Risk Of Dystocia Research Articles

Perineal hernia in a pregnant Angus heifer (Bos taurus)

AbstractThis case report details a perineal hernia in a 3‐year‐old Angus heifer in late gestation. The heifer had a gradually increasing swelling of the perineal region since 2 weeks. Upon palpation, the swelling was painless, hard and non‐reducible. Ultrasonographic examination revealed a hernial sac enclosing the non‐pregnant horn of the uterus, filled with homogenous hypoechoic fluid. Based on the anamnesis and clinical examination, a tentative diagnosis of perineal herniation was made. Considering the deteriorating clinical condition of the cow and the possible risk of dystocia, the viable calf was delivered by Caesarean section. The cow recovered with a reducible hernial sac, which was decided not to correct surgically due to its large size. After 7 days, the cow showed no further complications and was discharged. In conclusion, although rare, a perineal hernia involving the uterus should be considered in the differential diagnosis of perineal swellings in pregnant cows.

Prevalence and risk factors of reproductive health problems in dairy cows in Southern Ethiopia

Reproductive disorders are the leading cause of economic loss in the cattle industry, as they reduce the reproductive efficiency and lifetime productivity of cows. In Ethiopian dairy, without proper preventive measures, these disorders can have a severe impact on productivity. Therefore, it is crucial to identify the extent of these issues and the factors contributing to them in order to improve the health and productivity of dairy cows. This study aimed to assess the prevalence, type, and potential risk factors for reproductive health problems in dairy farms in Hawassa city and Wolaita Sodo town. We observed 391 pregnant and postpartum cows for reproductive disorders and used a logistic regression model to identify risk factors. The study found that 165 cows (41.6%; 95% CI: 36.8-46.5%) had at least one reproductive issue. The most common disorders included retained fetal membrane (11.6%), dystocia (10.5%), metritis (7.2%), abortion (5.6%), stillbirth (2.6%), uterine/vaginal prolapse (2.3%), endometritis (2.1%), and pyometra (0.5%). The risk of dystocia significantly increased with male calf deliveries (OR=2.9; p=0.004) and larger farm sizes (OR=2.1; p=0.039). Cows experiencing dystocia were 5.3 times more likely to have retained fetal membrane (p<0.001). Heifers were significantly more likely to develop metritis (OR=5.1; p=0.001), as were cows with retained fetal membrane (OR=11.6; p<0.001). The incidence of abortion was significantly elevated in cows from semi-intensive farms (OR= 5.3; p<0.001). The study concludes that these reproductive health issues can significantly impact future uterine health, resulting in prolonged uterine involution. It is crucial to raise awareness among dairy farmers about effective herd health management practices to minimize losses.

Nutrition during Pregnancy: Macronutrient and Specific Needs

Pregnancy is characterized by significant metabolic changes aimed at providing the fetus a regular nutritional intake, adapted to its needs in all circumstances. The nutritional impact on the fetus is assessed by development and growth fetal and by its repercussions on fetal programming which conditions the occurrence of metabolic diseases in adulthood. Maternal weight gain during pregnancy is an important nutritional indicator. Excessive energy intake increases the risk of pregnancy-related high blood pressure, gestational diabetes, macrosomia and dystocia. Insufficient, it exposes to the risk of fetal hypotrophy, morbidity and mortality increase in neonatal and postnatal developmental disorders. Desirable nutritional intakes are close to those recommended in the general population. A debate remains concerning the benefit of systematic supplementation with iron, vitamin D and iodine. It is accepted that a diversified, sufficient and balanced diet is enough to satisfy all needs, with the exception of folic acid, the subdeficiency of which, very common among women of childbearing age, is associated with malformations which can be prevented by systematic supplementation. Others supplementation is only necessary for women at risk.

Nutrition during Pregnancy: Macronutrient and Specific Needs

Pregnancy is characterized by significant metabolic changes aimed at providing the fetus a regular nutritional intake, adapted to its needs in all circumstances. The nutritional impact on the fetus is assessed by development and growth fetal and by its repercussions on fetal programming which conditions the occurrence of metabolic diseases in adulthood. Maternal weight gain during pregnancy is an important nutritional indicator. Excessive energy intake increases the risk of pregnancy-related high blood pressure, gestational diabetes, macrosomia and dystocia. Insufficient, it exposes to the risk of fetal hypotrophy, morbidity and mortality increase in neonatal and postnatal developmental disorders. Desirable nutritional intakes are close to those recommended in the general population. A debate remains concerning the benefit of systematic supplementation with iron, vitamin D and iodine. It is accepted that a diversified, sufficient and balanced diet is enough to satisfy all needs, with the exception of folic acid, the sub-deficiency of which, very common among women of childbearing age, is associated with malformations which can be prevented by systematic supplementation. Others supplementation is only necessary for women at risk.

Analysis of anesthetic protocols during cesarean section in dogs: a systematic review

There are many problems associated with uncontrolled artificial breeding of dogs, which lead to anatomical abnormalities. In the literature, there is a tendency for dog breeds to appear that have anatomical and physiological changes that lead to the development of pathological childbirth. In populations of breeds with a particularly high risk of dystocia, such as the English Bulldog, the frequency of planned cesarean sections can approach 80%, therefore it is necessary to take a responsible approach to the formation of anesthetic protocols. Thus, the survival rate of newborns and the state of the maternal body depend on this. Anesthesia protocols adopted for cesarean section should provide adequate muscle relaxation, anesthesia and anesthesia to ensure optimal working conditions. The use of opioid analgesics helps to ensure adequate pain control during cesarean section. One of the most commonly used opioids during this surgery in dogs is morphine. The dosage of morphine may vary depending on the size of the dog and the degree of pain. When performing a cesarean section, it is recommended to use drugs that do not cause neonatal depression. It is noted that epidural anesthesia reduces the need for intraoperative analgesics without causing severe neonatal depression. The main drugs that can be used in the preparation of an anesthesiological protocol during cesarean section are propofol, isoflurane, sevoflurane, lidocaine, morphine, fentanyl. The results of the analysis of the literature data showed the effectiveness of the use of drugs from different groups of medicines.

Determining the Association of the Dry Period Duration with Dystocia and Stillbirths in Dairy Cows by Considering Parity, Season, and Gestation Length.

This study aimed to assess the relationship between the length of the dry period (DL) and the risks of dystocia and stillbirths in Holstein cows. A total of 1072 healthy cows in lactations 1 and ≥2 were categorized based on the DL (mean: 58.07 ± 0.33 days) into three groups: short DL (<40 days; 13.0% of cows), medium DL (40-70 days; 60.1%), and long DL (>70 days; 26.9%). Dystocia occurred in 12.4% of cows, while stillbirths accounted for 4.1% of calves. The medium DL group had the highest number of unassisted calvings. The dystocia rates were 11.4% for cows with gestation (GA) ≤ 274 days; 6.0% for cows with GA = 275-282 days; and 19.9% for cows with GA ≥ 283 days (p < 0.001). In season 1 (November-April), dystocia occurred in 15.0% of cases compared to 8.8% in season 2 (May-October) (p < 0.001). The stillbirth rates ranged from 3.6% to 4.0% for cows with medium and long DLs; while those with a short DL had 5.8% (p < 0.05). The stillbirth rates were 5.2% for cows with GA ≤ 274 days; 3.2% for cows with GA = 275-282 days; and 5.1% for cows with GA ≥ 283 days (p < 0.001). Season 1 had a stillbirth rate of 4.8%, while season 2 had a stillbirth rate of 3.3% (p < 0.001). This research provides insights that could assist the dairy industry in making informed decisions to reduce the incidence rates of dystocia and stillbirths in cows.

A systematic review of the effects of maternal obesity on neonatal outcomes in women with gestational diabetes.

Maternal obesity and gestational diabetes mellitus (GDM) prevalence are increasing, with both conditions associated with adverse neonatal outcomes. This review aimed to determine the risk of adverse outcomes in women with obesity and GDM, compared with women with obesity alone. A systematic search identified 28 eligible articles. Meta-analysis was conducted using a random effects model, to generate pooled estimates (odds ratios, OR, or mean difference, MD). Compared with normal-weight controls, women with obesity had increased risks of large for gestational age (LGA, OR 1.98, 95% CI: 1.56, 2.52) and macrosomia (OR 2.93, 95% CI: 1.71, 5.03); the latter's risk almost double in women with obesity than GDM. Birth weight (MD 113 g, 95% CI: 69, 156) and shoulder dystocia (OR 1.23, 95% CI: 0.85, 1.78) risk was also higher. GDM significantly amplified neonatal risk in women with obesity, with a three- to four-fold risk of LGA (OR 3.22, 95% CI: 2.17, 4.79) and macrosomia (OR 3.71, 95% CI: 2.76, 4.98), as well as higher birth weights (MD 176 g, 95% CI: 89, 263), preterm delivery (OR 1.49, 95% CI: 1.25, 1.77), and shoulder dystocia (OR 1.99, 95% CI: 1.31, 3.03), when compared with normal-weight controls. Our findings demonstrate that maternal obesity increases serious neonatal adverse risk, magnified by the presence of GDM. Effective strategies are needed to safeguard against neonatal complications associated with maternal obesity, regardless of GDM status.

The impact of beef sire breed on dystocia, stillbirth, gestation length, health, and lactation performance of cows that carry beef × dairy calves

In the United States, it is becoming common for dairy herds to mate a portion of cows to beef semen to create a value-added calf. The objectives of this study were to determine if dystocia risk, stillbirth (SB) risk, gestation length (GL), probability of early-lactation clinical disease events, early-lactation culling risk, or subsequent milk production differ between cows that carried calves sired by different beef breeds and those that carried Holstein-sired calves. Records from 10 herds contained 75,256 lactations from 39,249 cows that had calves with known Holstein or beef breed sires from the years 2010 to 2023. Calf sire breeds with ≥150 records included in analyses were Holstein, Angus, Simmental, Limousin, crossbred beef, and Charolais. Additional beef sire breeds that existed in lower frequency (n < 150 records) were condensed together and classified as "other." Because GL is a continuous variable, sire breed inclusion criteria were reduced to n ≥ 100 records; thus, Wagyu sires were included as their own breed group. Some records did not contain all variables of interest, thus models included fewer lactations depending on variable. Binomial generalized mixed models evaluated dystocia risk (defined as calving ease score ≥4 or calving ease score ≥3), SB risk, clinical health event risk (defined as lameness, mastitis, metabolic, reproductive, other, or any health events occurring within 60 d in milk [DIM]), and early culling risk (defined as death or culling within 60 DIM). Gestation length and test-date milk, fat, and protein yields were evaluated with mixed models. Calves sired by crossbred beef bulls had a greater probability of being stillborn (5%; 95% confidence interval lower = 2.9% upper = 9.0%) than those sired by Holstein bulls (2%; 95% confidence interval lower = 1.5%, upper = 2.7%). All beef-sired calves increased GL from that of Holstein-sired calves (277 ± 0.15 d) with Limousin (282 ± 0.81 d) and Wagyu-sired calves (285 d ± 0.79) resulting in the longest GL. The risk of dystocia, clinical health events, and early-lactation culling did not differ by calf sire breed nor did subsequent milk and component yield. Generally, carrying a calf sired by the beef breeds included in this study did not negatively affect the dairy cow.

Prenatal Diagnosis of Canine and Feline Twins Using Ultrasound: A Retrospective Study.

Prenatal diagnosis comprises a set of investigations, both instrumental and laboratory-based, which aim to monitor the health of the foetus during pregnancy, from the early stages of embryonic development to the moments preceding delivery. A growing interest is emerging for the preterm ultrasound morphological screening of embryos and foetuses, aimed at assessing the integrity and viability of the conceptus, as well as the early diagnosis of anomalies which can cause complications. This study is a retrospective study of the ultrasonographic findings of twins in the authors' clinical activity from 2016 to 2022. Only seven cases of monochorionic twins were recorded, out of the whole number of evaluations performed on 3120 foetuses, with a prevalence of 0.6% and 0.2% in feline and canine foetuses. All the twins had their own amniotic sac and umbilical cord but presented a single placenta and a single allantoic sac. Unfortunately, the three feline cases were not more recognizable at term. In the four canine cases, three were of opposite sex and then necessarily dizygotic. Twins may have an impact on the success of a pregnancy due to the risk of dystocia, as observed in some of the reported cases. Prenatal ultrasound allows early recognition of twins in dogs and cats.

Effect of Dam Body Conformations on Birth Traits of Calves in Chinese Holsteins.

The objective of this study was to explore the effect of dam body conformations on birth traits including stillbirth, dystocia, gestation length and birth weight of Chinese Holstein calves and to provide a reference for improving cow reproductive performance. We collected phenotype data on 20 conformation traits of Chinese Holstein cows and analyzed the impact of dam conformation trait linear scores on stillbirth, dystocia, gestation length and calf birth weight. The feet angle, set of rear legs, fore udder attachment and rear attachment height traits of the dairy cows significantly affected the risk of stillbirth. The risk of dystocia decreases with the increase in stature and pin width. The bone quality of dairy cows had a significant positive correlation with gestation length. There was a significant positive correlation between fore udder attachment and calf weight at birth. The birth weight of calves from cows with high body conformation traits was significantly higher than that of calves with a low composite score. These results suggest that improving the body conformation traits, especially the selection of mammary system and body shape total score, will be beneficial in improving the reproductive performance of dairy cows.

The impact of diabetes during pregnancy on neonatal outcomes among the Aboriginal population in Western Australia: a whole-population study.

Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have a high prevalence of diabetes in pregnancy (DIP), which includes pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). We aimed to characterize the impact of DIP in babies born to Aboriginal mothers. A retrospective cohort study, using routinely collected linked health data that included all singleton births (N = 510 761) in Western Australia between 1998 and 2015. Stratified by Aboriginal status, generalized linear mixed models quantified the impact of DIP on neonatal outcomes, estimating relative risks (RRs) with 95% CIs. Ratio of RRs (RRRs) examined whether RRs differed between Aboriginal and non-Aboriginal populations. Exposure to DIP increased the risk of adverse outcomes to a greater extent in Aboriginal babies. PGDM heightened the risk of large for gestational age (LGA) (RR: 4.10, 95% CI: 3.56-4.72; RRR: 1.25, 95% CI: 1.09-1.43), macrosomia (RR: 2.03, 95% CI: 1.67-2.48; RRR: 1.39, 95% CI: 1.14-1.69), shoulder dystocia (RR: 4.51, 95% CI: 3.14-6.49; RRR: 2.19, 95% CI: 1.44-3.33) and major congenital anomalies (RR: 2.14, 95% CI: 1.68-2.74; RRR: 1.62, 95% CI: 1.24-2.10). GDM increased the risk of LGA (RR: 2.63, 95% CI: 2.36-2.94; RRR: 2.00, 95% CI: 1.80-2.22), macrosomia (RR: 1.95, 95% CI: 1.72-2.21; RRR: 2.27, 95% CI: 2.01-2.56) and shoulder dystocia (RR: 2.78, 95% CI: 2.12-3.63; RRR: 2.11, 95% CI: 1.61-2.77). Birthweight mediated about half of the DIP effect on shoulder dystocia only in the Aboriginal babies. DIP differentially increased the risks of fetal overgrowth, shoulder dystocia and congenital anomalies in Aboriginal babies. Improving care for Aboriginal women with diabetes and further research on preventing shoulder dystocia among these women can reduce the disparities.

Correlation between bituberous diameter and mode of delivery in a cohort of low-risk nulliparous women

ObjectiveThe aim our study was to evaluate the association between the antepartum clinical measurement of the Bituberous Diameter (BTD) and the occurrence of unplanned obstetrical intervention (UOI) due to labor dystocia, including either operative vaginal delivery or caesarean section in a cohort of low-risk, nulliparous at term. DesignRetrospective analysis of prospectively collected data. SettingTertiary maternity care. InterventionsWith the women lying in lithotomic the distance between two ischial tuberosities was assessed using a tape measure during the routine antenatal booking between 37 and 38 weeks of gestation. Measurements and findingsOverall, 116 patient were included, and of these 23(19.8%) were submitted to an UOI due to labor dystocia. Compared to women that had a spontaneous vaginal delivery, women submitted to an UOI had a shorter BTD (8.25 + 0.843 vs 9.60 + 1.12, p < 0.001), a higher frequency of epidural analgesia (21/23 or 91.3% vs 50/93 or 53.8%; p = 0.002) and of augmentation of labor (14/23 or 60.9% vs 19/93 or 20.4%; p < 0.001) as well as a longer first [455 (IQR 142–455 min vs 293 (IQR 142–455) min] and second stages of labor [129 (IQR 85–155) min vs 51 (IQR 27–78) min]. Multivariable logistic regression showed that the BTD (aOR 0.16, 95% CI 0.04–0.60; p = 0.007) and the length of the second stage of labor (aOR 6.83, 95% CI 2.10–22.23; p = 0.001) were independently associated with UOI. When evaluating the diagnostic accuracy of the BTD for the prediction of UOI due to labor dystocia, the BTD showed an AUC of 0.82 (95 %CI 0.73–0.91; p < 0.001) with an optimal cut-off value of 8.6 cm (78.3% (95 %CI 56.3–92.5) sensitivity, 77.4% (95 %CI 67.6–85.4) specificity, 46.2% (95% CI 30.1–62.8) PPV, 93.5% (95% CI 85.5–97.9) NPV, 3.5 (95% CI 2.3–5.4) positive LR, and 0.28 (95% CI 0.13–0.61) negative LR. A significant inverse correlation between the length of the second stage of labour and the BTD in patients that had a vaginal delivery was also demonstrated (Spearman’s rho = -0.24, p = 0.01). Key conclusionsOur study suggests that antepartum clinical assessment of the BTD might be used as a reliable predictor of UOI due to labor dystocia in low-risk, nulliparous women at term gestation. Implications for practiceAntenatal identification of women at higher risk for labor dystocia might trigger some interventions during the second stage of labor, such as maternal position shifting, to increase the pelvic capacity and potentially improve outcomes or might prompt a referral of the patient to a district hospital prior to the onset of labor.

Prenatal diagnosis of fetal defects and its implications on the delivery mode.

Congenital malformations are defined as single or multiple defects of the morphogenesis of organs or body parts, identifiable during intrauterine life or at birth. With recent advances in prenatal detection of congenital malformations, many of these disorders can be identified early on a routine fetal ultrasound. The aim of the present systematic review is to systematize the current knowledge about the mode of delivery in pregnancies complicated by fetal anomalies. The databases Medline and Ebsco were searched from 2002 to 2022. The inclusion criteria were prenatally diagnosed fetal malformation, singleton pregnancy, and known delivery mode. After the first round of research, 546 studies were found. For further analysis, studies with full text available concerning human single pregnancy with known neonatal outcomes were considered. Publications were divided into six groups: congenital heart defects, neural tube defects, gastroschisis, fetal tumors, microcephaly, and lung and thorax malformations. Eighteen articles with a descripted delivery mode and neonatal outcome were chosen for further analysis. In most pregnancies complicated by the presence of fetal anomalies, spontaneous vaginal delivery should be a primary option, as it is associated with lower maternal morbidity and mortality. Cesarean delivery is generally indicated if a fetal anomaly is associated with the risk of dystocia, bleeding, or disruption of a protective sac; examples of such anomalies include giant omphaloceles, severe hydrocephalus, and large myelomeningocele and teratomas. Fetal anatomy ultrasound should be carried out early, leaving enough time to familiarize parents with all available options, including pregnancy termination, if an anomaly is detected.

Double cervices in a Gypsy Vanner mare

A 7-year, purebred Gypsy Vanner, maiden mare was presented with abnormal cervical tissue that was detected during prebreeding examination. External vulvar examination, transrectal and ultrasonographic examination of uterus, and internal vaginal vault and cervical examination (via speculum and endoscopy) were conducted. Karyotype analysis included sex chromosome study with dual-color fluorescence in situ hybridization and polymerase chain reaction for SRY gene. Mare had normal 64,XX karyotype with no evidence of mosaicism. Two distinct, patent, cervical ora separated by a frenulum, leading to a single uterine body, were observed. It was recommended to avoid breeding because of dystocia risk. To the authors’ knowledge, this is the first reported case of this nature in a mare.

Predictors of shoulder dystocia at the time of operative vaginal delivery: a prospective cohort study

Our aim was to identify factors associated with shoulder dystocia following an attempted operative vaginal delivery (aOVD) in a prospective cohort study and to evaluate whether these factors can be used to accurately predict shoulder dystocia by building a score of shoulder dystocia risk. This was a planned secondary analysis of a prospective cohort study of deliveries with aOVD at term from 2008–2013. Cases were defined as women with shoulder dystocia following an aOVD defined as a delivery that requires additional obstetric maneuvers following failure of gentle downward traction on the fetal head to effect delivery of the shoulders. Multivariate logistic regression analyses were performed to determine risk factors for shoulder dystocia. Shoulder dystocia occurred in 57 (2.7%) of the 2118 women included. In the whole cohort, women with shoulder dystocia more often had a history of shoulder dystocia (3.5% vs. 0.2%, p = 0.01), and there was a significant interaction between aOVD and gestational age and the duration of the second stage of labor: women with shoulder dystocia more often had a gestational age > 40 weeks and a second stage of labor longer than 3 h specifically for midpelvic aOVD. In multivariable analysis, a history of shoulder dystocia was the only factor independently associated with shoulder dystocia following aOVD (aOR 27.00, 95% CI 4.10–178.00). The AUC for the receiver operating characteristic curve generated using a multivariate model with term interaction with head station was 0.70 (95% CI 0.62–0.77). The model failed to accurately predict shoulder dystocia.

Understanding risk factors for shoulder dystocia using interpretable machine learning

To use interpretable machine learning to identify the most important risk factors for shoulder dystocia (SD). This retrospective study used clinical data from 82,889 singleton vaginal births (24-43 weeks’ gestation) from 20 U.S. hospitals (01/2016 - 12/2021) to train and externally validate a predictive model for SD using 57 features available at the time of delivery plus birthweight (which can be estimated prenatally but is not known until birth). Using bootstrap analysis, an Explainable Boosting Machine (EBM) was trained using data from 59,665 births at 13 hospitals and externally validated using 23,224 births at 7 different hospitals. A logistic regression (LR) model was also trained for comparison. SD occurred in 3.4% of births. An AUC of 0.74 (95% CI 0.73 – 0.75) was obtained for the EBM. Sensitivity for SD was 62%, for a false positive rate (FPR) of 25%. LR yielded an AUC of 0.74 (95% CI 0.73 – 0.75). The most important features for predicting SD were birthweight, maternal height, BMI, cervical dilation at initial exam, and time from admission to full dilation. SD risk increased dramatically and linearly with birthweight and decreased as maternal height increased (Figure 1). Surprisingly, length of 2nd stage was not a strong predictor. Using only the top 5 features gave a slightly higher AUC of 0.75 (95% CI 0.74 – 0.76) and a 65% sensitivity for a 25% FPR, suggesting that eliminating some features might yield a small model with clinically useful SD prediction. AI models trained on these data yielded modest accuracy for predicting shoulder dystocia risk and EBM intelligibility highlighted that consideration of factors in addition to fetal weight, may add to the assessment of risk. EBMs also reinforced the need to accurately estimate fetal weight, as evident through birthweight’s exceptionally large contribution to risk. Our results suggest that a novel, clinically useful model for predicting SD at the time of delivery might be achievable using only a small number of features.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Canine Dystocia: The Risk Factors and Treatment Methods in Dogs of Hanoi, Vietnam

Dystocia is a common disorder that can cause harmful health risks to bitch and puppies. The aim of the current study was to evaluate some risk factors related to canine dystocia and the application of treatment methods to 612 diagnosed cases in Gaia Pets Clinic and Resort, Hanoi, Vietnam, from December 2013 to May 2020. The investigated factors comprised age, parity and breed size, and litter size, as well as fetal sex in relation to the proportion of dystocia in female canines. Dystocia was frequently observed in female dogs aged 1-3 years, with rates of 76.1%. The highest proportion of dystocia was found in the first litter group (80.21%). The incidence of dystocia increased as the weight of the dog decreased, and it was prevalent in the small breed (61.93%). Dystocia risk decreased as the litter size increased. The interventions used in this study were medical treatment with the hormone oxytocin (1.8%), surgical management with cesarean section (86.11%), and a combination of oxytocin and cesarean section (12.09%), with the success rates of each treatment method as 100%, 98.86%, and 100%, respectively. Some risk factors, such as age, parity, breed size, and litter size identified in the present research, could be used as prognostic indicators in the veterinary practice to optimize the survival rate of female dogs and puppies.

Gestational weight gain as a risk factor for dystocia during first delivery: a multicenter retrospective cohort study in Japan

BackgroundDystocia is a common obstetric complication among nulliparous women, which requires medical intervention and carries the risk of negative maternal and neonatal outcomes. Our aim was to examine the association between body mass index (BMI) and the occurrence of dystocia. We also identified cutoffs of gestational weight gain, based on pre-pregnancy BMI, associated with the risk of dystocia.MethodsThis was a multicenter, retrospective, cohort study conducted in two tertiary Maternal–Fetal medicine units in Fukushima, Japan. The study population included nullipara women who delivered at either of the two units between January 1, 2013, and December 31, 2020. Women (n = 2597) were categorized into six groups (G) based on their pre-pregnancy BMI: G1 (< 18.5 kg/m2), G2 (18.5 to < 20.0 kg/m2), G3 (20.0 to < 23.0 kg/m2), G4 (23.0 to < 25.0 kg/m2), G5 (25.0 to < 30.0 kg/m2), and G6 (≥ 30.0 kg/m2). Using G3 as a reference, multiple logistic regression analyses were performed to estimate the risk of dystocia for each BMI category. Receiver operating characteristic curve analyses were performed to determine the cutoff value of gestational weight gain for the risk of dystocia.ResultsThe highest BMI category (G6) was an independent risk factor for dystocia (adjusted odds ratio, 3.0; 95% confidence interval, 1.5–5.8). The receiver operating characteristic curve analysis revealed no association between gestational weight gain and the occurrence of dystocia in G5 and G6 (P = 0.446 and P = 0.291, respectively). For G1 to G4, AUC and predictive cutoffs of gestational weight gain for dystocia were as follows: G1, AUC 0.64 and cutoff 11.5 kg (P < 0.05); G2, AUC 0.63 and cutoff 12.3 kg (P < 0.05); G3, AUC 0.67 and cutoff 14.3 kg (P < 0.01); and G4, AUC 0.63 and cutoff 11.5 kg (P < 0.05).ConclusionA pre-pregnancy BMI > 30.0 kg/m2 was an independent risk factor for dystocia. For women with a pre-pregnancy BMI < 25.0 kg/m2, the risk of dystocia increases as a function of gestational weight gain. These findings could inform personalized preconception care for women to optimize maternal and neonatal health.

Risk factors for neonatal mortality prior to hospital discharge in brachycephalic and nonbrachycephalic dogs undergoing cesarean section.

To compare neonatal survival to discharge rates between brachycephalic and nonbrachycephalic dogs undergoing cesarean section (c-section) and identify risk factors for neonatal mortality. Retrospective study. A total of 480 puppies from 90 bitches undergoing 106 c-sections. Medical records of c-sections performed between January 2012 and September 2021 were reviewed. Data collected included brachycephalic versus nonbrachycephalic breed, elective versus emergency c-section, litter size (c-section and total [including those born prior to and via c-section]), and neonatal survival to discharge. A generalized linear mixed model (univariable and multivariable) was performed to evaluate variables versus neonatal survival. Overall neonatal survival to discharge was 93.1% (447/480); survival was similar between brachycephalic and nonbrachycephalic breeds (p=.221, 202/213 [94.8%] brachycephalic survival, 245/267 [91.8%] nonbrachycephalic survival). Puppies delivered via elective c-section were more likely to survive compared to emergency c-section (p < .001, 238/240 [99.2%] elective survival, 209/240 [87.1%] emergency survival). Puppies delivered in larger c-section litters were more likely to survive (p <.004) compared to smaller litters. Total litter size had no effect on survival. Brachycephalism had no effect on neonatal survival. Puppies delivered via elective c-section were more likely to survive compared to puppies delivered via emergency c-section. Outcomes following c-section are similar between brachycephalic and nonbrachycephalic breeds. While it is preferable to encourage selective breeding for bitches that are able to whelp naturally, elective c-section should be considered in bitches at high risk for dystocia to maximize neonatal survival.

Establishment of a method to predict dystocia due to physical imbalance between foetus and maternal pelvis in Japanese black cattle

AbstractThis study aimed to clarify the relationship between the maternal pelvis and calf size in normal and dystocia groups (Experiment 1) and to establish a method to predict dystocia due to physical imbalance between foetus and maternal pelvis before calving based on the parameters found in Experiment 1 (Experiment 2). In Experiment 1, 26 pairs of dams and their offspring were tested immediately after calving, and various parameters of offspring size and maternal pelvis were measured in normal and dystocia cases. The longitudinal diameter of the maternal pelvis was smaller (p &lt; .01), and ratios of the offspring's birth weight and the width of the hoof crown (hoof width; measured using callipers) to the longitudinal diameter of the maternal pelvis were larger (p &lt; .01) in the dystocia group than those in the normal group. In Experiment 2, 37 cows were tested, and in addition to the measurement items of Experiment 1, the inner pelvic diameter and the foetal hoof width were measured via ultrasonography at 285 days of gestation. The ratio of the internal diameter of the maternal pelvis (longitudinal diameter, transverse diameter and area) to the foetal hoof width was compared and was greater (p &lt; .01) in the dystocia group than in the normal group. In conclusion, the risk of dystocia can be estimated by the ratio of the foetal hoof width to the longitudinal diameter of the maternal pelvis before calving.