Postterm Group Research Articles

POSTTERM PREGNANCY: MATERNAL AND FETAL OUTCOMES

Postterm Pregnancy is one of the commonest obstetric conditions which associated with an increased risk of fetal and neonatal mortality and morbidity as well as an increased maternal morbidity. The aim of the present study is to determine the maternal and fetal outcomes of postterm pregnancy at Al-Sadaqa Teaching Hospital. A prospective case–control study was conducted at Al-Sadaqa Teaching Hospital, Aden from January 1st to December 31th 2020. Cases were considered postterm pregnancy (≥ 42 weeks) while control term pregnancy (37weeks - 41weeksand 6 days). Significant association between gestational age and the studied variables of postterm and term pregnancy were analyzed using appropriate statistical methods. A total of 185 cases of postterm pregnancy and 370 control group of term birth, the frequency of postterm pregnancy was (2.78%), we found statistically significant association between some of socio-demographic factors and postterm pregnancy, cesarean section was higher in postterm group (OR 2.80) with the indications were cephalopelvic disproportion (OR 12.38). Maternal complications were significantly association to postterm birth like prolonged labor (OR 12.99) and postpartum hemorrhage (OR 8.32). Regarding to fetal outcomes, Postterm pregnancy has showed a significant association with neonatal low Apgar score(p=0.000), Oligohydramnios (OR 42.24) asphyxia (OR 2.86), meconium aspiration (OR 9.41) and Perinatal death (p value 0.012). This study concluded that postterm pregnancy is associated with adverse maternal outcomes such as, prolonged labor and postpartum hemorrhage, and associated with adverse fetal outcomes like oligohydramnios, asphyxia and meconium aspiration syndrome. The outcome of prolonged pregnancy can be improved by proper counselling for follow up during pregnancy and proper monitoring and appropriate management during labor.

Association of Gestational Age at Birth With Subsequent Neurodevelopment in Early Childhood: A National Retrospective Cohort Study in China.

BackgroundThe association between preterm birth and neurodevelopmental delays have been well examined, however, reliable estimates for the full range of gestational age (GA) are limited, and few studies explored the impact of post-term birth on child development.ObjectiveThis study aimed to examine the long-term neuropsychological outcomes of children born in a full range of GA with a national representative sample in China.MethodsIn this retrospective population-based cohort study, a total of 137,530 preschoolers aged 3–5 years old (65,295/47.5% females and 72,235/52.5% males) were included in the final analysis. The Ages and Stages Questionnaires-Third Edition (ASQ-3) was completed by parents to evaluate children's neurodevelopment. The associations between GA and neurodevelopment were analyzed by a generalized additive mixed model with thin plate regression splines. Logistic regression was also conducted to examine the differences in children's development with different GAs.ResultsThere was a non-linear relationship between GA and children's neurodevelopmental outcomes with the highest scores at 40 weeks gestational age. The adjusted risks of GAs (very and moderately preterm, late-preterm, early-term, and post-term groups) on suspected developmental delays were observed in communication (OR were 1.83, 1.28, 1.13, and 1.21 respectively, each p < 0.05), gross motor skill (OR were 1.67, 1.38, 1.10, and 1.05 respectively, each p < 0.05), and personal social behavior (OR were 1.01, 1.36, 1.12, and 1.18 respectively, each p < 0.05). The adjusted OR of very and moderately preterm, late-preterm, and early-term were observed in fine motor skills (OR were 1.53, 1.22, and 1.09 respectively, each p < 0.05) and problem-solving (OR were 1.33, 1.12, and 1.06 respectively, each p < 0.05).ConclusionGAs is a risk factor for neurodevelopmental delays in preschoolers after controlling for a wide range of covariates, and 40–41 weeks may be the ideal delivery GA for optimal neurodevelopmental outcomes. Close observation and monitoring should be considered for early- and post-term born children as well as pre-term children.

The paraoxonase 1 activity and lipid levels in umbilical cord blood and maternal venous blood, and their relations according to birth weight

Objectives: Aim of this study is to find out the clinical relevance of estimating paraoxonase activity of PON1 enzyme, triglyceride (TG), total cholesterol, HDL, and LDL levels in maternal serum and umbilical cord blood according to birth weight. Methods: Venous blood samples were taken from mothers just before birth. Babies were divided into four groups: normal-weight babies, premature babies, low birth weight babies, and postmature babies. The weight of the newborns was measured and cord blood was taken. The samples were looked at HDL, LDL, total cholesterol, triglyceride levels and PON1 activities. We have investigated the paraoxonase activity of the PON1 enzyme. Enzyme activity assay was obtained spectrophotometrically measurement of p‐nitrophenol at 412 nm. Results: Maternal PON1 paraoxonase activity levels in Pre-Term show a significant decrease in cases as compared to other groups. Baby PON1 paraoxonase activity levels are also found to be significantly decreased in cases concerning the Term and Post-Term groups. There was a significant difference in all values the such as baby's weight, TG, Total cholesterol, HDL, LDL and PON1.belonging to babies (p &amp;lt; 0.05). Conclusions: Decreased paraoxonase activity in maternal serum may be considered as an additional risk factor for the development of low birth weight. It appears that PON1 activity plays an important role in infant development and affects birth weight. We think that the paraoxonase activity of the PON1 enzyme in mothers may be a marker in predicting the babies who are at risk in terms of birth weight.

C31. Closure of patent ductus arteriosus using intravenous paracetamol : a case series

Abstract Background Although patency of ductal arteriosus is essential for fetal circulation, postnatal ductal closure is critical for postnatal circulation adaptation in order to avoid pulmonary overcirculation with diminished circulation blood flow. Standard medical treatment for patent ductal arteriosus (PDA) consists of pharmacotheraphy and or surgical intervention. Case Summary We present 17 cases of PDA confirmed by echocardiography and was observed for ductal closure after 3 days of intravenous paracetamol intervention (10-15 mg/kg) given every 8 hours. The echocardiography evaluation of PDA status was conducted after those pharmacological intervention and divided based on the gestational age group. In the preterm groups (&amp;lt;36 weeks), 3 cases remained open, 3 cases were closed, and 1 case with reduced flow. In the aterm groups (36-42 weeks), 5 out of 8 cases were closed, while the other 3 showed reduced flow. In the postterm groups (&amp;gt;42 weeks), 1 case was closed and 1 case with reduced flow. Successful rate for PDA closure of each groups were 43%, 62,5% and 50%. Discussion Indomethacin and ibuprofen are standard treaments for PDA closure. However, they have some side effects such as acute renal failure and gastrointestinal complications. From this case series, paracetamol has a promising effect similar to indomethacin and ibuprofen in conducting PDA closure with less side effects. Paracetamol inhibits prostaglandin synthetase activity eventhough its precise mechanism of action remains controversial.

C31. Closure of patent ductus arteriosus using intravenous paracetamol : a case series

Abstract Background Although patency of ductal arteriosus is essential for fetal circulation, postnatal ductal closure is critical for postnatal circulation adaptation in order to avoid pulmonary overcirculation with diminished circulation blood flow. Standard medical treatment for patent ductal arteriosus (PDA) consists of pharmacotheraphy and or surgical intervention. Case Summary We present 17 cases of PDA confirmed by echocardiography and was observed for ductal closure after 3 days of intravenous paracetamol intervention (10-15 mg/kg) given every 8 hours. The echocardiography evaluation of PDA status was conducted after those pharmacological intervention and divided based on the gestational age group. In the preterm groups (&amp;lt;36 weeks), 3 cases remained open, 3 cases were closed, and 1 case with reduced flow. In the aterm groups (36-42 weeks), 5 out of 8 cases were closed, while the other 3 showed reduced flow. In the postterm groups (&amp;gt;42 weeks), 1 case was closed and 1 case with reduced flow. Successful rate for PDA closure of each groups were 43%, 62,5% and 50%. Discussion Indomethacin and ibuprofen are standard treaments for PDA closure. However, they have some side effects such as acute renal failure and gastrointestinal complications. From this case series, paracetamol has a promising effect similar to indomethacin and ibuprofen in conducting PDA closure with less side effects. Paracetamol inhibits prostaglandin synthetase activity eventhough its precise mechanism of action remains controversial.

Rates of Neuropsychiatric Disorders and Gestational Age at Birth in a Danish Population

Nonoptimal gestational durations could be associated with neurodevelopmental disabilities, yet evidence regarding finer classification of gestational age and rates of multiple major neuropsychiatric disorders beyond childhood is limited. To comprehensively evaluate associations between 6 gestational age groups and rates of 9 major types and 8 subtypes of childhood and adult-onset neuropsychiatric disorders. This cohort study evaluated data from a nationwide register of singleton births in Denmark from January 1, 1978, to December 31, 2016. Data analyses were conducted from October 1, 2019, through November 15, 2020. Gestational age subgroups were classified according to data from the Danish Medical Birth Register: very preterm (20-31 completed weeks), moderately preterm (32-33 completed weeks), late preterm (34-36 completed weeks), early term (37-38 completed weeks), term (39-40 completed weeks, reference), and late or postterm (41-45 completed weeks). Neuropsychiatric diagnostic records (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F00-F99) were ascertained from the Danish Psychiatric Central Register up to August 10, 2017. Poisson regression was used to estimate the incidence rate ratio (IRR) and 95% CI for neuropsychiatric disorders, adjusting for selected sociodemographic factors. Of all 2 327 639 singleton births studied (1 194 925 male newborns [51.3%]), 22 647 (1.0%) were born very preterm, 19 801 (0.9%) were born moderately preterm, 99 488 (4.3%) were born late preterm, 388 416 (16.7%) were born early term, 1 198 605 (51.5%) were born at term, and 598 682 (25.7%) were born late or postterm. A gradient of decreasing IRRs was found from very preterm to late preterm for having any or each of the 9 neuropsychiatric disorders (eg, very preterm: IRR, 1.49 [95% CI, 1.43-1.55]; moderately preterm: IRR, 1.23 [95% CI, 1.18-1.28]; late preterm: IRR, 1.17 [95% CI, 1.14-1.19] for any disorders) compared with term births. Individuals born early term had 7% higher rates (IRR, 1.07 [95% CI, 1.06-1.08]) for any neuropsychiatric diagnosis and a 31% higher rate for intellectual disability (IRR, 1.31 [95% CI, 1.25-1.37]) compared with those born at term. The late or postterm group had lower IRRs for most disorders, except pervasive developmental disorders, for which the rate was higher for postterm births compared with term births (IRR, 1.06 [95% CI, 1.03-1.09]). Higher incidences of all major neuropsychiatric disorders were observed across the spectrum of preterm births. Early term and late or postterm births might not share a homogeneous low risk with individuals born at term. These findings suggest that interventions that address perinatal factors associated with nonoptimal gestation might reduce long-term neuropsychiatric risks in the population.

The physical characteristics and anthropometric measurements among different gestational age of newborn infants

Background: Prematurity or short gestational age is associated with increased neonatal mortality and morbidity. In low income or developing countries precise gestational age is still frequently not known and making the identification of premature newborns is not easy. The aim of this study was to investigate the physical characteristics and anthropometric measurements to estimate gestational age of newborn infants.Methods: In a cross-sectional study, we included 90 pregnant women, 27 were preterm with gestational age 28-36 weeks, 55 were term with gestational age 37-41 weeks and remaining 8 were post term with gestational age 42-43 weeks. After normal delivery the physical characteristics and anthropometric measurements were recorded in all 90 singleton live newborns. Statistical analysis was performed using SPSS windows version 20.0 software.Results: The physical characteristics namely sole creases, ear firmness, skin texture, skull firmness, hair texture and anterior Fontenelle were well developed in term and post term newborns as compared pre term newborns babies. All the anthropometric measurements such as length of infants, birth weight, head circumference, chest circumference and crown rump length were significantly higher in newborns of post term (p&lt;0.0001) and term (p&lt;0.001) groups as compared to newborns in preterm group.Conclusions: It is concluded from this study that the physical characteristics and anthropometric measurements in generally have increased with the advancement of gestational age. Hence, physical characteristics and anthropometric measurement can be used to estimate the gestational age of newborn babies.

SUMMARY DISEASE MODEL IN EARLY NEWBORNS AT

Objectives: To describe disease model according to each kind of newborn … in 2019. Population and Method: It was the cross-sectional study in 376 early newborns. Results and Conclusions: Disease Model: common disease model included the highest rate of early onset infection (41.5%), then free hyperbilirubinemia jaundice 35.9%, respiratory failure 12.2%, malformation 7.7%, NEC 1.6% and lowest rate of metabolic disease (1.1%). Disease model of each kind of newborn: free hyperbilirubinemia jaundice (47.1%) and early onset infection (36.8%) were the most common. In preterm group, early onset infection represented the most (53.8%), then respiratory (28.2%) and NEC 5.1%. In post term group, early onset infection was 57,1% and free hyperbilirubinemia jaundice was 28,5%.

Hospital admissions for lower respiratory tract infections after early-, late-, and post-term birth.

Recent data suggest that early-term births are associated with later respiratory morbidity (LRTI), and post-term births may decrease this risk. The objective was to determine the impact of early-term, late-term, and post-term birth on hospital admission for LRTI up to the age of seven years. Additionally, we explored maternal and perinatal factors associated with the risk of admission for LRTIs. The association of early-term (37+0 -38+6 weeks), late-term (41+0 -41+6 weeks), and post-term (≥42weeks) birth with hospital admissions for lower respiratory tract infections (LRTI) in comparison with infants born full-term (39+0 -40+6 weeks) was assessed and early predictors of LRTI were established. The register study included 948695 infants born in Finland in 1991-2008. Data were analysed in four-term subgroups. Hospital admissions for bronchiolitis/bronchitis and pneumonia were collected up to 7years of age. Adjusted Cox proportional hazards models were used to assess risk factors of LRTI admissions. The rates of hospital admission in the early-, full-, late-, and post-term groups were 6.7%, 5.5%, 5.1%, and 4.8% for bronchiolitis/bronchitis, and 2.8%, 2.4%, 2.3%, and 2.3% for pneumonia. Early-term birth was associated with an increased risk of admission for bronchiolitis/bronchitis (hazard ratio HR 1.21, 95% confidence interval CI 1.18, 1.23) and pneumonia (HR 1.16, 95% CI 1.12, 1.20), while late-term (HR 0.93, 95% CI 0.91, 0.95) and post-term births (HR 0.89, 95% CI 0.85, 0.93) were associated with a decreased risk of bronchiolitis/bronchitis admission compared with the full-term group. Maternal age≤20years, smoking during pregnancy, male sex, caesarean delivery, small for gestational age, 1-minute Apgar score<4, ventilator support, and neonatal antibiotic therapy were associated with an increased risk of LRTI admission, while being firstborn, born in a level-II hospital and in the Northern region was associated with decreased risk. Early-term birth was associated with a higher risk of all LRTI admissions while late-term and post-term births were associated with lower risk of bronchiolitis/bronchitis admission. Modifiable risk factors of LRTIs were smoking during pregnancy, birth by elective caesarean delivery, neonatal ventilator support, and antibiotic therapy.

Effect of spinal anesthesia on the QT interval in term and post-term pregnancies scheduled for elective cesarean section: a prospective study

Objectives: In this study, we aimed to investigate the effects of spinal anesthesia on the QT interval in patients with term and post-term pregnancy that were scheduled for elective cesarean section. Materials and methods: Forty pregnant women scheduled for elective cesarean section under spinal anesthesia were assigned into two groups: Post-term group (Group P) (n = 20) and Term group (Group T) (n = 20). After entering the operation room, standard monitoring [electrocardiography (ECG), noninvasive blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation] was performed. The patient was placed in the sitting position and spinal anesthesia was performed with a median approach at the L3–L4a level using a 25G Quincke-type spinal needle. After cerebrospinal fluid was viewed, 12.5 mg (2.5 mL) hyperbaric bupivacaine was administered intrathecally over 1 min. Other ECG records were made at min 1 (T1), 5 (T2), and 10 (T3) after the induction of spinal anesthesia and after skin closure (T4). QT and QT dispersion were measured from ECG. Heart rate-corrected QT (QTc) and QT dispersion (QTcd) values were calculated using the Bazett formula. Results: Demographic characteristics of the patients were similar in both groups. Postoperative QTc, QTd, and QTcd values were significantly increased in Group P compared to those in Group T (p < .05). Conclusion: Spinal anesthesia led to increased postoperative QTc, QTd, and QTcd values in the patients with a gestational age of ≥42 weeks who underwent cesarean section. Accordingly, it is advisable to perform postoperative strict cardiac monitoring particularly in post-term pregnant women undergoing spinal anesthesia.

Gestational age and the long-term impact on children's infectious urinary morbidity.

Given the negative impact of prematurity on offspring's health, we sought to determine whether different gestational ages at birth impact differently on the prevalence of childhood infectious urinary morbidity in the offspring. In this population-based cohort analysis, all singleton deliveries occurring between 1991 and 2014 at a single regional tertiary medical center were included. Gestational age upon delivery was sub-divided into early preterm (< 34 weeks), late preterm (34-36 6/7 weeks), early term (37-38 6/7 weeks), full term (39-40 6/7 weeks), late term (41-41 6/7 weeks) and post-term (> 42 weeks). Congenital malformations were excluded. Rates of infectious urinary morbidity-related hospitalizations of offspring up to age 18 years were assessed using a survival curve and a Cox multivariable model. During the study period, 238,620 deliveries met the inclusion criteria. Urinary-related hospitalization (n = 1395) rates decreased as gestational age increased, from 1.7% in the early preterm group, 0.9% in the late preterm group, 0.6% in the early-term group and only 0.5% in the full, late and post-term groups (p > 0.001; chi-square test for trends). In the Cox model, controlled for maternal age, preterm as well as early-term deliveries exhibited an independent association with pediatric urinary morbidity as compared with full term (early preterm: aHR-3.305, 95% CI 2.4-4.54; late preterm: aHR-1.63, 95% CI 1.33-1.99; early term: aHR-1.26, 95% CI 1.1-1.43, p = 0.01). Deliveries occurring at preterm and at early term are independently associated with pediatric urinary morbidity in the offspring. This risk decreases as gestational age advances.

The association between gestational age and otitis media during childhood: a population-based cohort analysis.

Otitis media (OM) carries a tremendous global health burden and potentially severe long-term consequences. The objective of this study was to determine the impact of birth at different gestational ages on the incidence of childhood OM.A population-based cohort analysis was conducted. All singleton deliveries occurring between 1991 and 2014 at a regional tertiary medical center were included. Gestational age on delivery was divided into six subgroups: early (&lt;34 weeks gestation; 0 out of 7) and late (34 weeks gestation; 0 out of 7 to 36 weeks gestation; 6 out of 7) preterm, and early (37 weeks gestation; 0 out of 7 to 38 weeks gestation; 6 out of 7), full (39 weeks gestation; 0 out of 7 to 40 weeks gestation; 6 out of 7), late (41 weeks gestation; 0 out of 7 to 41 weeks gestation; 6 out of 7) and post (⩾42 weeks 0 out of 7) term deliveries. Rates of OM-related hospitalizations up to 18 years of age were assessed. Weibull parametric hazards model was used to study the association between gestational age at birth and the risk for OM-related hospitalizations while controlling for potential confounders.During the study period, 238,622 deliveries met the inclusion criteria. OM-related hospitalizations of the offspring (n=4724) were significantly more common in the preterm (early 3.6%, late 2.4%) and early-term born children (2.2%) and decreased gradually across the full (1.9%), late (1.7%) and post (1.6%) term groups (χ2-test for trends P&lt;0.001). In the Weibull regression model, early preterm, as well as early-term deliveries exhibited an independent association with pediatric OM (adjusted hazard ratios: 1.67 and 1.09, respectively, P&lt;0.02).Deliveries occurring at preterm and early term are associated with higher rates of pediatric OM-related hospitalizations, which decrease gradually as gestational age advances.

A Learning Community Approach for Post-Secondary Large Lecture Courses

This design-based research study examined the ways in which a learning community approach can be enacted in large undergraduate lecture courses through a scaffolded, complex curricular design that utilizes active and inquiry-based learning. By combining a traditional lecture with breakout tutorials, the study involved two iterations, firstly by adopting the Fostering Communities of Learners pedagogical model, then by augmenting the model by blending its methodology with elements from a more recent model called Knowledge Community and Inquiry (KCI). Both iterations were evaluated for adherence to, and enactment of, the Fostering Communities of Learners principles. The second iteration was further evaluated to determine the impact of adding a KCI collective knowledge base. Measures included the enactment of the curricular design, achievement of course learning outcomes, the group inquiry project, tutorial activities, pre- and post-term surveys and focus groups for teaching assistants and students. Findings provided evidence of the viability and effectiveness of a learning community approach in large lecture courses at the undergraduate level when combining the learning principles of the Fostering Communities of Learners model with the student-populated dynamic knowledge base. Students achieved both individual and group success in meeting learning outcomes through individual inquiry and collaborative, active learning, with the knowledge base providing a forum for students to share their research and access ideas for their inquiry.

Fetal cerebral and cardiac hemodynamics in postdate pregnancy

Objective: We aimed to determine the fetal cerebro-placental Doppler indices and modified myocardial performance index (Mod-myocardial performance index (MPI)) in this homogenous group of postdated pregnancies.Methods: A total of 92 singleton pregnant women were included in this prospective study. The study involved three groups; full term control (Group 1, n = 42, 39 0/7 to 40 6/7 week’ gestation), late term (Group 2, n = 34, 41 0/7 to 41 6/7 week’ gestation) and post term (Group 3, n = 16, ≥ 42 0/7 weeks’ gestation). Each participant underwent a Doppler assessment of the fetal umbilical artery (UA), middle cerebral artery (MCA), Mod-MPI. We determined the correlation of the Doppler indices and mod-MPI in patients with unfavorable outcome.Results: MCA pulcatility indices (PI), cerebroplacental ratio (CPR) values were significantly higher in the control group than those in the late-term and post-term groups (Group 1: 1.63 ± 0.3, Group 2: 1.27 ± 0.51, Group 3: 1.13 ± 0.22, respectively, p < .001). The Mod-MPI was significantly higher in the late-term and post-term groups than in the control group (Group 1:0.38 ± 0.1, Group 2: 0.59 ± 0.09, Group 3: 0.60 ± 0.08, respectively, p < .001. MCA PI and CPR were only significantly lower in patients with unfavorable outcome). The threshold value for CPR levels for predicting unfavorable outcome in postdate pregnancies was calculated as 1.11 (area under curve [AUC] 0.762, confidence interval [CI] 0.575–0.95) with 72.7% sensitivity and 71.8% specificity.Conclusions: Fetal Mod-MPI does not differ in postdate pregnancies with favorable and unfavorable outcome. The monitorization of fetal well-being with CPR may help to clinicians to select patient for expectant management in postdate pregnancies.

Asthma and atopic dermatitis after early‐, late‐, and post‐term birth

To assess the incidence and risk factors of asthma and atopic dermatitis by seven years of age after early-term (ET) (37+0 -38+6 weeks), full-term (FT) (39+0 -40+6 weeks), late-term (LT) (41+0 -41+6 weeks), and especially post-term (PT) (≥42 weeks) birth. Altogether, 965 203 infants born between 1991 and 2008 in Finland were investigated in ET, FT, LT, and PT groups. Data on asthma medication reimbursement and hospital visits for atopic dermatitis were retrieved from national health databases. The frequencies of asthma medication reimbursement in the ET, FT, LT, and PT groups were 4.5%, 3.7%, 3.3%, and 3.2%, respectively. Hospital visits due to atopic dermatitis were most common after PT birth. Compared with FT births, ET births were associated with an increased risk of asthma (adjusted odds ratio (aOR), 95% confidence interval (CI) 1.20, 1.17-1.23), while LT (aOR, 95%CI 0.91, 0.89-0.93) births and PT (aOR, 95%CI 0.87, 0.83-0.92) births decreased this risk. PT birth (aOR, 95%CI 1.06, 1.01-1.10) predicted atopic dermatitis. From a population point of view, the most relevant risk factors for asthma were male sex, ET birth, smoking during pregnancy and birth by elective cesarean section, and for atopic dermatitis male sex, first delivery, birth in a level II hospital and birth by cesarean section. Early-term birth was a predictor of asthma, and PT birth was associated with atopic dermatitis. Counseling against smoking and following strict indications for planned ET deliveries and cesarean sections may be means to reduce the risk of later asthma.

Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies

ObjectiveTo determine the independent association of post-term pregnancy with neonatal outcome in low-risk newborns.DesignRetrospective cohort.SettingTertiary university-affiliated medical centre.PatientsAll newborns of low-risk singleton pregnancies born at 39+0 to 44+0 weeks’ gestation...

Perinatal morbidity and mortality in late-term and post-term pregnancy. NEOSANO perinatal network's experience in Mexico

The objective of this study is to identify adverse perinatal outcomes associated with pregnancies at or beyond 40 weeks. Retrospective cohort study conducted in Mexico, with information obtained from the NEOSANO's Perinatal Network Database from April 2006 to April 2009. Multiple births, babies with inaccurate gestational age or babies with congenital malformations were excluded. Logistic regression models were used to analyze perinatal complications associated with pregnancies ≥ 40 weeks. A total of 21 275 babies were analyzed; of these, 4545 (21.3%) were of 40 to 40[frac67] weeks, 3024 (14.2%) 41 to 41[frac67] weeks and 388 (1.8%) 42 to 44 weeks of gestation. Adverse perinatal outcomes associated with 40 to 40[frac67] weeks deliveries were (odds ratio; 95% confidence interval): macrosomia (1.9; 1.5 to 2.6), acute fetal distress (1.4; 1.2 to 1.7), emergency cesarean delivery (1.4; 1.2 to 1.5) and chorioamnionitis (1.4; 1.2 to 1.6). Adverse perinatal outcomes associated with 41 to 41[frac67] weeks were macrosomia (2.5; 1.8 to 3.3), chorioamnionitis (2; 1.7 to 2.3), emergency cesarean delivery (1.8; 1.6 to 2.1) and acute fetal distress (1.4; 1.1 to 1.7). Adverse perinatal outcomes associated with 42 to 44 weeks were macrosomia (7; 4.6 to 10.7), meconium aspiration syndrome (5.6; 2.8 to 11.2), neonatal death (4.8; 1.7 to 13.8), stillbirth (4.3; 1.4 to 13.5), 5' Apgar <4 (4.2; 1.1 to 15.7), chorioamnionitis (2.8; 2.2 to 3.9), admission to neonatal intensive care unit (2.7; 1.5 to 4.8), admission to neonatal intensive care unit or step-down unit (2.4; 1.5 to 3.9), acute fetal distress (1.8; 1.2 to 2.6) and emergency cesarean delivery (1.8; 1.3 to 2.4). An increased risk for perinatal and maternal complications were detected as early as 40 weeks' gestation. The risks of stillbirth and neonatal death were significantly higher in the post-term group than the control group.

Regulation of progesterone receptor A and B expression in human preterm, term, and postterm placental villi

The progesterone receptor (PR)-A/B ratio in the myometrium is reported to be closely related to labor onset. This might represent a potential target for therapeutic interventions for postterm and preterm deliveries, though the mechanisms currently remain unknown. The aim of this study was to investigate the regulation mechanism of PR-A and B expression in human preterm, term, and postterm placental villi. Experimental study. People's Hospital of Jiangsu Province, China. Singleton women of preterm (PRNIL, not in labor, n = 10), term (TNIL, not in labor, n = 10; TIL, in labor, n = 10), and postterm (PONIL, not in labor, n = 10) cesarean deliveries. The PR-A/PR-B mRNA and protein ratios were analyzed using real-time reverse transcription-polymerase chain reaction and western blots in villi from preterm, term, postterm groups. PONIL and PRNIL villi were incubated with prostaglandin F(2alpha) (PG) and indomethacin for 72 hours, respectively, and the PR-A/PR-B mRNA and protein ratios and p38 signaling pathway were explored. The PR-A/PR-B ratio was highest in TIL, followed by PRNIL, PONIL and TNIL. Indomethacin significantly up-regulated PR-B expression, thereby decreasing the PR-A/PR-B ratio (p < 0.05). Meanwhile, PG reduced the expression of PR-B and increased PR-A, leading to a significant increase in the PR-A/PR-B ratio (p < 0.05). We also determined that the PR-A/PR-B ratio was mediated through the activation of p38 mitogen-activated protein kinase. These results demonstrate that the PR-A/PR-B ratio plays a key role in the mechanisms regulating preterm, term, and postterm deliveries.

Cervical nitric oxide release in women postterm.

Nitric oxide may be a factor in cervical ripening. We compared the nitric oxide metabolite levels in cervical fluid in women going beyond term and in women delivering spontaneously at term. We studied a total of 208 women with singleton pregnancies: 108 women who went beyond term (294 days or longer), and 100 women who went spontaneously into labor at term. Cervical fluid samples, collected well before the initiation of labor, were assessed for nitric oxide metabolites using an assay with a detection limit of 3.8 micromol/L. Women going beyond term had detectable levels of nitric oxide metabolites in their cervical fluid (60%) less often (P =.001) than women delivering at term (87%). The nitric oxide metabolite concentration in cervical fluid in women going beyond term (median 23.5 micromol/L; 95% confidence interval less than 3.8, 31.8) was 4.5 times lower (P <.001) than that in women delivering at term (median 106.0 micromol/L; 95% confidence interval 81.8, 135.0). Such a difference (14.0 versus 106.0 micromol/L) also existed when only the 66 women going into spontaneous postterm labor were included in the comparison. Both nulliparous (median less than 3.8 micromol/L) and parous (median 31.3 micromol/L) women going beyond term had lower (P <.01) cervical fluid nitric oxide metabolite levels than nulliparous and parous women delivering at term (medians 76.1 and 101.3 micromol/L, respectively). In the postterm group, women with cervical fluid nitric oxide metabolite concentrations at or below the median failed more often (P <.001) to progress in labor and had longer (P =.02) duration of labor than those with cervical fluid nitric oxide metabolite concentrations above the median. Reduced cervical nitric oxide release may contribute to prolonged pregnancy. II-2

Perinatal and maternal complications related to postterm delivery: A national register-based study, 1978-1993

Objective: This study was undertaken to estimate the risk of fetal and maternal complications associated with postterm delivery in Denmark. Study Design: A cross-sectional study that used records from the Danish Medical Birth Registry from 1978 to 1993 was performed. All women with registered prolonged pregnancy (n = 78,022) and a 5% random sample of all women who gave birth (n = 47,021) were linked to the Danish National Discharge Register. We established a postterm group of 77,956 singleton deliveries and a term group of 34,140 singleton spontaneous deliveries. Logistic regression models were used to analyze data. Results: The risk of perinatal and obstetric complications was high in postterm delivery compared with term delivery (adjusted odds ratios between 1.2 and 3.1). The risk of perinatal death was 1.33 (1.05-1.68). Conclusion: Postterm delivery was associated with significantly increased risks of perinatal and maternal complications in Denmark in the period from 1978 to 1993. (Am J Obstet Gynecol 2003;189:222-7.)