Outcomes In Low-risk Pregnancies Research Articles

Local cerebroplacental ratio reference ranges are better predictors for adverse delivery outcomes in normal weight fetuses during pregnancy

Objective To evaluate the predictive value of local versus external cerebroplacental ratio (CPR) reference ranges for delivery outcomes in low-risk pregnancies. Methods A retrospective analysis of all feto-maternal demographic and biometric data in fetuses with normal estimated fetal weight (EFW) and a CPR examination between the years 2014–2019, in a university medical center. The study group included healthy singleton pregnancies from 32-week gestation, with an examination-to-delivery interval of <31 days. The three models compared two thresholds: <5th percentile (CPR 1, CPR 3) and <10th percentile (CPR2). The CPR1 and CPR2 models both use local CPR reference ranges, while the CPR3 model uses an external CPR reference range. The main outcome was predictive accuracy for urgent cesarean delivery (CD), operative delivery (OD), and composite outcome (CO), defined as an Apgar score of <7, fetal blood pH < 7.1 or admission to the neonatal intensive care unit (NICU). Results Overall, 410 low-risk pregnancies with normal weight fetuses were enrolled in the study. All three CPR models turned out to be significant predictors of CD, with an odds ratio (OR) of 9, 95% CI (2.7–27), p < .001 for CPR1, and an OR of 2.9, 95% CI (1.1–7.4), p < .04 for CPR2, and an OR of 3.4, 95% CI (1.7–6.8), p < .001 for CPR3. All the three models were also found to be predictors of OD, and an OR of 6.9, 95% CI (2.1–22) p < .04 for CPR1, and an OR of 2.8, 95% CI (1.2–6.7), p < .04 for CPR2, and an OR of 2.8, 95% CI (1.4–5.3) p < .01 for CPR3. The positive predictive values (PPV) for CD and OD were both 50% for CPR1, versus 28% and 26% in CPR2, and 24% and 25% in CPR3. The negative predictive value (NPV) was similar, around 88% in all three models. None of the models were found to be significant predictors for CO. Conclusions A CPR model based on local reference ranges and <5th percentile cutoffs showed the highest PPV for CD and OD. The calculation of local references for CPR should be encouraged.

Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial

ObjectivesTo investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy...

Effect of gestational thrombocytopenia on negative fetal and maternal outcomes in low-risk pregnancies

Objective: Thrombocytopenia, expressed as platelet counts lower than 150 × 10 9 /L, is a common hematological anomaly seen in 6.6% of the pregnancies. Incidental thrombocytopenia of the pregnancy, commonly referred to as gestational thrombocytopenia, accounts for 70%–80% of cases. This study aimed to elucidate the effect of gestational thrombocytopenia on negative fetal and maternal results in low-risk pregnancies. Method: The patients were divided into two groups. The control group ( n = 240) consisted of healthy pregnant women with normal platelet count, and the study group ( n = 80) consisted of pregnant women with gestational thrombocytopenia. Results: Maternal age, pre-pregnancy body mass indexes, parity, and previous cesarean history rates were similar in both groups. Gestational age during delivery, fetal weight, delivery induction, amniotic fluid stained with meconium, hyperbilirubinemia, admission to neonatal intensive care unit, transient tachypnea of the newborn , respiratory distress syndrome, hypoxic–ischemic encephalopathy, necrotizing enterocolitis, intraventricular hemorrhage, and 5-min Apgar scores of <7 were not different between the groups ( P = 0.056, P = 0.233, P = 0.582, P = 0.798, P = 0.711, P = 0.859, P = 0.634, P = 1, P = 1, P = 1, P = 1,and P = 1, respectively). Spontaneous vaginal delivery, necessity for emergency cesarean delivery, postpartum hemorrhage , abnormal hemorrhage during cesarean , necessity for blood transfusion, and postpartum hysterectomy rates did not differ between the groups ( P = 0.530, P = 0.752, P <0.001, P <0.001, P = 0.758, P = 1, P = 1,and P = 1, respectively) . Despite being within normal limits, discharge time after C/S and spontaneous vaginal delivery was longer in the gestational thrombocytopenia group than in the control group. Conclusions: The results of the study showed that gestational thrombocytopenia did not pose a risk for both the mother and the fetus in low-risk pregnancies.

Impact of continuous electronic fetal monitoring on birth outcomes in low-risk pregnancies.

Continuous electronic fetal monitoring (CEFM) is a standard of hospital care during the intrapartum period. We investigated its use on childbirth outcomes in low-risk pregnancies, and examined whether outcomes differed by gestational age within a term pregnancy. A retrospective secondary data analysis using birth registry data from two diverse northeastern US states from 1992 to 2014. Chi-square test and the Fisher exact tests were used to examine associations between CEFM and childbirth outcomes. Multivariable Poisson regression models were used to estimate risk ratios of childbirth outcomes related to CEFM use, adjusting for potential confounders. Use of CEFM was independently associated with a 10% (State 1) and 40% (State 2) increased risk for primary cesarean delivery and an increased risk for assisted vaginal births (14% and 24%, respectively) after adjustment for confounders. CEFM use was not associated with reduced risk for infant mortality (neonatal mortality, 0-27days, and post-neonatal mortality, 28-364days) in term births (37-41weeks' gestation). After stratifying term pregnancies into early term, full term, and late term, use of CEFM was associated with reduced risk for neonatal mortality in early-term births (37 0/7weeks' to 38 6/7weeks' gestation) in State 2 (RR 0.44 [95% CI 0.21-0.92]), but not in State 1. There was no association between CEFM use and infant mortality (neonatal and post-neonatal) in full-term or late-term births. The study results do not support universal use of CEFM in pregnancies that are low-risk and at term.

Elective Deliveries and Neonatal Outcomes in Full-Term Pregnancies.

Cesarean and induced delivery rates have risen substantially in recent decades and currently account for over one-third and one-fourth of US births, respectively. Initiatives to encourage delaying deliveries until a gestational age of 39 weeks appear to have slowed the increases but have not led to declines. The rates are at historic highs and the consequences of these interventions when not medically necessary have not been systematically explored at the population level. In this study, we used population-level data on births in New Jersey (1997-2011) to document trends in elective deliveries (induced vaginal delivery, cesarean delivery with no labor trial, and cesarean delivery after induction) and estimate logistic and linear regression models of associations between delivery method and neonatal morbidities and cost-related outcomes in low-risk pregnancies. We found that elective deliveries more than doubled during the observation period and were associated with neonatal morbidities and cost-related outcomes even at gestational ages of 39 and 40 weeks. Findings suggest that delaying beyond 39 weeks and avoiding delivery interventions when not medically necessary would improve infant health and reduce health-care costs.

General versus spinal anesthesia during elective cesarean section in term low-risk pregnancy as regards maternal and neonatal outcomes: a prospective, controlled clinical trial

Objective The objective of this study was to compare general and spinal anesthesia as regards its maternal and neonatal outcomes in low-risk pregnancies undergoing elective cesarean section (C-section) at term. Patients and methods In a prospective, controlled clinical trial, 64 low-risk pregnant women underwent elective C-section for the first time for variant indications. The included women were randomly divided into two groups; group I (n=32) received spinal anesthesia and group II (n=32) received general anesthesia. The distinction between preoperative and postoperative maternal hematological indices, intraoperative and postoperative maternal hemodynamic parameters, the maternal requirement for analgesia, return of bowel function, and neonatal outcomes were compared between the two groups. Results The mean time for bowel to be open (9.7±1.3 vs. 6.8±1.6 h, P=0.001), and the first analgesia requirement was significantly (5.33±4 vs. 2.91±2.16 h, P=0.004) longer, and the hemoglobin and hematocrit difference values at 24 h postoperative were significantly (P=0.03, and 0.02, respectively) larger in group II. Urine output at the first postoperative hour was more (P=0.002) in the spinal group. The median Apgar scores at the first minute and at fifth minute were significantly higher (P=0.001, and 0.005, respectively) in the spinal group. Conclusion As long as it is not contraindicated, spinal anesthesia during elective C-section was safer for both neonates (higher Apgar scores), and mother (less bleeding, less postoperative pain) than general anesthesia and can be the ideal anesthesia and method of choice during elective C-section.

Induction of Labour in Low-Risk Pregnancies before 40 Weeks of Gestation: A Systematic Review and Meta-Analysis [11P

INTRODUCTION: Retrospective data suggest that adverse outcomes in low-risk pregnancies are lowest at 39 weeks, and systematic reviews of randomized controlled trials (RCTs) suggests that induction of labour (IOL) after 37 weeks regardless of indication and cervical favourability is associated with lower rates of caesarean deliveries (CD) when compared with expectant management. Our objective was to determine whether IOL &lt;40 weeks reduces CD rates and improves pregnancy outcomes. METHODS: We conducted a systematic review of RCTs comparing IOL to expectant management in low-risk women. We searched four databases until November 2016 using appropriate keywords and MeSH terms. Two authors independently completed title screening, data extraction and risk-of-bias (ROB) assessment using the Cochrane ROB tool. Meta-analysis was performed using RevMan 5.3 and results were reported as odds ratios and 95% confidence intervals (OR, 95%CI). RESULTS: We identified 2523 titles and included 14 eligible articles, most of which had low ROB. Outcomes for IOL (n=1268) vs. expectant management (n=1266) were as follows: CD 1.02 (0.81, 1.28), operative vaginal delivery 1.32 (1.06, 1.66), infective morbidity 1.26 (0.79, 1.99), perinatal mortality 0.72 (0.14, 3.71), postpartum 1.00 (0.73, 1.38), neonatal admissions 0.71 (0.33, 1.51), abnormal cord gases 0.69 (0.26, 1.87) and low 5-minute Apgar scores 0.94 (0.44, 2.03). CONCLUSION: There were no differences in rates of CD or other adverse pregnancy outcomes when IOL &lt;40 weeks is compared with expectant management in low-risk pregnancies. A policy of IOL at 39 weeks to lower CD rates and improve pregnancy outcomes can only be recommended under the confines of RCTs.

A Resource and Cost Analysis on the Impact of Reduced Visits for Prenatal Care [29F

INTRODUCTION: Prenatal care is resource intensive, marked by frequent provider visits. Several studies have demonstrated reduced prenatal visits show no difference of outcomes in low risk pregnancies, yet are subject to decreased patient satisfaction. Our objective was to perform a resource analysis of reduced visits supplemented by the use of digital tools during prenatal care for improved satisfaction. METHODS: As accurate data on resource consumption during prenatal care is lacking, we first gathered these data from interviews of over 100 clinicians representing a variety of practice settings (private practices, academic centers & large systems). We then studied an alternative prenatal schedule with reduced visits supplemented with mobile technology and home monitoring. Finally, we extrapolated the impact of visit reduction from an individual pregnancy to a large system. RESULTS: On average, outpatient prenatal care was $1,164.66. With a modified visit schedule, the cost for a low risk pregnancy is reduced to $665.52, leading to a cost savings of $499.14 per pregnancy. Similarly, an analysis of clinic time per pregnancy showed that effective care was delivered with an average of 6 fewer visits (or 90 minutes clinical time) with the modified schedule. When extrapolated to a typical practice with 1000 deliveries/year, this translated to $499,140 in cost savings and 6000 fewer visits (or 1,500 hours). CONCLUSION: While further studies are required to validate the benefits for using mobile/digital tools, the initial analysis indicates that it could lead to significant cost savings or additional revenue while still delivering high quality care.

Remote Prenatal Care Monitoring With Digital Health Tools Can Reduce Visit Frequency While Improving Satisfaction [3

INTRODUCTION: A high frequency of in-clinic visits is standard for prenatal surveillance. Yet in studies, reduction in prenatal care visits is not correlated with adverse perinatal outcomes for low-risk pregnancies. However, it is associated with decreased patient satisfaction. This study sought to measure the effect of reducing the frequency of prenatal visits while applying mobile/digital health technology for improved patient satisfaction and equivalent outcomes in low-risk pregnancies. METHODS: 100 first-trimester low-risk obstetric patients were enrolled in a controlled study. 50 patients were placed on an alternative prenatal care schedule (8 visits), supplemented with an integrated technology platform of a mobile application and connected devices (wireless weight scale and blood pressure cuff). The remaining 50 patients in the control group received routine frequency of care, without technology. Patients were evaluated for satisfaction, outcomes and engagement throughout pregnancy. RESULTS: The study group attended 8.0±0.0 prenatal care visits, compared to 14.0±0.0, P<.005 in the control group. There was also increased patient satisfaction, and high engagement rates with the technology platform (determined by mean app task completion rates of 86.7±18.1%). On average, we generated fivefold more data points for weight and blood pressure measurements per patient with the digital devices. No adverse clinical outcomes occurred in either group. CONCLUSION/IMPLICATIONS: Despite a 43% reduction of in-clinic visits, prenatal care supplemented with remote monitoring demonstrates enhanced satisfaction and increased engagement with no change in perinatal outcomes. Thus, mobile/digital technology may facilitate a new paradigm of prenatal care delivery that is safe, cost-effective and risk-appropriate.

Maternal uterine artery Doppler in the first and second trimesters as screening method for hypertensive disorders and adverse perinatal outcomes in low-risk pregnancies.

ObjectiveTo assess the maternal demographic characteristics and uterine artery (UA) Doppler parameters at first and second trimesters of pregnancy as predictors for hypertensive disorders (HDs) and adverse perinatal outcomes.MethodsThis prospective cohort study comprised 162 singleton low-risk women undergoing routine antenatal care. The left and right UA were assessed by color and pulsed Doppler and the mean pulsatility and resistance indices as well as the presence of a bilateral protodiastolic notch were recorded at 11 to 14 and 20 to 24 weeks' gestation. Multilevel regression analysis was used to determine the effects of maternal characteristics and abnormal UA Doppler parameters on the incidence of HD, small for gestational age newborn, cesarean section rate, Apgar score <7 at 1st and 5th minute, and admission to the neonatal intensive care unit.ResultsFifteen women (9.2%) developed HD. UA mean resistance index (RI), UA mean pulsatility index, and parity were independent predictors of HD. Compared to the pregnancies with a normal UA mean RI at the first and second trimesters, pregnancies with UA mean RI >95th percentile only at the first trimester showed an increased risk for HD (odds ratio, 23.25; 95% confidence interval, 3.47 to 155.73; P<0.01). Similar result was found for UA mean pulsatility index >95th percentile (odds ratio, 9.84; 95% confidence interval, 1.05 to 92.10; P=0.05). The model including maternal age, maternal and paternal ethnicity, occupation, parity and UA mean RI increased the relative risk for HD (area under receiver operating characteristics, 0.81).ConclusionA first-trimester screening combining maternal characteristics and UA Doppler parameters is useful to predict HD in a low-risk population.

Intrapartum Amniotic Fluid Volume Estimation in Low-risk Pregnancy as a Predictor of Perinatal Outcome

ABSTRACT Objectives The study was undertaken to determine the efficacy of routine estimation of amniotic fluid volume using the amniotic fluid index (AFI) as a means of predicting an adverse perinatal outcome in low-risk pregnancies. Materials and methods Five hundred and three singleton lowrisk pregnancies with cephalic presentation between 37 and 40 weeks and 6 days of gestation with intact or ruptured membranes had AFI estimations within 36 hours of delivery. Results The frequency of nonreassuring fetal heart patterns and perinatal outcomes among patients with oligohydramnios (&lt;5 cm), borderline oligohydramnios (5 to 8 cm) and normal (&gt;8 cm) liquor were compared and not found to be different. Cesarean section for nonreassuring fetal status was also similar in the three groups. Conclusion This study suggests that AFI estimation during labor in low-risk pregnancies does not predict adverse perinatal outcomes. Further studies are needed to verify this impression. How to cite this article Jeanet J, Benjamin SJ, Mathews JE, Rathore S, Sebastian A, Thomas E. Intrapartum Amniotic Fluid Volume Estimation in Low-risk Pregnancy as a Predictor of Perinatal Outcome. J South Asian Feder Obst Gynae 2014;6(3):156-158.

Cell-Free Fetal DNA and Adverse Outcome in Low Risk Pregnancies

Abstract Objective To analyze in a large prospective cohort study of low risk pregnancies whether cell-free fetal (cff) DNA in maternal plasma of the second trimester might be associated with the development of preeclampsia, preterm delivery, and small for gestational age. Study design A subset of a large prospective cohort study in serological RhD negative pregnant women with RHD positive fetuses was used. Cff DNA was determined through the detection of RHD specific sequences with real-time PCR. Results In 611 pregnancies, rates of 7.2% preeclampsia, 1.6% preterm birth ≤32, 2.9% ≤34, and 12.4% ≤37 weeks of gestation, 5.7% of small for gestational age Conclusion Cff DNA in maternal plasma of the second trimester was not found to be a marker for an adverse pregnancy outcome in low risk pregnancies.

Cell-free fetal DNA and adverse outcome in low risk pregnancies

To analyze in a large prospective cohort study of low risk pregnancies whether cell-free fetal (cff) DNA in maternal plasma of the second trimester might be associated with the development of preeclampsia, preterm delivery, and small for gestational age. A subset of a large prospective cohort study in serological RhD negative pregnant women with RHD positive fetuses was used. Cff DNA was determined through the detection of RHD specific sequences with real-time PCR. In 611 pregnancies, rates of 7.2% preeclampsia, 1.6% preterm birth ≤32, 2.9% ≤34, and 12.4% ≤37 weeks of gestation, 5.7% of small for gestational age <5th percentile, and 8.2% <10th percentile were observed. For none of these risk groups an association with cff DNA could be established. Cff DNA in maternal plasma of the second trimester was not found to be a marker for an adverse pregnancy outcome in low risk pregnancies.

O665 Correlation of intrapartum amniotic fluid volume and perinatal outcome in low risk pregnancies

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S283-S283 Free communication (oral) presentations O665 Correlation of intrapartum amniotic fluid volume and perinatal outcome in low risk pregnancies P. Natarajan, P. NatarajanSearch for more papers by this authorP. Grv, P. GrvSearch for more papers by this authorS. Saha, S. SahaSearch for more papers by this author P. Natarajan, P. NatarajanSearch for more papers by this authorP. Grv, P. GrvSearch for more papers by this authorS. Saha, S. SahaSearch for more papers by this author First published: 06 October 2011 https://doi.org/10.1016/S0020-7292(09)61038-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S283-S283 RelatedInformation

The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns

This study was designed to investigate the relationship between the second trimester maternal serum markers and adverse pregnancy outcomes in healthy newborns. A total of 749 women who delivered in our institution with complete follow up and second-trimester triple marker test data available were included in the study. Women with multiple pregnancies, chronic diseases, diabetes mellitus, obesity, smokers and infants with chromosomal and congenital abnormalities were excluded. Maternal serum alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and unconjugated estriol (uE(3)) values were investigated in our cohort who developed preeclampsia (n = 28), gestational diabetes (GM) (n = 69), preterm labor-birth (n = 100), oligohydramnios (n = 37) and macrosomia (n = 59) by using receiver operating characteristic (ROC) curve analysis, with chi-square and Pearson's correlation tests. Women with uE(3) < or = 1.26 MoM (P = 0.001, AUC = 0.666), HCG > 1.04 MoM (P = 0.032, AUC = 0.599) or AFP < or = 0.69 MoM (P = 0.049, AUC = 0.600) values significantly developed oligohydramnios. Also, macrosomic infants were observed in women who had HCG values > 0.86 MoM (P = 0.047, AUC = 0.578). Patients with HCG > 1.04 MoM (P = 0.04, AUC = 0.565) and uE(3) < or =0.88 MoM (P = 0.049, AUC = 0.571) developed GDM. HCG levels > or =2.5 or > or =3 MoM were significantly associated with the development of oligohydramnios [P = 0.005; OR = 4 (95% CI: 1.7-9.7)], [P = 0.008; OR = 4.9 (95% CI: 1.7-13.7)], respectively. When women with adverse (n = 237) and normal (n = 512) outcomes were compared there were significant differences in maternal serum AFP (1.40 +/- 0.84 vs. 1.23 +/- 0.75 MoM, P = 0.006) and uE(3) values (1.38 +/- 1.42 vs. 1.45 +/- 0.98 MoM, P = 0.001). Serum estriol, AFP or HCG values in triple test results may be associated with development of oligohydramnios, gestational diabetes and macrosomia in women with healthy and normal appearing fetuses.

Admission cardiotocography did not improve neonatal outcome in low risk pregnancies

Admission cardiotocography did not improve neonatal outcome in low risk pregnancies

Outcome in low risk pregnancies.

To determine the obstetric and neonatal outcomes of a cohort of very low risk pregnancies in hospital, that would be suitable for home delivery. A retrospective analysis was undertaken of computerised records covering five years from July 1988 to August 1993 of 32424 pregnant women who delivered at the North Staffordshire Maternity Hospital, Stoke on Trent, during that period. Of 32424 deliveries, only 1314 (4%) fulfilled our criteria for being low risk. Sixty seven (5.1%) of the low risk group had an operative delivery, with Caesarean section accounting for 32 (2.4%) cases, 16 (23.9%) babies were resuscitated and three were intubated. A normal vaginal delivery occurred in 1245 women, but a paediatrician attended 122 births (9.22%), assisted ventilation was provided in 65 cases (5.2%), and five babies were intubated (0.4%). Fourteen babies in total were admitted to the neonatal unit and one died. These results suggest that at least 5% of women suitable for delivery at home will require transfer in labour. Midwives attending home births must be skilled in bag and mask resuscitation as only rarely will an urgent intubation be required. The British Paediatric Association Working Party report on neonatal resuscitation suggests a need for resuscitation in only 0.2% of low risk deliveries: but these findings suggest that the need is greater.