal-care clinic in an urban area, Isfahan, Iran. The questionnaires in this study included the General Health Questionnaire and additional structured questionnaires exploring sociodemographic, obstetric, and economic risk factors and empowerment for decision-making regarding pregnancy, parenting, financial authority, trust, and confidence in health-care staff. Regression analysis was performed to assess the impact of the number of variables on the likelihood of the presence of mental health problems.RESULTS:Overall, 54.2% and 11.7% of the women had anxiety and depression, respectively. No statistically significant associations were reported between anxiety and depression and obstetric characteristics such as gestational age, parity, abortion, previous infertility, unwanted pregnancy, and the screening test results. According to the logistic regression analysis, the predictors of depression and anxiety were acknowledging psychological changes in pregnancy and empowerment for decision-making regarding pregnancy and parenting and financial authority (P < 0.05).CONCLUSIONS:probably, women's empowerment on becoming aware of psychological changes during pregnancy and making decisions on pregnancy, parenting, and financial authority is the factor affecting the mental health of pregnant women.

A study on transfusion practice in obstetric hemorrhage in a tertiary care centre

Context: Blood Transfusion is identified as one of the essential components of comprehensive emergency obstetric care which has drastically reduced the maternal mortality. Aims: This study retrospectively reviewed blood transfusion pattern in patients with obstetric hemorrhage in our tertiary care center Government Medical College, Trivandrum (Sree Avittam Thirunal is a part of Government Medical College, Trivandrum) and analyzed the obstetric indications and risk factors for transfusion. We also analyzed the ratio of components transfused. Materials and Methods: Transfusion request forms of 310 patients admitted to the Department of Gynaecology and Obstetrics in Sree Avittom Thirunal Hospital from January 2013 to May 2013 were retrospectively reviewed for the types and volume of blood component transfused indication for each blood component transfusion noted. Patients who had massive obstetric hemorrhage (MOH) were further analyzed to estimate the ratio of components transfused. Statistical Analysis: Chi-square test (for categorical variables) was done to assess frequency distribution. Logistic regression analysis was done to identify major risk factors. The analysis was done using SPSS version 16. P

Risk Factors of Hyperemesis Gravidarum: Review Article

Hyperemesis gravidarum (HG) is the most severe form of nausea and vomiting during pregnancy (NVP). It is diagnosed clinically by its typical clinical picture and exclusion of other causes of nausea and vomiting in the pregnant woman. Nausea and vomiting are a common experience affecting 50% to 90% of all women. It is the most common indication for hospitalization during the first half of pregnancy. HG occurs in only about 0.5 to 2% of cases but when it occurs, it may be associated with morbidity of both mother and fetus. There are many risk factors related to HG, but we are still in need of adequate clinical research methodology and design for reporting these associations. In this article, we will discuss them and review epidemiological studies and statistics that support them. HG is found to be common in young aged mothers. There is a debate between studies regarding ethnicity as a risk factor. Low socio-economic level is found to be associated with HG. Dietary factors are considered in Indians who are mostly vegan and Asians who are mostly lactose intolerant. Deficiencies of trace elements are associated with more progression of the disease. Women affected by NVP are mostly nonsmoker. Molar pregnancy, multiple pregnancies, fetus with Down syndrome and primi-gravidity are common obstetric risk factors. Studies theorize relation between hyperthyroidism and HG based on structural similarity between hCG and TSH but more studies are needed to highlight this relation. Mood and anxiety disorders are associated with the disease but causal relation has not been established yet. GERD, peptic ulcer disease and specifically H. pylori infection are among common risk factors. Asthma is associated with prolonged duration of hospitalization. Strong positive family history of HG in patients highlights genetic predisposition of this disease.

What are the risk factors associated with hospital birth among women planning to give birth in a birth center in Washington State?

Few studies have evaluated risk factors associated with hospital birth among women planning to give birth in a birth center in the United States. This study describes the obstetrical risk factors for hospital birth among women intending to deliver in a birth center in Washington State. We performed a retrospective cohort study of Washington State birth certificate data for women with singleton, term pregnancies planning to give birth at a birth center from 2004 to 2011. We assessed risk factors for hospital birth including demographic, obstetrical, and medical characteristics. We used multivariable logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between risk factors and hospital birth. Among the 7118 women planning to give birth at a birth center during the study period, 7% (N=501) had a hospital birth, and 93% delivered at a birth center (N=6617). The strongest risk factors for hospital transfer included nulliparity (OR 7.2 [95% CI 5.3-9.8]), maternal age >40years (OR 3.7 [95% CI 2.1-6.7]), inadequate prenatal care (OR 3.7 [95% CI 2.7-5.0]), body mass index ≥30 (OR 2.1 [95% CI 1.6-3.0]), government health insurance (OR 9.3 [95% CI 5.0-17.1]), and hypertension (10.1 [95% CI 5.7-18.1]). Among nulliparous women, all of these demographic and obstetrical factors remained strongly associated with hospital birth. This information may be useful for counseling women who plan a birth center birth about the risk of hospital birth.

Effect of Maternal and Pregnancy Risk Factors on Early Neonatal Death in Planned Home Births Delivering at Home

ObjectiveThe prevalence of home birth in the United States is increasing, although its safety is undetermined. The objective of this study was to investigate the effects of obstetrical risk factors on early neonatal death in planned home births delivering at home. MethodsThe authors conducted a retrospective 3-year cohort study consisting of planned home births that delivered at home in the United States between 2011 and 2013. The study excluded infants with congenital and chromosomal anomalies and infants born at ≤34 weeks' gestation. Multivariate logistic regression models were used to estimate the adjusted effects of individual obstetrical variables on early neonatal deaths within 7 days of delivery. ResultsDuring the study period, there were 71 704 planned and delivered home births. The overall early neonatal death rate was 1.5 deaths per 1000 planned home births. The risks of early neonatal death were significantly higher in nulliparous births (OR 2.71; 95% CI 1.71–4.31), women with a previous CS (OR 2.62, 95% CI 1.25–5.52), non-vertex presentations (OR 4.27; 95% CI 1.33–13.75), plural births (OR 9.79; 95% CI 4.25–22.57), preterm births (OR 4.68; 95% CI 2.30–9.51), and births at ≥41 weeks of gestation (OR 1.76; 95% CI 1.09–2.84). ConclusionEarly neonatal deaths occur more commonly in certain obstetrical contexts. Patient selection may reduce adverse neonatal outcomes among planned home births.

Evaluation of hospitalization costs and associated factors among maternity stays involving low-risk and moderate- to high-risk childbirths in the United States

ABSTRACTObjectives: This study aimed to assess the costs of childbirth and to identify factors associated with such hospital costs for low- and moderate/high-risk childbirth groups.Methods: All hospitalizations for childbirth between 2010–2014 in the Premier Perspective Hospital Database were identified. Risk category for each birth was defined by the age of the subject and/or presence of specific maternal comorbidities and obstetric risk factors. Hospital childbirth costs were determined and stratified by risk groups. Factors associated with costs for each risk group were evaluated by multiple regression.Results: Among 2,367,195 hospitalizations for childbirth, vaginal birth was the most common delivery method (n = 1,596,757; 68%). Among women characterized as moderate/high-risk, 42% (n = 642,495) had C-sections, while 11% (n = 90,211) of women categorized as low-risk had C-sections. The proportion of women with serious maternal morbidity among moderate/high-risk vs. low-risk women was 2% (n = 29,496) vs. 0.3% (n = 2749), respectively. The mean costs for moderate/high-risk vs. low-risk hospitalizations were $6145 (median = $5760) and $5397 (median = $5001), respectively (p < 0.0001). Factors significantly associated with costs for moderate/high-risk hospitalizations included delivery type (C-section vs. vaginal birth), LOS, urban/rural hospital status, geographic regions, calendar year of hospitalization, teaching status, payer types and serious maternal morbidity. Similar factors were found to impact costs among low-risk hospitalizations.Conclusions: Characteristics such as delivery type, LOS, geographical region, teaching status, serious maternal morbidity and hospital urban/rural status were shown to impact hospital costs of childbirth. Screening and prevention strategies of factors that negatively impact costs may aid in reducing the hospitalization costs associated with childbirths.

Obstetric risk factors for depression during the postpartum period in South Korea: a nationwide study

ObjectivePostpartum depression is related to many adverse effects in both mothers and their children; therefore, proper screening and early interventions are needed. This study aims to identify the risk factors of postpartum depression. Our primary focus is on obstetric risk factors. MethodsThis study is a cross-sectional study which we extracted the data of women who gave birth between January 1st, 2010 and December 31st, 2012 from the Health Insurance Review and Assessment service (HIRA) database. We analyzed the data using multivariable logistic regression models. ResultsA total of 17,483 (1.4%) women suffered from depression during the postpartum period. Younger (<20years) and advanced maternal age (≥35years), primiparity, previous depression, peripartum hysterectomy, uterine artery embolization, preterm delivery, placental abruption, cesarean delivery, induced labor, and preeclampsia were found to increase the likelihood of having depression after delivery. ConclusionsOur findings suggest that there are several risk factors that lead women to postpartum depression. Therefore, early detection and well-management of the symptoms and risk factors for postpartum depression along with social support can help both physical and psychological conditions of women after childbirth.

Factors associated with the increased risk of cesarean delivery in ART pregnancies

To determine the extent to which medical and obstetric risk factors in pregnancies among ART-treated and Subfertile women not treated with ART, contribute to the greater use of Cesarean delivery in these women compared with Fertile women. Retrospective cohort study using Massachusetts ART data linked to vital records. Primigravid vaginal and Cesarean deliveries from 2004-10 with a minimum of adequate prenatal care resulting in singleton live birth or fetal death at >20 weeks were classified as ART-treated (linked to ART data from SART CORS); Subfertile (not ART-treated but with indicators of subfertility); or Fertile (neither ART-treated nor subfertile). Demographic, medical history, and delivery characteristics were determined from birth certificates and hospital discharge data. Logistic regression models quantified adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) comparing ART and Subfertile to Fertile and ART to Subfertile deliveries using two models: Model A adjusted for maternal age, race, insurance, education, marital status, diabetes, chronic hypertension; Model B adjusted for these same factors and, previous uterine surgery, gestational diabetes, pregnancy hypertension, bleeding, and placenta complications. There were 173,130 deliveries: 5,768 ART, 2,657 Subfertile, 164,705 Fertile: 117,743 vaginal and 55,387 Cesarean. Odds of Cesarean vs. vaginal delivery differed between groups by demographics, prior uterine surgery, gestational diabetes, pregnancy hypertension, uterine bleeding, and placental complications (all p-values<0.0001). Prior uterine surgery was 5.6% in ART treated and 5.3% in Subfertile women with Cesarean and <1% in Fertile women with Cesarean and also vaginal deliveries in all three groups; Placenta previa was present in 6.4% of ART treated, 2.6% of Subfertile, 1.1% of Fertile Cesarean deliveries, and <1% of vaginal deliveries. Cesarean rates and models are shown in the Table.Tabled 1Cesarean RateCrudeAdjusted Model AAdjusted Model BFertility GroupOR95% CIAOR95% CIAOR95%CIFertile31.3%refrefrefSubfertile43.3%1.681.55-1.811.201.10-1.291.141.05-1.23ART45.7%1.841.75-1.941.221.15-1.291.151.08-1.21Subfertile43.3%refrefrefART45.7%1.101.00-1.211.030.93-1.131.010.92-1.11 Open table in a new tab Adjustment for the underlying medical and obstetric risks present in ART treated and Subfertile women accounted for a large portion of the greater odds of Cesarean delivery compared to Fertile women. This stands in contrast to the assumption that Cesarean delivery is over utilized in assisted conceptions.

Delivery parameters, neonatal parameters and incidence of urinary incontinence six months postpartum: a cohort study.

Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between the incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors. This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. This substudy was based on 7561 primiparous women who were continent before and during pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and six months postpartum. Data were linked to the Medical Birth Registry of Norway. Single and combined delivery- and neonatal parameters were analyzed by logistic regression analyses. Birthweight was associated with significantly higher risk of urinary incontinence six months postpartum [3541-4180 g: odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.6; >4180 g: OR 1.6, 95% CI 1.2-2.0]. Fetal presentation, obstetric anal sphincter injuries, episiotomy and epidural analgesia were not significantly associated with increased risk of urinary incontinence. The following combinations of risk factors among women delivering by spontaneous vaginal delivery increased the risk of urinary incontinence six months postpartum; birthweight ≥3540 g and ≥36 cm head circumference; birthweight ≥3540 g and forceps, birthweight ≥3540 g and episiotomy; and ≥36 cm head circumference and episiotomy. Some combinations of delivery parameters and neonatal parameters seem to act together and may increase the risk of incidence of urinary incontinence six months postpartum in a synergetic way.

Assessment of risk factors and predictors for spontaneous pre-term birth in a South Indian antenatal cohort

ObjectiveTo assess incidence of spontaneous preterm births and determine biochemical and obstetric risk factors for spontaneous pre-term births in a cohort of antenatal women visiting a secondary care hospital. MethodsA prospective cohort study was designed to include 1420 pregnant women coming for antenatal care at a secondary care hospital. The cohort was followed throughout pregnancy and relevant history, obstetric and ultrasonographic examination and biochemical investigations was carried out in 2nd (20-24 weeks period of gestation) and 3rd trimester (28-32 weeks period of gestation). Outcome of delivery was noted for all the subjects. ResultsA total of 1133 women were recruited. Among the 1071 respondents, 11 had abortions, 93.1% delivered at term while 5.9% had preterm deliveries. Preterm deliveries were noted among 6.5% women with short stature, 13.3% with cervical length <2.5cms and 5.2% among women with anaemia. Statistically significant association was noted between Oligohydramnios, IUGR and preterm births. Salivary estriol was lower in women who had preterm births as compared to term births. ConclusionsThe incidence of preterm births (5.9%) was low in the present cohort. Oligohydramnios and Intrauterine Growth Retardation (IUGR) were identified as significant risk factors for preterm births. Conventional risk factors like short cervix, short stature and biochemical inflammatory markers were not identified as predictors of prematurity. Lower levels of salivary estriol identified among women at risk of preterm births demonstrates the utility of the test as a non-invasive investigation for early identification of preterm births.

Obstetric risk factors for poor neonatal adaptation at birth

Purpose: To identify obstetric risk factors of delivering a neonate with poor neonatal adaptation at birth. Material and methods: Nested case–control study. Poor neonatal adaptation was defined for presence of at least: umbilical cord artery pH <7.10, base deficit ≥12 mmol/L, Apgar score at 1′ ≤5. Controls were selected from the same population and matched with cases. The association between clinical parameters and poor neonatal adaptation was analyzed by logistic regression. Results: One hundred and thirty three women (2.1% of all live births) with a neonate presenting a poor neonatal adaptation were matched with 133 subsequent controls. Significant contributions for the prediction of poor neonatal adaptation were provided by maternal age ≥35 years (p ≤ .001, odds ratio (OR) 3.9 [95%CI: 2.3–6.8]), nulliparity (p ≤ .001, OR 3.3 [95%CI: 1.8–6]), complications during pregnancy (p = .032, OR 2.2 [95%CI: 1.1–4.4]), gestational age at delivery <37 weeks (p = .008, OR 5.2 [95%CI: 1.5–17.8]) and cardiotocography category II or III (p ≤ .001, OR 36.3 [95%CI: 16.5–80.1]). The receiver operative characteristic curve was 0.91 [95%CI: 0.87–0.95], and detection rates 82.7% and 89.5% at 10% and 20% of false positive rates, respectively. Conclusions: Several obstetric risk factors before and during labor can identify a subgroup of newborns at higher risk of a poor neonatal adaptation at birth.

Frequency and Risk Profiles Associated with Antenatal Anxiety and Depression in Middle Socioeconomic Women

Objective: To determine the frequency of antenatal anxiety and depression and its risk profile including demographic, psychosocial and obstetric risk factors, in middle socioeconomic women.&#x0D; Methods: A cross-sectional study was carried out at two private hospital centres of Karachi, over a pe- riod of five months from October 2016 to March 2017. A questionnaire (age, education, parity, socio- economic status, employment) and the Hospital Anxiety and Depression Scale (HADS) were the tools used to gather required information from pregnant women. Data collected was entered in SPSS 16 software. Descriptive statistics were used to calculate frequency and mean values. Logistic regres- sion both binary and multinomial was performed to identify significant predictors of anxiety and de- pression.&#x0D; Results: Our study showed that out of 520 pregnant women, 130 (25%) women had anxiety, whereas&#x0D; 220 (42.3%) had depression. The mean age of women was 26.9 ± 4.198 years. The range being from 18 years to 35 years. Significant risk factors among anxiety group were: working woman; 30.8% (p-value=0.000, OR=0.286), domestic violence; 84.6% (p-value=0.000, OR=2.8), difficult relationship with in-laws; 84.6% (p-value=0.000, OR=12.375), sleep disturbance; 76.9% (p-value=0.000, OR=9.667), primigravida; 23% (p-value=0.000, OR=2.576) and unplanned pregnancy; 23.1% (p- value=0.029, OR=0.511).&#x0D; Significant risk factors among women with depression were: working woman; 31.8% (p- value=0.000,OR=0.286), domestic violence; 68.2% (p-value=0.000, OR=3.571), difficult relationship with in-laws; 22.7% (p-value=0.000, OR=4.8), sleep disturbance; 54.5% (p-value=0.008, OR=2.0), primigravida; 45.5% (p-value=0.000, OR=17.246) and unplanned pregnancy; 18.2% (p-value=0.000, OR=3.0). Other factors that were found to be significant in the depression group only were: unsatis- factory relationship with husband; 22.7% (p-value=0.000, OR=4.118), stressful life event in previous year; 45.5% (p-value=0.000, OR=2.167), and tertiary education; 68.2% (p-value=0.002, OR=0.916).&#x0D; Conclusion: Psychosocial and demographic factors such as working woman, domestic violence, and difficult relationship with in-laws and sleep disturbance had a significant association with antenatal anxiety and depression. Obstetric risk factors were primigravida and unplanned pregnancy. Significant association with depression was unsatisfactory relationship with husband, stressful life event in a previous year and tertiary education.

Do obstetric risk factors truly influence the etiopathogenesis of congenital muscular torticollis?

BackgroundCongenital muscular torticollis (CMT) is seen in childhood and presents within months after birth. The etiology remains unknown; however, medical textbooks suggest trauma at birth as a main reason. The aim of this study was to systematically describe obstetric and perinatal outcomes in a population of children with a confirmed congenital muscular torticollis diagnosis.Materials and methodsChildren with a validated diagnosis of congenital muscular torticollis born at Aarhus University Hospital from 2000 to 2014 were included in the study. Information on perinatal, intrapartum and neonatal characteristics were obtained from databases and from medical records, and systematically described.ResultsIn this study, there were no differences in birth characteristics in children with left- and right-sided torticollis, between boys and girls or between the conservatively treated and the children who needed surgery. Most of the children with congenital muscular torticollis in this study were delivered at term without signs of birth complications or trauma. None experienced moderate or severe asphyxia.ConclusionsThe results of the present study suggests that complicated birth or birth trauma may not be the main cause of congenital muscular torticollis and point towards intrauterine and prenatal reasons for its development.Level of evidence according to OCEBM levels of evidence working group3

The “Fetal Reserve Index”: Re-Engineering the Interpretation and Responses to Fetal Heart Rate Patterns

Objective: Electronic fetal monitoring (EFM) correlates poorly with neonatal outcome. We present a new metric: the “Fetal Reserve Index” (FRI), formally incorporating EFM with maternal, obstetrical, fetal risk factors, and excessive uterine activity for assessment of risk for cerebral palsy (CP). Methods: We performed a retrospective, case-control series of 50 term CP cases with apparent intrapartum neurological injury and 200 controls. All were deemed neurologically normal on admission. We compared the FRI against ACOG Category (I-III) system and long-term outcome parameters against ACOG monograph (NEACP) requirements for labor-induced fetal neurological injury. Results: Abnormal FRI's identified 100% of CP cases and did so hours before injury. ACOG Category III identified only 44% and much later. Retrospective ACOG monograph criteria were found in at most 30% of intrapartum-acquired CP patients; only 27% had umbilical or neonatal pH <7.0. Conclusions: In this initial, retrospective trial, an abnormal FRI identified all cases of labor-related neurological injury more reliably and earlier than Category III, which may allow fetal therapy by intrauterine resuscitation. The combination of traditional EFM with maternal, obstetrical, and fetal risk factors creating the FRI performed much better as a screening test than EFM alone. Our quantified screening system needs further evaluation in prospective trials.

Ante- and intrapartum risk factors for neonatal hypoxic ischemic encephalopathy

Purpose: To identify obstetrical risk factors for the diagnosis of neonatal hypoxic ischemic encephalopathy (HIE). A secondary aim was to determine the incidence of HIE. Materials and methods: A retrospective cohort study including 36,086 women with singleton term pregnancies giving live births in Sweden between 2009 and 2013. Cases of HIE were identified from three different sources. Risk factors for HIE were evaluated using univariate and multivariate analyses. Cases of HIE were extracted from available Swedish Medical Health registers to determine incidence. Results: A diagnosis of HIE was associated with: acute obstetrical events, mode of delivery other than unassisted vaginal birth, abnormal CTG admission test, and nulliparity. The incidence of HIE was 1.7/1000 infants born. Conclusions: Acute obstetrical events will always occur, and some of the risk factors for these events are not responsive to interventions, but a careful risk assessment could lower the risk associated with acute obstetrical events. By alertness to early symptoms and timely measures taken by a trained staff at the delivery unit, damage could be reduced.

Importance of Adopting BMI Classifications Using Public Health Action Points to Delineate Obstetric Risk Factors Resulting in Worsening Obstetric Outcomes Among Asian Population.

The aim of this study is to compare obstetric outcomes between overweight and class 1 obesity among pregnant women in their first pregnancy based on WHO's BMI cut-offs and the potential public health action points identified by WHO expert consultations specific for high-risk population such as Asians. This is a retrospective cohort review of data obtained from the Malaysian National Obstetrics and Gynaecology Registry between the year 2010 and year 2012. All women in their first pregnancy with a booking BMI in their first trimester were included in this study. The association between BMI classifications as defined by the WHO cut-offs and the potential public health action points identified by WHO expert consultations towards adverse obstetric outcomes was compared. A total of 88,837 pregnant women were included in this study. We noted that the risk of adverse obstetric outcomes was significantly higher using the public health action points identified by WHO expert consultations even among the overweight group as the risk of stillbirths was (OR 1.2; 95% CI 1.0,1.4), shoulder dystocia (OR 1.9; 95% CI 1.2,2.9), foetal macrosomia (OR 1.8; 95% CI 1.6,2.0), caesarean section (OR 1.9; 95% CI 1.8,2.0) and assisted conception (OR 1.9; 95% CI 1.6,2.1). A specifically lower BMI references based on the potential public health action points for BMI classifications were a more sensitive predictor of adverse obstetric outcomes, and we recommend the use of these references in pregnancy especially among Asian population.

System, Provider, Patient, and Placental Factors Associated With Neonatal Hypoxia in a Single Hospital System [10C

INTRODUCTION: This is a systematic and collaborative review to determine multifactorial correlates of neonatal hypoxic conditions. METHODS: A systematic review was performed on all term neonates diagnosed with hypoxic conditions by a designated review team using a published morbidity form with at least 2 different reviewers extracting data from each case followed by a group discussion for consensus. RESULTS: Of 16,890 term singleton pregnancies from 2013-2014, 54 cases of neonatal hypoxia were identified, including hypoxic-ischemic encephalopathy (10, 18.5%), meconium aspiration syndrome (9, 16.7%), hypoxemia of the newborn (29, 53.7%), perinatal asphyxia (2, 3.7%), and other acidosis of the newborn (4, 7.4%). Obstetrical risk factors were present in 94.4%, including category 2 fetal heart rate patterns (20, 29%), repeat cesarean delivery (8, 11.6%), chorioamnionitis (5, 7.2%), birth defects (5, 7.2%), labor dystocia (4, 5.8%), IUGR (4, 5.8%), and abnormal biophysical profile (4, 5.8%). Placental pathology was present in 35 cases (64.8%) and absent in 9 cases (16.7%), with another 10 cases (18.5%) where the placenta was not submitted to pathology. The most common findings were thrombus (n = 14, 20.9%), inflammation (16, 23.9%), meconium staining (12, 17.9%), and infarcts (8, 11.9%). From a systems-based view, potential contributors to morbidity were problems with diagnosis (9, 16.7%), treatment (13, 24.1%), documentation (7, 13.5%) and team communication (3, 5.6%). Opportunities to improve care were felt to be present in 19 cases (35.2%). CONCLUSION: Neonatal hypoxic conditions are rare and are associated with significant prenatal morbidity. In a minority of cases, opportunities to alter care may be possible.

Use of Intrauterine Pressure Catheters (IUPC) Increases Risk of Post-Cesarean Surgical Site Infection [9B

INTRODUCTION: Surgical site infection (SSI) rates are increasingly being linked to payment incentives for hospitals and represent an important clinical quality indicator of care. Clinical interventions aimed to significantly reduce cost and morbidity can be designed through identification of key predisposing obstetrical risk factors for SSI. Studies conducted in a limited number of subjects suggest an association between IUPC and post-partum endomyometritis. Our objective was to examine the relationship between intra-partum use of IUPC and risk of post-cesarean SSI. METHODS: We performed a secondary analysis using data from Maternal-Fetal Medicine Units Network (MFMU) Cesarean Registry (1999-2002). Patients included in this analysis had a singleton viable pregnancy and a cesarean delivery following labor for recognized obstetrical indication from 24 to 42 weeks gestational age (GA). A multivariable logistic regression model was used to control for GA, race, BMI at delivery, smoking, limited prenatal care, length of labor, length of membrane rupture, PPROM, pre-gestational diabetes, hypertensive diseases, physical health status assessed using American Society of Anesthesiologists established categories, and maternal clinical chorioamnionitis. RESULTS: 25,986 women were included in this analysis. The rate of SSI was 12.9% (1,542 of 11,941) in the patients with IUPC and 7.8% (1,099 of 14,045) in the patients without IUPC (P= &lt; 0.001). The adjusted Odds Ratio for SSI among patients who had IUPC was 1.40, (95% CI=1.26-1.57, P= &lt; 0.001). CONCLUSION: We present compelling data that in laboring women undergoing cesarean delivery, the use of IUPC is an independent risk factor for post-cesarean SSI.

C-Section Prevalence Among Obese Mothers and Neonatal Hypoglycemia: a Cohort Analysis of the Department of Gynecology and Obstetrics of the University of Lübeck.

Data from the World Health Organization (WHO) demonstrates an increasing prevalence of obesity in Western countries. This study investigates the influence of obesity on the mode of delivery and the occurrence of hypoglycemia in newborns. A retrospective analysis of all deliveries at the Department of Gynecology and Obstetrics of the University of Lübeck, Germany was conducted over a period of eleven years with the primary outcome as non-elective C-sections and hypoglycemia of newborns from obese mothers. Patients were divided into six subgroups according to WHO weight classifications as follows: control group body mass index (BMI) 18.5 - 24.9 kg/m 2 , n = 7712; general obesity BMI ≥ 25 kg/m 2 , n = 4227; overweight BMI 25 - 29.9 kg/m 2 , n = 2628; obesity I° BMI 30 - 34.9 kg/m 2 , n = 1017; obesity II° BMI 35 - 39.9 kg/m 2 , n = 370; obesity III° BMI ≥ 40 kg/m 2 , n = 212. Analysis of the primary outcome shows an increased incidence of non-elective C-sections with an elevated BMI (general obesity vs. control group: 20.5 vs. 15.9%, p < 0.001; OR 1.3; 95% CI 1.2 - 1.4) and elevated rates of neonatal hypoglycemia in newborns of obese mothers (general obesity vs. control group: 0.6 vs. 0.3%, p < 0.05; OR 1.8; 95% CI 1.0 - 3.0). Obesity is an essential obstetric risk factor. Obese women face an increased risk of non-elective C-sections, and newborns of obese mothers suffer from elevated rates of hypoglycemia.

Short-term neonatal outcome in routine use of painless delivery: a retrospective study

The painless delivery, recently included among the essential levels of care, is an application of epidural analgesia to the last stage of labor which may greatly improve the quality of childbirth experience. This technique is poorly used in Italy, because of the lack of information in the population, disruption of services and scarcity of economic resources. There are not many retrospective studies quantifying the use of this technique in recent years, nor clinical indicators highlighting any adverse event from the neonatal point of view. We describe the ten-year experience of a birth point belonging to a peripheral hospital, comparing two populations of neonates born in the same center in two different periods, in order to determine whether the routine use of analgesia in labor can influence the short-term neonatal outcome. We examined the basic data regarding all neonates born in the years 2004 and 2014. In 2004 the painless delivery was not yet used in our center, while in 2014 it was used routinely in every spontaneous birth. We examined data obtained retrospectively from the paper files of the delivery room and neonatal ones. The two populations of infants examined were comparable for baseline characteristics, such as full-term pregnancy, absence of obstetric risk factors and similar operative protocols for emergency caesarean section indications. For every baby the type of delivery, the Apgar score, the transfer rate in the neonatal intensive care unit and eventual death were marked. The analyzed data confirm that there are no statistically significant differences in short-term neonatal outcome between the two groups of infants.