Spontaneous Vaginal Delivery Rate Research Articles

A comparative study between dinoprostone pessary and dinoprostone gel for induction of labor and neonatal outcome

This study compares the safety and efficacy of two dinoprostone formulations – a pessary and a gel. A retrospective randomised observational study was conducted to compare Dinoprostone controlled release pessary and Dinoprostone gel for induction of labor at term in women with unfavourable cervix at Apollo Hospitals BGS, Mysuru during August 2018 – May 2020. Among study participants 50 expectant mothers received Dinoprostone pessary while 50 women received Dinoprostone gel for induction of labour. Both groups were compared and the outcomes were analysed. The primary outcomes of the study were induction to delivery interval, successful vaginal delivery, need for operative vaginal delivery and need for caesarean section. Secondary outcomes were observed for neonatal morbidity and uterine hyperstimulation. There was a significant (p=<0.001) improvement in Bishop scores after induction in both groups. When only the post-induction scores for the two formulations were compared, the pessary helped to improve the bishops score (or helps in cervical ripening) better than the gel formulation and therefore can help to improve the chances of vaginal delivery(because there is a significant change in post induction bishop score in pessary group). The mean interval from induction to delivery for the pessary group was 11.03±4.648 hours and for the gel it was 21.18±9.127 hours with a significant p value <0.005The pessary showed a significant improvement in the post-induction Bishop score and a shorter induction to delivery time compared to the gel. Differences in the mode of delivery were not significant. Fortunately, no serious side effects to the mother or fetus were observed with both products. Both formulations of dinoprostone are safe for induction of labor at term. However, pessary achieves comparitively a higher rate of spontaneous vaginal delivery with a shorter labor induction time. Ease of administration, single application and thus decreased chance of infections are its additional benefits.

Effects of magnesium sulfate combined with labetalol on inflammatory stress and pregnancy outcome of patients with gestational hypertension.

Gestational hypertension (GH) is a common disorder during pregnancy that can cause adverse pregnancy outcomes. In the present study, magnesium sulfate (MgSO4) combined with labetalol was used for clinical treatment. Randomized controlled trial was conducted in 100 patients with GH, documented in the Department of Obstetrics and Gynecology (Taicang TCM Hospital) grouped into the experimental (Expt) and control (Ctrl) groups (n=50 cases/group). The Ctrl group was treated with MgSO4, whereas the Expt group was treated with MgSO4 + labetalol. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the Expt group were not significantly different from those in the Ctrl group (P>0.05). By contrast, the SBP and DBP were significantly lower after treatment than those before treatment in both groups (P<0.05). Whole blood viscosity, plasma viscosity and hematocrit were significantly lower in the Expt group compared with those in the Ctrl group after treatment (P<0.05). High mobility group box-1 protein, homocysteine and serum cystatin C levels in the Expt group were also markedly lower than those in the Ctrl group after treatment (P<0.05). In the Expt group, the rate of spontaneous vaginal delivery was much higher, whereas the rates of cesarean section and postpartum hemorrhage were markedly lower than those in the Ctrl group (P<0.05). The occurrence of fetal intrauterine distress, placental abruption, neonatal asphyxia, premature birth and neonatal death were also significantly lower in the Expt group than those in the Ctrl group (P<0.05). In conclusion, MgSO4 + labetalol could improve inflammatory stress and the hemodynamics of patients with GH, and may have a marked antihypertensive effect. Thus, it may improve pregnancy outcome and reduce perinatal complications.

Management of sporadic intracranial vascular malformations in pregnancy: a retrospective analysis

BackgroundSporadic intracranial vascular malformations can pose significant risk to parturients, and additional reports of management may inform patient care. Here we describe the peripartum management of parturients with intracranial vascular malformations. MethodsAfter Institutional Review Board approval, we performed a retrospective analysis of parturients with a known sporadic intracranial vascular malformation including cavernous malformation, developmental venous anomaly, or arteriovenous malformation who delivered at our institution between 2007 and 2020. ResultsWe identified 10 parturients (five cavernous malformations, three developmental venous anomalies, and two arteriovenous malformations) with 16 deliveries. Among all deliveries, 13 (81.3%) were cesarean deliveries without trial of labor; 11 of these (84.6%) received a single-shot spinal and two (15.4%) received an epidural for surgical anesthesia. Two deliveries (12.5%) began with attempted trial of labor but ultimately required cesarean delivery for failure to progress; one of these cases received epidural anesthesia and the other received combined spinal-epidural anesthesia. One delivery was via spontaneous vaginal delivery with epidural analgesia. Overall, our study’s cesarean delivery rate was 93.8% and spontaneous vaginal delivery rate was 6.2%.Three of 16 pregnancies were complicated by seizure, obstructive hydrocephalus, or intracranial hemorrhage. There were no intensive care unit admissions or maternal deaths. ConclusionsIn our case series of 16 deliveries, there were no complications directly resulting from neuraxial procedures. It remains unclear whether intracranial developmental venous anomalies or unruptured arteriovenous malformations impart increased risk during pregnancy. Antepartum planning with a multidisciplinary team approach enables risk stratification and optimal management.

The Rate of Epidural Analgesia in Labor with Maternal And Neonatal Outcome at Tertiary Hospital in Oman

Objectives: The primary objective is to determine the epidural analgesia rate and its effect on the mode of delivery. The secondary objectives are to assess patient satisfaction, duration of second stage of labour and incidence of maternal, fetal and neonatal outcomes. Methods: A retrospective cohort design utilized in this study, involving all pregnant women received epidural analgesia in labour at Sultan Qaboos University Hospital over 3 years period (March 2020 to March 2023). All data is collected from the delivery register at Delivery ward, SQUH track care system, and epidural record chart. Women’s information remained confidential. All entered data in the SPSS program is stored in a passwordprotected computer. Results: There was a total of 7076 deliveries, out of which 389 received epidural analgesia, with a rate of 5.0% (95% CI: 5.0 – 6.0). Out of 389 deliveries, around half were nulliparous and the other half were multiparous. The rate of spontaneous vaginal delivery constituted 60.7%. On the other hand, instrumental deliveries and LSCS constituted 14.9% and 24.4% respectively. The median and mean (±SD) period of 2nd stage were 24.0 and 38.3±40.1. Only 1% of all included patients had prolonged second stage of labor. The rate of oxytocin use was 54.5%, and around 52.4% of it was among nulliparous. 148 patients (52.5% ) reported full benefit from epidural analgesia use, compared to 6% who reported no benefit. In addition, 12.7% of CTG showed fetal distress and postpartum hemorrhage constituted 6.7% among delivered ladies. The study showed that 10.0% of included ladies suffered one or more of post-partum complications, including fever (n 13, 3.3%), headache (n 10, 2.6%), backache (n 3, 0.8%), hypotension (n 9, 2.3%), urine retention (n 3, 0.8%), pruritus (n 1, 0.3%), and nausea and vomiting (n 1, 0.3%). 6.2% was the rate of NICU admissions among the newborns. Conclusions: The study revealed that 5% was the rate of epidural analgesia usage and spontaneous vaginal delivery was the main mode of delivery. However, the indications for delivery by cesarean section or instruments were not related to epidural analgesia in labour. In addition, there was no significant adverse effect on maternal, fetal and neonatal outcome. Based on that, we need to elaborate more on epidural analgesia awareness and usage in order to be offered. Although some previous reviewed studies reported adverse effects of epidural analgesia on labour outcome. Future researches are recommended including prospective design study, bigger sample size, wider variation and multicenter studies.

Bridging Health Disparities and Improving Reproductive Outcomes With Health Center-Affiliated Doula Programs.

Doulas are community perinatal professionals trained in pregnancy health, childbirth preparation, labor support, lactation counseling, and postnatal care. Doulas serve as patient advocates and provide laboring patients with continuous one-to-one support including informational, physical, and emotional support. Research shows that access to continuous labor support contributes to positive health outcomes such as increasing rates of spontaneous vaginal delivery, shorter labor, less need for analgesics, and increased satisfaction with the birthing process. However, despite their benefits, socioeconomic, structural, and systemic factors limit doula accessibility and manifest in low utilization among patients who could benefit from doulas the most. Given the positive health implications of doula support and the need for these services in underserved populations, there is an urgency to increase the accessibility of doulas. Several health centers in the United States have created successful doula programs to meet the needs of their patient populations. To better understand these programs, we interviewed and collaborated on this paper with program representatives from Boston Medical Center's Birth Sisters and DREAM: Delivery Resources, Education, and Advocacy for Moms; UNC Health's Birth Partners; and Michigan Medicine's Dial-A-Doula. Because many health centers serve as large public safety-net hospitals, having more health center-affiliated doula programs nationwide could be a positive step in bridging disparities and improving maternal and child health.

Pregnancy, delivery and neonatal outcomes in women with gastrointestinal system cancer in pregnancy. An evaluation of a population database.

Gastrointestinal system (GIS) cancer in pregnancy is a rare disease. Our aim was to evaluate the association between this type of cancer and pregnancy, delivery and neonatal outcomes. We conducted a retrospective population-based cohort study using the Healthcare Cost and Utilization Project, Nation-wide Inpatient Sample (HCUP-NIS). We included all women who delivered or had a maternal death in the US between 2004 and 2014. We compared women with an ICD-9 diagnosis of GIS cancer to those without. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. A total of 9,096,788 women met inclusion criteria. Amongst them, 194 women (2/100,000) had a diagnosis of GIS cancer during pregnancy. Women with GIS cancer, compared to those without, were more likely to be Caucasian, older than 35 years of age, and to suffer from obesity, chronic hypertension, pregestational diabetes and thyroid disease. The cancer group had a lower rate of spontaneous vaginal delivery (aOR 0.2, 95 % CI 0.13-0.27, p<0.001), and a higher rate of preterm delivery (aOR 1.85, 95 % CI 1.21-2.82, p=0.04), and of maternal complications such as blood transfusion (aOR 24.7, 95 % CI 17.11-35.66, p<0.001), disseminated intravascular coagulation (aOR 14.56, 95 % CI 3.56-59.55, p<0.001), venous thromboembolism (aOR 9.4, 95 % CI 2.3-38.42, p=0.002) and maternal death (aOR 8.02, 95 % CI 2.55-25.34, p<0.001). Neonatal outcomes were comparable between the two groups. Women with a diagnosis of GIS cancer in pregnancy have a higher incidence of maternal complications including maternal death, without any differences in neonatal outcomes.

Delivery Outcomes in Pregnant Women With Third-Trimester Vaginal Bleeding [ID: 1376165

INTRODUCTION: We sought to determine delivery-related morbidity outcomes in patients presenting with third-trimester vaginal bleeding in the absence of placenta previa or placenta accreta spectrum (PAS). METHODS: A retrospective cohort study was conducted among women presenting with third-trimester vaginal bleeding at our tertiary center from July 2020 to June 2022 with exclusion of placenta previa or PAS. Bleeding was categorized by amount documented on provider examination as follows: “light,” less than 50 mL; “heavy,” 50 mL or more. The primary outcome was postpartum hemorrhage (PPH; ≥1,000 mL). Secondary outcomes included relevant maternal and neonatal morbidity measures. RESULTS: Among 6,584 singleton pregnancies, 76 (1.2%) presented with third-trimester vaginal bleeding without evidence of placenta previa or PAS; 68 of patients had light and 8 had heavy bleeding. Bleeding was frequently accompanied by contractions (62%) and cervical change (74%). Bleeding on admission was not associated with increased risk of PPH (light: relative risk [RR] 0.7, 95% CI [0.3, 1.4], P=.14; heavy: RR 1.7, 95% CI [0.5, 5.5], P=.2) or need for blood transfusion. Cesarean delivery (CD), general anesthesia, preterm birth (PTB), and neonatal intensive care unit admissions were more common in patients with heavy bleeding (all P&lt;.05). Light bleeding did not increase the risk of PTB or CD and was associated with a higher rate of spontaneous vaginal delivery (RR 1.24, 95% CI [1.1, 1.4], P=.0003). No patients with bleeding required intensive care unit admission, hysterectomy, or had neonatal demise. Seventy-five percent of patients with heavy bleeding (n=8) and 16% of patients with light bleeding (n=11) had clinical or pathological evidence of abruption. CONCLUSION: Third-trimester vaginal bleeding, without placenta previa or PAS, is not associated with increased risk for PPH. Heavy bleeding, however, is associated with increased risk of preterm delivery and cesarean section, with abruption evident in 75% of these patients. Light bleeding on admission is usually not associated with an abruption or an increase in adverse maternal or neonatal outcomes.

The REDUCED trial: a cluster randomized trial for REDucing the Utilization of CEsarean delivery for Dystocia

To reduce cesarean delivery rates in nulliparous women, guidelines for diagnosing nonprogressive labor have been developed by the National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. These are mainly based on data from the Consortium for Safe Labor study. The guidelines have not been tested in a clinical trial, so the efficacy and safety of this new approach is uncertain. This study aimed to assess whether adoption of new guidelines for diagnosing nonprogressing labor would reduce cesarean delivery rates. We conducted a cluster randomized controlled trial of a knowledge translation program of the guidelines in 26 Canadian hospitals (13 control sites and 13 intervention sites). The sites included all intrapartum care sites in Alberta that perform cesarean delivery and deliver at least 70 nulliparous women annually. The baseline period started on January 1, 2015. The intervention was initiated at the first intervention site in January 2017. The follow-up period began at the first intervention site in February 2017 and lasted till February 2020. The primary outcome was the rate of cesarean delivery in nulliparous women with vertex presentation in labor at term. The secondary outcomes included spontaneous vaginal birth and maternal and neonatal safety. The main data source for the primary and secondary outcomes was the Alberta Perinatal Health Program database. The cesarean delivery rates were assessed using repeated measures mixed effects logistic regression applied to individual births. The analysis was based on 45,193 deliveries at intervention sites and 43,725 deliveries at control sites. There was no evidence of a decrease in the rate of cesarean delivery in association with the intervention (baseline-adjusted odds ratio, 0.94; 95% confidence interval [0.85-1.05]; P=.259). The rate of spontaneous vaginal delivery increased slightly (baseline-adjusted odds ratio, 1.10; 95% confidence interval, [1.01-1.18]; P=.024). We did not observe any differences in adverse maternal or neonatal outcomes. Cesarean delivery rates in nulliparous women were not reduced by the application of recent guidelines for the diagnosis of nonprogressive labor. Spontaneous vaginal delivery-a secondary outcome-was increased in the intervention group. The intervention appears to be safe.

Comparison of different delivery modalities of epidural analgesia and intravenous analgesia in labour: a systematic review and network meta-analysis.

In labour, neuraxial analgesia is the standard in the provision of pain relief. However, the optimal mode of delivering epidural solution has not been determined, and some parturients may need an alternative to epidural analgesia. We sought to conduct a systematic review and network meta-analysis to compare continuous epidural infusion (CEI), programmed intermittent epidural bolus (PIEB), computer-integrated CEI, computer-integrated PIEB, patient-controlled epidural bolus (PCEA), fentanyl patient-controlled analgesia (PCA), and remifentanil PCA, either alone or in combination. We searched CENTRAL, CINAHL, Ovid Embase, Ovid Medline, and Web of Science for randomized controlled trials that included nulliparous and/or multiparous parturients in spontaneous or induced labour. The maintenance epidural solution had to include a low concentration local anesthetic and an opioid. Specific subgroups in the obstetric population such as preeclampsia were excluded. Network meta-analysis was performed with a frequentist method, and continuous and dichotomous outcomes are presented as mean differences and odds ratios, respectively, with 95% confidence intervals. Overall, 73 trials were included. For the first coprimary outcome, the need for rescue analgesia, CEI was inferior to PIEB and PIEB + PCEA was superior to PCEA alone, with a low certainty of evidence given the presence of serious limitations and imprecision. The second coprimary outcome, the maternal satisfaction, was improved by PIEB + PCEA compared with CEI + PCEA and PCEA alone, with a low quality of evidence in view of the presence of serious limitations and imprecision. Fentanyl PCA increased the requirement for rescue analgesia and decreased maternal satisfaction relative to many methods of delivering epidural solution. In terms of secondary outcomes, PIEB increased analgesic efficacy compared with CEI, and PCEA reduced local anesthetic consumption at the expense of inferior analgesia relative to CEI and PIEB. PIEB+PCEA was superior to CEI+PCEA in regard to the pain score at 2h and 4h, consumption of local anesthetic, incidence of lower lower limb motor blockade and the rate of spontaneous vaginal delivery. Fentanyl and remifentanil PCA did not provide the same level of analgesia as all epidural methods, resulted in increasing analgesic ineffectiveness with time spent in labour, and predisposed to a higher incidence of side effects such as nausea and/or vomiting and sedation. Remifentanil PCA was superior to fentanyl PCA for analgesia at an early time point, and it increased the incidence of oxygen desaturation relative to other strategies of delivering epidural solution. Opioid PCA did not provide the same level of analgesia as epidural methods with a higher incidence of side effects. We interpret the findings of our systematic review and network meta-analysis as suggesting PIEB + PCEA to be the optimal delivery mode of epidural solution. Nevertheless, the potential differing importance of the various maternal, fetal, and neonatal outcomes in determining which is optimal has not, to our knowledge, been elucidated yet. PROSPERO (CRD42021254978); registered 27 May 2021.

Title: The effects of demographic transformation due to refugee migration in Turkey on maternal and neonatal outcomes Running Title: Syrian pregnancies and their adverse outcomes

Objective: This research analyzes the obstetric and neonatal outcomes of Syrian and Turkish pregnant women. Methods: This retrospective cross-sectional study included 1,823 pregnant Turkish and Syrian women aged 13 to 47 who gave birth at a tertiary care facility in the Mediterranean region of Turkey. Between September 2020 and August 2021, 940 Turkish and 883 Syrian refugees (SYR) pregnant women participated in the study. The groups were compared for demographic data, obstetric outcomes, and neonatal features. Results: The maternal age distribution for SYR includes younger ages (p&lt;0,001). The literacy status among Syrians is lower than that of Turks (p&lt;0,001). Syrian pregnant women have a lower prevalence of cesarean section (CS); they have a greater rate of first spontaneous vaginal delivery (fSVD) and spontaneous vaginal delivery (SVD) than Turkish pregnant women (p&lt;0,001). Amniotic membrane rupture is more prevalent among pregnant Syrian women (p=0,007). APGAR scores differ by nationality (p=0.004). There is a significant difference in maternal hemoglobin median values (g/dL) according to nationality (p&lt;0.001). There is a substantial difference between the birth weights of newborns with low birth weight (LBW) (1500 ≤ - &lt;2500 grams) and those with 2500 grams or more in both groups (p&lt;0.001). Conclusion: There is a strong correlation between education and prenatal care utilization. As women's education levels increase, the rates of prenatal care also increase. Antenatal care is the most valuable and effective method for preventing adverse pregnancy and neonatal outcomes.

Delivery Mode among Patients with Oligohydramnios with or without Fetal Growth Restriction by Induction Method.

This study aimed to evaluate the association of induction method on delivery mode in pregnancies complicated by oligohydramnios with and without fetal growth restriction (FGR). This was a secondary analysis of a National Institutes of Health funded retrospective cohort study of singleton deliveries at a tertiary-care hospital between 2002 and 2013 with diabetes, mild hypertension, and/or FGR. Chart abstraction was performed by trained research nurses. Patients with a diagnosis of fetal oligohydramnios with and without FGR were identified. Our analytic cohort was further stratified into three groups per initial induction agent: prostaglandins (PGEs) alone, PGE plus mechanical ripening, or oxytocin only. Primary outcome was mode of delivery. Secondary outcomes included indications for cesarean delivery and neonatal morbidity. Out of 4,929 patients in the original database, 546 subjects with fetal oligohydramnios were identified; of these, 270 were induced and included for analysis. Outcomes were compared between 171 patients who had fetuses with isolated oligohydramnios and 99 patients who had fetuses with oligohydramnios and FGR. There were no significant differences in demographic characteristics between the groups. Patients with fetuses with isolated oligohydramnios had similar rates of spontaneous vaginal delivery (SVD) when PGEs were used (n = 44/79, 55.7% PGE alone, n = 44/76, 57.9% PGE with mechanical ripening) and when they were not used (n = 5/13, 38.5% oxytocin alone; p = 0.43). Similarly, the majority of patients in both cohorts underwent SVD regardless of induction method (n = 30/44, 68.2% PGE alone, n = 30/44, 68.2% PGE with mechanical ripening, and n = 6/10, 60% oxytocin alone; p = 0.90). There was no significant difference in composite neonatal morbidity. In patients with fetuses with oligohydramnios with and without FGR, most patients delivered by SVD regardless of induction method. In this population, PGE use was associated with a high chance of SVD in patients with fetuses with suspected placental insufficiency regardless of the presence of absence of FGR. · The majority of fetuses with oligohydramnios with or without FGR deliver vaginally.. · The use of prostaglandins did not increase rates of cesarean for fetal distress in oligohydramnios.. · Prostaglandin use did not increase rate of neonatal intensive care unit admission among pregnancies with oligohydramnios..

Induction of labour with misoprostol in premature rupture of membranes after 34 weeks: Which route is better and at what dose a randomized control trial in a tertiary care hospital

Background: The idea of this study was to evaluate the efficacy and safety of different routes of administration of misoprostol - 50µg oral, 25µg vaginal and 50µg sublingual for induction of labour in women with premature rupture of membranes after 34 weeks of gestation.Design: Randomized controlled trial.Sample: A total of 252 women with premature rupture of membranes after 34 weeks of gestation with indications of induction of labour.Methods: Study was conducted from 01/02/2022 to 31/11/2022, Women admitted to ward with premature rupture of membranes (PROM) after 34 weeks of gestation and requiring induction of labour were randomized into three groups. A total of 252 women participated in the study and were assigned to three groups to receive either 50µg oral misoprostol (n=82) or 25µg vaginal misoprostol (n=85) or 50µg sublingual misoprostol (n=85). The doses were repeated 4 hourly till active labour was established or up to a maximum of 4 doses.Major outcomes: 1.Induction to active labour 2.induction to delivery intervals 3.Delivery modes and 4.fetal outcomes were noted.Results: The mean induction to active labour interval was not significantly different in the three groups (oral vs vaginal vs sublingual- 7.54±4.8 vs 7.77±4.1 h vs 7.68±5.1 h; p=0.92). There was no significant difference in the induction to delivery time interval among the three misoprostol groups (oral vs vaginal vs sublingual – 10.7± 5.5 h vs 11.2±5.0 h vs 11.2±6.4 h; p= 0.88). Spontaneous vaginal delivery rate, instrumental delivery rate and lower segment caesarean section rates were comparable among the three groups. The spontaneous vaginal delivery is more in vaginal group and least in the sublingual group. The oral group is almost equal to the sublingual group in spontaneous delivery. The number of neonates with APGAR score <7 (low APGAR) at 1 minute of birth was highest in sublingual group and lowest in vaginal group which was statistically significant (oral vs vaginal vs sublingual, 16.8% vs 9.4% vs 20%; p= 0. 04). APGAR score <7 at 5 minutes was not significantly different among the three groups (oral vs vaginal vs sublingual, 6.02% vs 3.5% vs 7.05%; p=0.2). This implies that the need for immediate resuscitation was more in the sublingual group. Neonatal intensive care admission was least in the vaginal group although the difference was not statistically significant.Conclusion: 50µg oral misoprostol, 25µg vaginal misoprostol or 50µg sublingual misoprostol for induction of labour after 34 weeks of gestation have equal efficacy for induction of labour in women with spontaneous vaginal delivery is highest in vaginal route. The spontaneous vaginal delivery is more in vaginal route. The sublingual route having slightly higher incidence of low APGAR scores at one minute for the neonate.

Evaluation of obstetric and neonatal outcomes and cesarean section rates of Syrian and Turkish adolescent pregnant women according to the Robson ten group classification system.

Aim: Our research has two purposes. To begin with, we sought to determine whether there were any differences in maternal and newborn outcomes between Syrian adolescent and adult pregnant women living in Turkey after the Syrian civil war and Turkish adolescent and adult pregnant women. Second, we wanted to examine and compare the rates of cesarean section (CS) and spontaneous vaginal delivery (SVD) in adolescent and adult pregnant women using the Robson ten group classification system (RTGCS). Material and Method: Our study investigated data from a retrospective cross-sectional study of 1823 Turkish and Syrian pregnant women who gave birth between September 2020 and August 2021 in a tertiary reference hospital in Turkey's Mediterranean area. Our study enrolled 838 pregnant adolescent girls between the ages of 13 and 19 and 985 pregnant adult women between the ages of 20 and 47. Results: The probability of adolescent pregnancy is 3.081 times greater among Syrian refugees than among Turkish natives (p

471 Impact of manual rotation of occiput posterior fetal positions: the rmos randomized controlled trial

Aims of the study: To evaluate the impact of manual rotation at full dilation of posterior varieties on the rate of spontaneous vaginal delivery. Methods: In an open, single center, controlled and randomized trial on two parallel balanced groups at the Angers University Hospital in France, all patients over 18 years old with a singleton pregnancy, at a gestational age of 37 weeks or more, with a cephalic presentation, avec une analgésie péridurale and Following to ultrasound confirmation of posterior position at the start of second stage, were randomized either the manual rotation group or to the expectant management group.

The Charité external cephalic version for leading twin breech without regional anesthesia and tocolysis. A prospective study on feasibility, sonographic assessment and outcomes

ObjectivesTo assess the feasibility of external cephalic version (ECV) for the leading twin (twin A) in breech presentation in dichorionic and diamniotic twin pregnancies without the use of regional anesthetics and tocolysis and to characterize the sonographic parameters, maternal and neonatal outcomes. Study designProspective study performed in the Charité University Hospital outpatient obstetric department in Berlin, Germany. A total of 23 women from the 35th completed week of pregnancy with confirmed dichorionic-diamniotic twin pregnancy were recruited. ECVs were performed by the lead consultant for the breech and ECV clinic. Ethical approval provided by the Charité Ethics Commission (EA2/241/18). Demographic data were recorded. Fetal sonographic parameters were assessed. The success rate of ECV, duration of the ECV, gestational age at delivery, mode of delivery for both fetuses, maternal and neonatal outcomes were analyzed. ResultsOur main finding showed that ECV for twin A breech in dichorionic-diamniotic twins is successful in 56% (10/18) of cases without the need for regional anesthesia and without tocolysis. There is a significant increase in the spontaneous vaginal delivery rate for both twins of 95% (19/20) vs 12.5% (2/16) (p < 0.001). There is also a significant reduction in blood loss at delivery of 300 ml vs 500 ml (p = 0.034) in successful cases. ConclusionsWe show that ECV for twin A in breech is feasible and in 56% (10/18) successful without regional anesthesia and tocolysis. The option of ECV for twin A breech should be offered to women.

The use of immature granulocyte and other complete blood count parameters in the diagnosis of transient tachypnea of the newborn

BackgroundAlthough Transient tachypnea of the newborn (TTN) is one of the most common causes of respiratory distress in the newborn period, there is no laboratory parameter used to diagnose it. Immatur granulocyte (IG) measurement is accepted as a useful indicator that can be used in early detection of many infectious conditions, especially neonatal sepsis. In this study, it was aimed to determine if IG and other complete blood count (CBC) parameters could be used as laboratory findings supporting TTN diagnosis. Materials and methodsThis study, which was retrospectively planned, was conducted in the neonatal intensive care unit (NICU) a public hospital between January 1, 2019 and January 31, 2021. Randomly selected 50 infants, hospitalized with the diagnosis of TTN, constituted the patient group of the study. 50 infants hospitalized with the diagnosis of hyperbilirubinemia and did not have any additional problems accepted as the control group. IG and other CBC parameters of infants in the patient and control groups were compared in the study. ResultsThere was no significant difference between the patient and control groups in terms of demographic data and types of delivery (p > 0.05). The rate of delivery by elective cesarean section (C/S) was significantly higher than the rate of normal spontaneous vaginal (NSV) delivery in the patient group (p < 0.001). The IG number and percentage, WBC (white blood cell) count, RDW (red cell distribution width), number and percentage of NRBC (nucleated red blood cell), neutrophil and lymphocyte ratio, count and percentage of basophil and PLR (platelet/lymphocyte ratio) of the patient group was significantly higher than the control group (p < 0.05). ConclusionAccording to the findings obtained in the study, it was concluded that IG and other CBC parameters may be used to support clinical and imaging findings to diagnose transient tachypnea of the newborn.

Delivery Mode After Manual Rotation of Occiput Posterior Fetal Positions: A Randomized Controlled Trial.

To evaluate whether manual rotation of fetuses in occiput posterior positions at full dilation increases the rate of spontaneous vaginal delivery. In an open, single-center, randomized controlled trial, patients with a term, singleton gestation, epidural analgesia, and ultrasonogram-confirmed occiput posterior position at the start of the second stage of labor were randomized to either manual rotation or expectant management. Our primary endpoint was the rate of spontaneous vaginal delivery. Secondary endpoints were operative vaginal delivery, cesarean delivery, and maternal and neonatal morbidity. Analyses were based on an intention-to-treat method. A sample size of 107 patients per group (n=214) was planned to detect a 20% increase in the percent of patients with a spontaneous vaginal delivery (assuming 60% without manual rotation vs 80% with manual rotation) with 90% power and alpha of 0.05. Between February 2017 and January 2020, 236 patients were randomized to either manual rotation (n=117) or expectant management (n=119). The success rate of the manual rotation maneuver, defined by conversion to an anterior position as confirmed by ultrasonogram, was 68%. The rate of the primary endpoint did not differ between the groups (58.1% in manual rotation group vs 59.7% in expectant management group (risk difference -1.6; 95% CI -14.1 to 11.0). Manual rotation did not decrease the rate of operative vaginal delivery (29.9% in manual rotation group vs 33.6% in expectant management group (risk difference -3.7; 95% CI -16.6 to 8.2) nor the rate of cesarean delivery (12.0% in manual rotation group vs 6.7% in expectant management group (risk difference 5.3; 95% CI -2.2 to 12.6). Maternal and neonatal morbidity was also similar across the two groups. Manual rotation of occiput posterior positions at the start of second stage of labor does not increase the rate of vaginal delivery without instrumental assistance. ClinicalTrials.gov, NCT03009435.

448 Combination of early pushing with extended second stage might increase adverse maternal and neonatal outcomes

To evaluate the effect of combining the technique of early pushing and extended second stage on the rate of cesarean deliveries, as well as adverse maternal and neonatal outcomes. This retrospective data analysis included all women delivering in a single tertiary medical center through 2015-2020. In January 2017 the protocol of second stage management was changed to a combination of extended second stage (i.e. addition of an extra-hour to the traditional Fridman cutoffs), as well as early pushing (i.e. initiation of active pushing within the first 30 minutes of full dilatation). We compared delivery outcomes in women reaching full dilatation during January 2015 to December 2016, vs. January 2017 to July 2020. Of the 15,788 parturients, 10,415 (66.0%) were managed using the "new" protocol. No difference was found in terms of baseline characteristics, except for higher rates of epidural analgesia (72.8% vs. 70.4%, p=0.002) and induction of labor (22.4% vs. 17.8%, p<0.0001) during the new protocol period. In subgroup analysis by parity and epidural analgesia, no change was noted in the rate of cesarean deliveries. A significant increase in spontaneous vaginal deliveries in favor of the "new" protocol was noted, except for multiparous women with no analgesia (Table 1). In addition, in primiparous women with epidural analgesia, a decrease in vacuum deliveries was noted. In secondary outcome analysis, a significant increase in postpartum hemorrhage was noted in women with epidural analgesia, both primi- and multiparous (Table 2). In addition, marked increase was demonstrated in neonatal intensive care unit admissions (up to OR 15.48 (95%CI 3.78-63.42) in primiparous women with epidural analgesia), in all subgroups except for primipara without epidural. Early pushing along with extension of the second stage was associated with higher rate of spontaneous vaginal deliveries, at the expense of increased risk for adverse maternal and neonatal outcomes. Thus, combination of these two techniques must be practiced with caution.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

348 Prenatal care and the hispanic paradox

The aim of this study was to determine the effect of insufficient PNC on perinatal outcomes according to Hispanic ethnicity. This was a retrospective cohort study of 10,495 low-risk parturients delivering between April 2014-2017. Demographic, obstetric, and neonatal outcomes were recorded. PNC was considered sufficient if begun in the first-trimester with completion of ≥80% of visits. Data was compared between Hispanic and Non-Hispanic ethnicity and stratified by PNC received. Group variables were analyzed using chi-square/fisher exact. T-test was used for normally distributed data and Wilcoxon rank sum test for non-normal data. Data was collected on 19,665 women during the study period. Of those, 10,495 met inclusion criteria. There were 5,749 (55%) Hispanic women of which 62.5% received insufficient prenatal care. Vaginal delivery rates were significantly higher for Hispanic women with insufficient care (p=0.009), while the rate of operative vaginal delivery was lower (p=0.009) compared to non-Hispanics. There were no differences in maternal morbidities including chorioamnionitis or blood transfusion in either ethnic group with regards to PNC (p>0.05; Table 1). Results demonstrate an increased spontaneous vaginal delivery rate for low risk Hispanic women with insufficient PNC, supporting the epidemiologic phenomenon of the Hispanic Paradox.

Association of Persistent Breech Presentation With External Cephalic Version Success.

To evaluate a possible correlation between a new variable-persistent breech presentation-and the success rate of external cephalic version (ECV). This was a retrospective study of ECVs performed from January 2008 through January 2019 in an Israeli tertiary care hospital. The study group included all pregnant women who underwent an ECV at or beyond 37 weeks of gestation. Persistent breech presentation was defined as persistent breech presentation during all ultrasound examinations performed between the anatomy scan at mid-pregnancy and the gestational week when ECV was attempted. Women in whom cephalic presentation was documented at least once on these ultrasound examinations were defined as not having persistent breech presentation. The primary outcome was defined as the success rate of ECV, and the secondary outcome was defined as the mode of delivery after a successful ECV. We identified 1,271 women with breech presentation during the study period. They had undergone median of five (range 2-7) ultrasound examinations. External cephalic version was attempted in 684 women (53.8%), with a success rate of 61.5%. External cephalic version succeeded in 19.6% of those with persistent breech presentation (44/224) compared with 82.0% (377/460) of those without persistent breech presentation (P<.001). Ultimately, women with persistent breech presentation and successful ECV experienced a lower rate of vaginal delivery (27.3% vs 79%, P<.001), and a higher rate of instrumental (29% vs 13%, P<.001) and cesarean deliveries (43% vs 7%, P<.001) compared with the nonpersistent breech presentation group. The rate of noninstrumental vaginal delivery among women with persistent breech presentation, regardless of ECV, was 5.4%. Women with persistent breech presentation experienced a high rate of ECV failure and a low rate of spontaneous vaginal delivery.