Risk Of Fetal Distress Research Articles

Umbilical cord length affects the efficacy of amnioinfusion for repetitive variable deceleration during labor

Objectives Although amnioinfusion (AI) for repetitive variable deceleration has been reported to reduce the frequency of variable deceleration and cesarean section (CS) rate, CS is sometimes unavoidable even after therapeutic AI. The purpose of this study was to investigate prenatal factors related to the efficacy of therapeutic AI during labor. Methods This retrospective study investigated 80 singleton pregnancies that underwent transcervical therapeutic AI for repetitive variable deceleration during labor. AI was performed with 500 mL of warmed saline through an intrauterine pressure catheter by gravity infusion. Prenatal factors related to emergency CS for fetal distress even after therapeutic AI were investigated. Results Emergency CS was performed for 12 of the 80 cases due to fetal distress. Z-score for umbilical cord length was significantly smaller in the CS group (−0.68 SD) than in the vaginal delivery group (0.15 SD, p < .001). No CSs were performed in cases with Z-score for umbilical cord length >–0.05 SD. No significant differences between CS and vaginal delivery groups were seen in gestational age at delivery, cervical dilatation at AI, birth weight, Z-score of birth weight, incidence of the nuchal cord or incidence of abnormal umbilical cord insertion. Conclusions Therapeutic AI for repetitive variable deceleration was considered useful, in many cases avoiding emergency CS. Short umbilical cord length (lower Z-score) was related to emergency CS after therapeutic AI for repetitive variable deceleration. Umbilical cord length may offer an important factor for assessing the risk of fetal distress that is difficult to avoid, if methods to accurately determine umbilical cord length can be developed.

Maternal Kronik Hepatit B Virüs Enfeksiyonu Gebelik ve Fetal Riskleri Artırıyor Mu?

Amaç: Dünyada 400 milyondan fazla kişi Hepatit B virüs (HBV)’ü ile enfektedir. Hepatit B virüs enfeksiyonun gebeler üzerindeki etkisi açık değildir. Gebelikte Kronik HBV varlığının gestasyonel diyabet, antepartum hemoraji, erken doğum tehdidi, yenidoğan sarılığı, düşük doğum ağırlığı gibi maternal ve fetal riskleri artırdığı belirtilmektedir. Bu çalışmanın amacı HBV’nün gebelik ve fetal riskler üzerine etkilerini araştırmaktır. Gereç-Yöntem: 2014-2017 yılları arasında hastanemizde canlı doğum yapan HBV ile enfekte 301 gebe ve bebeği vaka grubu; aynı yıllarda rastgele seçilen, hastanemizde canlı doğum yapan HBV ile enfekte olmayan gebeler ve bebekleri kontrol grubu olarak çalışmamıza dahil edildi. Retrospektif olarak hasta dosyalarından doğum şekli, abortus, preeklampsi, gestasyonel diyabet, antepartum hemoraji, fetal distres, gebelik haftası, doğum ağırlığı, intrauterin gelişme geriliği(IUGR) gibi maternal ve fetal sonuçları analiz edildi. Bulgular: Çalışmaya dahil edilen 301 HBsAg pozitif gebe kadının 189(%62,8)’inin doğum şekli normal vajinal doğum olup, 4(%1,3)’ü diyabet, 2(%0,7)’i preeklampsi, 82(%27,2)’inde abortus öyküsü ve 5(%1,7)’inde plesanta dekolmanı mevcuttu. HBsAg negatif hastalarla arasında istatistisel olarak anlamlı fark tespit edilmedi(p&amp;gt;0,05). HBsAg(+) annenin 6(%2) bebeğinde IUGR ve 12(%40)’ında fetal distres vardı. HBsAg(+) anne bebeklerinde fetal distres varlığını istatistiksel olarak anlamlı fark tespit ettik(p:0,036). Sonuç: Yapılmış bir çok çalışmada HBV enfeksiyonunun maternal ve fetal komplikasyonları artırdığı gösterilmiş olmasına rağmen çalışmamızda yalnızca fetal distres riskini anlamlı olarak bulduk. Çalışmamızda dikkat çeken nokta HBV varlığının hekimin doğum şekline karar vermesini etkilemediğini gördük.

Maternal hemoglobin level and its relation to fetal distress, mode of delivery, and short-term neonatal outcome: a retrospective cohort study

Aim: We aimed to investigate if the risk of fetal distress during term labor is related to the intrapartum maternal hemoglobin (Hb) level. Second, we investigated the relation between mode of delivery, reason for instrumental delivery and short-term neonatal outcome and maternal Hb. Third, we aimed to identify factors influencing intrapartum maternal Hb level.Methods: A retrospective cohort study was performed in a tertiary hospital in The Netherlands, including data from women who gave birth between 2009 and 2016. To determine whether the likelihood of fetal distress to occur was dependent on intrapartum Hb, multivariate regression models were run with intrapartum Hb as the main independent variable of interest. Hb was used as a continuous value. We repeated this procedure for the likelihood of instrumental vaginal delivery (IVD), cesarean section (CS), 5-min Apgar score < 7, and umbilical cord arterial pH ≤ 7.05 to occur. Also, we identified factors influencing intrapartum Hb level using linear regression analysis.Results: Data of 9144 patients were analyzed. Intrapartum Hb did not contribute to the prediction of the likelihood of fetal distress, IVD for nonprogressive labor, CS for fetal condition, 5-min Apgar score < 7, and pHa ≤ 7.05. However, there was a unique statistically significant contribution of Hb to the prediction of the likelihood of IVD for any reason and IVD for fetal distress and CS for any reason and CS for nonprogressive labor. IVD for fetal distress was related to a higher intrapartum Hb level, whereas CS for nonprogressive labor was related to a lower intrapartum Hb level. Intrapartum Hb level was influenced by maternal age, ethnicity, parity, fetal sex, and birth weight.Conclusions: The risk of fetal distress and adverse neonatal outcome is not related to intrapartum Hb levels. However, our data suggest that mode of delivery is dependent on intrapartum Hb, as shown in a large tertiary population. We recommend further investigating this relation in a large prospective study.

Maternal exposure to fine particulate matter and the risk of fetal distress

Prenatal life exposure to fine particulate matter (aerodynamic diameter less than or equal to 2.5 µm, PM2.5) has been linked with increased risk of adverse fetal development and birth outcomes in previous studies. However, to our knowledge, no study has investigated the association of maternal PM2.5 with the risk of fetal distress, which is a harmful fetal status and may lead to fetal brain damage, even fetal death. Therefore, we conducted a study to determine the association between maternal PM2.5 and fetal distress among 7835 mother-infant pairs from a birth cohort, in Wuhan, China, 2013–2015. The individual daily PM2.5 level was assessed using land use regression model. We evaluated the association of maternal PM2.5 level over the whole pregnancy with fetal distress by logistic regression model, and estimated the risk between PM2.5 exposure in specific trimester and fetal distress using generalized estimating equations. We observed that per 10 µg/m3 change of maternal PM2.5 level over the whole pregnancy was associated with 25% increased risk of fetal distress (95% confidence interval: 1.09–1.44). Further, we found PM2.5 level in the 2nd trimester, but not in the 1st and 3rd trimesters, was associated with fetal distress. Stratified analyses indicated that the association was only significant among infants who were born in cold seasons. Our study suggested that PM2.5 exposure during the whole pregnancy exhibited significant associations with the risk of fetal distress, and exposure in the 2nd trimester maybe the susceptible window. Further stratified analyses indicated that birth season is a possible modifier in the association.

Peripartum fetal distress in diabetic women: a retrospective case-cohort study

BackgroundMajor concerns of pregnancies complicated by diabetes mellitus are an increased risk of adverse perinatal outcome. The objective of this study was to analyse the rate of fetal distress during labor in women with type 1, type 2 and gestational diabetes compared to control women.MethodsA retrospective case-cohort study was conducted at the VU University Medical Center, Amsterdam; a tertiary care hospital. 117 women with type 1 diabetes, 59 women with type 2 diabetes, 303 women with gestational diabetes and 15,260 control women were included, who delivered between March 2004 and February 2014. Linear and logistic regression analyses were used to compare maternal and pregnancy characteristics. Risk of fetal distress and perinatal asphyxia was assessed by multiple regression analyses, adjusted for confounding factors as age, smoking, parity, previous cesarean section, hypertensive disorder, pre-eclampsia, prematurity, induction of labor and macrosomia. Main outcome measure was fetal distress, defined either as clinical indication for instrumental or cesarean delivery; or low umbilical artery pH (UA pH), or admission to neonatal unit (NU).ResultsThe indication for instrumental or cesarean delivery in women with type 1 and type 2 diabetes mellitus was more frequently based on fetal distress as compared to controls (adjusted OR 2.76 CI 1.74–4.40 and adjusted OR 2.31 CI 1.19–4.51, respectively). In comparison with the control group, infants of women with type 1 diabetes had an increased risk of UA pH < 7.20 (adjusted OR 1.88 CI 1.23–2.87) or UA pH < 7.10 (adjusted OR 3.35 CI 1.79–6.27). Also, infants of women with type 1 diabetes were at increased risk for admission to NU as compared to infants of control women (OR 8.07 CI 4.75–13.70).ConclusionsWomen with type 1 and type 2 diabetes are at increased risk of fetal distress during labor as compared to controls.

Ретроспективный анализ гестационных осложнений и перинатальных исходов у женщин с дисфункцией щитовидной железы

The objective: A study of features of the course of pregnancy and perinatal outcomes in women with thyroid dysfunction. Analysis of the risk prediction of gestational and perinatal complications, depending on the level of antibodies to thyroid peroxidase (AB-TPO). Patients and methods. A retrospective study of 526 histories and stories birth of generations of women-carriers of antibodies to thyroid peroxidase and 489 of their newborns The group of comparison was formed of 40 stories birth somatically healthy women without the elevated levels of AB-TPO and 40 stories of their newborns. The analysis of the course of pregnancy and perinatal outcomes, evaluation of risk prediction of gestational and perinatal complications, depending on the level of AB-TPO. Results. Established that women carriers of AB-TPO age has the older category; among extragenital diseases most often identified diseases of otolaryngology and neurocirculatory dystonia. Obstetric anamnesis burdened by the pregnancy miscarriage and perinatal losses. In the structure of gestational and perinatal complications, the principal place is the threatened miscarriage, preeclampsia, fetal distress, asphyxia of newborns. Discovered the effect of the starting threshold level of AB-TPO on the risk of occurrence impendence interruption of pregnancy (AB-TPO=315 IU/ml); the risk of miscarriage (AB-TPO=339.8 IU/ml); the risk of fetal distress (AB-TPO = of 247.5 IU/ml); the risk of neonatal asphyxia (AB-TPO=234.8 IU/ml). Didn’t discovere influence of starting threshold level of AB-TPO on the risk of preeclampsia and pathological birht. Conclusion. Women carriers of the AB-TPO constitute a group of high risk of obstetric and perinatal pathology. Discovered the influence of the starting threshold level of AB-TPO on the risk of gestational complications. Key words: pregnancy, level of antibodies to thyroid peroxidase, miscarriage, gestational and perinatal complications.

To Determine the Effects of Labor Induction on Maternal and Fetal Outcome in Postterm Pregnancies (41 Weeks Plus)

Background: Pregnancies progressing postterm are associated with a higher perinatal morbidity and mortality rates than those delivered at term. In a United Kingdom study, the rate of stillbirth increased from 0.35 in 1000 live births in pregnancies of 37 weeks to 2.12 in 1000 live births in pregnancies of 43 weeks gestation. Morbidities associated with postterm births include an increased risk of fetal distress, intrauterine growth restriction, dysfunctional labor, shoulder dystocia, obstetric trauma (relative risk 1.09 - 1.68) and an increase in perinatal complications, such as aspiration of meconium and asphyxia, peripheral nerve injury, greenstick bone fractures, pneumonia and septicemia (adjusted odds ratio 1.4 - 2.0). Antenatal surveillance and induction of labor may decrease the risks of an adverse outcome. In a recent review of term and postterm pregnancies in Norway, we found that there were adverse outcomes associated with both postterm pregnancy and induction of labor independently. On comparison of the two, a randomized controlled trial showed no difference in their neonatal outcome, but demonstrated a reduction in the cesarean delivery rate when labor was induced at 41 weeks. Aim of the Work: The aim of this study was to determine the effect of labor induction on maternal and fetal outcome in postterm pregnancies. Subjects and Methods: This study was carried out on 150 pregnant women who had completed 41 weeks of gestation between Jun. 1, 2012 up to Dec. 31, 2012 at Department of Obstetrics & Gynecology, Faculty of Medicine, Benghazi University, and were scheduled for induction of labor after cardiotocography (CTG) and ultrasonography (USS) have been done and Bishop’s score assessed, to determine the effects of labor induction on maternal and fetal outcome in postterm pregnancies (41 weeks plus). Results: Regarding the relationship between a history of (H/O) postdatism and fetal distress, it was found that there was no significant relationship between them. There was a significant relationship between a history of macrosomia and fetal distress. There was a significant relationship between instrumental delivery and fetal distress. The majority of the fetal distress had an indication for Caesarean section (CS) (fetal distress (FD) and fetal distress meconium (FDM) more than those without fetal distress. All fetuses that had APGAR scores of 8 were distressed. There was a significant relationship between the APGAR score at 10 minutes with fetal distress. All fetuses that had meconium aspiration had fetal distress. There was a significant increase in the amount of oxytocin in unit in distressed cases than the non-distressed ones. The total duration of induction was also significantly increased in stressed fetuses than the non-stressed ones. There was a significant increase in the weight of distressed fetuses than the non-distressed. Conclusions: In conclusion, there was no difference in the neonatal outcome or mode of delivery for postterm pregnancies managed either by immediate induction of labor or expectantly with serial antenatal surveillance. The outcomes were generally good, and neonatal morbidity, cesarean section, and operative vaginal delivery rates were low. If pregnancy is uncomplicated and continued surveillance is possible, women’s own wishes may guide the decision to induce or monitor a pregnancy beyond 41 weeks.

Nuchal cord complication in male small for gestational age increases fetal distress risk during labor

ObjectiveThis study aimed to evaluate whether a nuchal cord increases the risk of perinatal complications during labor, and whether fetal growth and sex affect the risk of fetal distress. Materials and MethodsMedical records of 1749 women with singleton pregnancies planning a vaginal delivery were enrolled. Patients were divided into two groups according to the presence or absence of a nuchal cord at birth. Multivariate logistic regression analyses, odds ratios (ORs), and 95% confidence intervals (CIs) were used to determine whether the risks of perinatal complications increased in the nuchal cord group. ResultsA nuchal cord is associated with higher risks of Rupture of membranes (ROM) prior to delivery (OR = 1.40, 95% CI: 1.12–1.76, p = 0.0031), need for augmentation during labor (OR = 1.68, 95% CI: 1.27–2.23, p = 0.0003), prolonged second stage of labor (OR = 2.54, 95% CI: 1.55–4.25, p = 0.0002), nonreassuring fetal heart risk during labor (OR = 2.89, 95% CI: 2.18–3.84, p < 0.0001), and instrumental delivery or cesarean delivery (OR = 2.00, 95% CI: 1.55–2.58, p < 0.0001). Fetal distress risk during labor was affected by fetal growth and sex, with male small for gestational age fetuses with a nuchal cord having a significantly higher risk than the control group (OR = 9.77, 95% CI: 3.67–25.79, p < 0.0001), despite there being no significant differences in the neonatal Apgar scores at 1 minute or 5 minutes, or in the need for neonatology between the two groups. ConclusionNuchal cord is associated with perinatal outcomes. Male small for gestational age fetuses with a nuchal cord have a significantly higher risk of fetal distress during labor. Our results suggest that evaluation of fetal sex and body weight is also important in antenatal ultrasonography if a nuchal cord is found.

Surgical Strategy Using Endoscopy to Minimize Fetal Surgical Risks in Treating a Pregnant Woman with Herniated Lumbar Disc Disease

Pregnancy poses a special clinical challenge in surgical treatments for spinal diseases. Here we present the case of a 30-year-old woman with a ruptured lumbar disc on the right side of L5–S1. The patient was 18 weeks pregnant. Conservative managements for 3 weeks had failed to relieve her pain. We performed interlaminar percutaneous endoscopic lumbar discectomy (PELD) using spinal anesthesia. The left lateral decubitus position was chosen to minimize abdominal compression. Preoperative magnetic resonance imaging (MRI) taken after attaching few fiducial markers at patient's mid-lower back was used to secure the correct surgical level without X-rays. The surgery was successful, and the patient's pain score on a visual analogue scale was reduced from 9/10 to 3/10. Ultrasonography was used to confirm that the baby was healthy postoperatively. PELD causes less pain, and dose not require general anesthesia, which imposes a higher risk of fetal distress than regional anesthesia. Combination of the interlaminar approach of accessing from the midline and a marking MRI permitted PELD without X-ray imaging. The relative ease of performing surgery on either side of the lateral decubitus position makes PELD more feasible for pregnant patients.

Comparison of Vaginal and Oral Doses of Misoprostol for Labour Induction in Post-Term Pregnancies.

Considering maternal complications, it is preferred to induce labour after 40 weeks. Labour induction is a procedure used to stimulate uterine contractions during pregnancy before the beginning of the labour. The aim of this study was to compare oral misoprostol with vaginal misoprostol for induction of labour in post-term pregnancies. This double blind clinical-trial study was performed on 180 post-term pregnant women who were admitted to the labour ward of Besat Hospital Sanandaj, Iran in 2013-2014. Participants were equally divided into three groups using block randomization method. The induction was performed for the first group with 100 μg of oral misoprostol, for the second group with 50 μg of oral misoprostol, and for the third group with 25 μg of vaginal misoprostol. Vaginal examination and FHR was done before repeating each dose to determine Bishop Score. Induction time with misoprostol to the start of uterine contractions, induction time to delivery, and mode of delivery, systolic tachycardia, hyper stimulation and fetal outcomes were studied as well. First minute Apgar scores and medication dosage of the study groups were significantly different (p=0.0001). But labour induction, induction frequency, mode of delivery, complications, and 5 minutes Apgar score in the groups had no significant difference (p>0.05). The risk of fetal distress and neonatal hospitalization of the groups were statistically significant (p=0. 02). There was no significant difference between the three groups in terms of mean time interval from the administration of misoprostol to the start of uterine contractions (labour induction), the time interval from the start of uterine contractions to delivery and taking misoprostol to delivery. From the administration of misoprostol to start of the uterine contractions the mean difference between time intervals in the three groups were not statistically significant. Based on our findings it can be concluded that prescribing 100μg oral misoprostol is effective than 50 μg oral or 25 μg vaginal misoprostol in terms of induction time, maternal and neonatal outcomes in post- term pregnancy. However, the best dose and route should be decided according to evidence based information.

PARTIAL DIRECTED COHERENCE OF CARDIOTOCOGRAPHIC SIGNALS FOR ANALYSIS OF PRETERM BIRTH RISK

Traditional methods of fetal monitoring are used mainly during labor, leaving the only course of action . the caesarean intervention . in cases with high risk of fetal distress. We used another approach and set up a database that consists of cardiotocographic (CTG) recordings acquired ante partum during the 25th-28th week of pregnancy, by means of a Monica Healthcare AN24 fetal monitoring system. The analyzed signals are the maternal heart rate (MHR), the fetal heart rate (FHR) and the maternal uterine contractions (UC). The database is divided into two groups based on the risk of preterm labor: the control group that consists of 64 normal recordings and the study group that has 48 pathological or suspicious recordings. The analyzing method implemented is the Partial Directed Coherence (PDC) that determines the degree of correlation and the dynamic of couplings between corresponding signals. The purpose of the analysis is to identify the differences between the two groups and correlation degree for the specified signals in pathological or suspicious cases.

Self-reported sleep in late pregnancy in relation to birth size and fetal distress: the E Moe, Māmā prospective cohort study

ObjectivesTo explore associations between features of sleep during pregnancy and adverse outcomes for the infant.SettingE Moe, Māmā is a cohort study in Aotearoa/New Zealand that investigates self-reported sleep and maternal...

Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial.

As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section. Prospective randomized controlled clinical trial in a tertiary-level public hospital. Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50) and spinal anesthesia (n = 50) groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups. Mean bowel sounds (P = 0.036) and gas discharge time (P = 0.049) were significantly greater and 24th hour hemoglobin difference values (P = 0.001) were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively), urine volume at the first postoperative hour (P < 0.001) and median Apgar score at the first minute (P < 0.0005) were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042), in the spinal anesthesia group. In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.

Anaemia of Pregnancy, Perinatal Outcomes and Children's Developmental Vulnerability: a Whole‐of‐Population Study

There is limited longitudinal data from high-income countries on the sequelae of anaemia during pregnancy. The aim of this study is to examine whether anaemia of pregnancy is associated with adverse perinatal outcomes and with children's developmental vulnerability. We conducted a population-based study to link routinely collected government administrative data that involved all live births in the state of South Australia 1999-2005 (n = 124 061) and a subset for whom developmental data were collected during a national census of children attending their first year of school in 2009 (n = 13 654). Perinatal outcomes were recorded by midwives using a validated, standardised form. Development was recorded by schoolteachers using the Australian Early Development Index (AEDI). Children in the lowest 10% of AEDI scores are indicative of developmental vulnerability. There were 8764/124 061 (7.1%) cases of anaemia. After adjustment for a range of potentially confounding factors, anaemia of pregnancy was associated with a higher risk of fetal distress [incident rate ratio (IRR) 1.20 [95% CI 1.13, 1.27]] and preterm birth <37 weeks gestation (IRR 1.23 [1.15, 1.31]), slightly higher birthweight [14 g (2, 26)] and newborns were less likely to require resuscitation (IRR 0.94 [0.91, 0.097]). Anaemia of pregnancy was not associated with children's developmental vulnerability after adjustment for maternal, obstetric and sociodemographic covariables, either in complete case analyses (n = 11 949) or after imputation for missing data (n = 13 654). Anaemia of pregnancy is associated with perinatal complications but not with children's developmental vulnerability at school entry.

Fetal head circumference, operative delivery, and fetal outcomes: a multi-ethnic population-based cohort study.

BackgroundOperative delivery procedures, such as primary cesarean section, vacuum-assisted, and forceps-assisted vaginal delivery increase maternal and fetal morbidity, and the cost of care. We evaluated whether large fetal head circumference (FHC) independently increases risk of such interventions, as well as fetal distress or low Apgar score, in anatomically normal infants.MethodsWe conducted a population-based retrospective cohort study using Washington State birth certificate data. We included singleton, term infants born to nulliparous mothers from 2003–2009. We compared mode of delivery and fetal outcomes in 10,750 large-FHC (37-41 cm) infants relative to 10,750 average-FHC (34 cm) infants, frequency matched by birth-year.ResultsLarge-FHC infants were nearly twice as likely to be delivered by primary cesarean section as average-FHC infants (unadjusted relative risk [RR] 1.84, 95% confidence interval [CI]: 1.77, 1.92). The RR for primary cesarean section associated with large-FHC was largest for mothers aged 19 years or less (RR 2.28; 95% CI: 1.99, 2.61), and smallest for mothers aged 35 years or greater (RR 1.51; 95% CI: 1.37, 1.66) [test of homogeneity, p < 0.001]. Large-FHC infants were at increased risk of vacuum-assisted vaginal delivery (RR 1.55; 95% CI: 1.43, 1.69), and forceps-assisted vaginal delivery (RR 1.61; 95% CI: 1.32, 1.97). There was no difference in risk of fetal distress (RR 0.97; 95% CI: 0.89, 1.07) for large-FHC versus average-FHC infants. Risk estimates were unaffected by adjustment for potential confounders.ConclusionsNulliparous mothers of large-FHC infants are at increased risk of primary cesarean section, vacuum-assisted and forceps-assisted vaginal delivery relative to mothers of average-FHC infants. Maternal age modifies the association between FHC and primary cesarean section.

Maternal oxygen administration for fetal distress

Maternal oxygen administration has been used in an attempt to lessen fetal distress by increasing the available oxygen from the mother. This has been used for suspected fetal distress during labour, and prophylactically during the second stage of labour on the assumption that the second stage is a time of high risk for fetal distress. The objective of this review was to assess the effects of maternal oxygenation for fetal distress during labour and to assess the effects of prophylactic oxygen therapy during the second stage of labour on perinatal outcome. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (22 October 2012) and searched reference lists of retrieved studies. Randomized trials comparing maternal oxygen administration for fetal distress during labour and prophylactic oxygen administration during the second stage of labour with a control group (dummy or no oxygen therapy). Both review authors assessed eligibility and trial quality. Data were extracted, checked and entered into Review Manager software. For dichotomous data, we calculated relative risks (RR) and 95% confidence intervals (CI). For continuous data, we calculated weighted mean differences and 95% CI. We located no trials addressing maternal oxygen therapy for fetal distress. We included two trials which addressed prophylactic oxygen administration during labour. Abnormal cord blood pH values (less than 7.2) were recorded significantly more frequently in the oxygenation group than the control group (RR 3.51, 95% CI 1.34 to 9.19). There were no other statistically significant differences between the groups. There were conflicting conclusions on the effect of the duration of oxygen administration on umbilical artery pH values between the two trials. Implications for practice There is not enough evidence to support the use of prophylactic oxygen therapy for women in labour, nor to evaluate its effectiveness for fetal distress.Implications for research In view of the widespread use of oxygen administration during labour and the possibility that it may be ineffective or harmful, there is an urgent need for randomized trials to assess its effects.

Low placental weight and risk for fetal distress at birth

Abstract Objective: The objective of this study was to assess whether low placental weight is associated with higher risk of emergency delivery (cesarean section and vacuum-assisted delivery). This was a retrospective cohort study, including 657 normally developed term pregnancies. A strict methodology was used to provide reliable and reproducible placental weight measurement. Fetal heart rate patterns were analyzed according to the guidelines of the Royal College of Obstetricians and Gynecologists. Linear and logistic multiple regression analyses were used to assess risk factors for emergency delivery. Nulliparity, placental weight <10th percentile, and delivery after 40 weeks of gestation remain significantly associated with higher risk of emergency delivery for non-reassuring fetal status in the multivariable model [odds ratio (OR) 5.13, 95% confidence interval (CI) 2.85-9.22, P<0.001; OR 2.46, 95% CI 1.49-4.06, P<0.001; OR 2.23, 95% CI 1.26-4.51, P=0.01, respectively]. In the group of women who had an emergency delivery, 17.3% had a placental weight <10th percentile, which was significantly different to the group of women who delivered normally (9.4%, P≤0.04). If only emergency cesarean sections were analyzed, the percentage of women with placental weight <10th percentile was 37.5% in the cesarean section group compared to 9.8% in women who delivered normally (P≤0.001). This study suggests that, in clinically normally developed term pregnancies, placental weight <10th percentile is associated with an increased risk for emergency delivery during labor. These results warrant further prospective studies for potential use in clinical practice.

OP12.09: Follow‐up and perinatal outcome of fetuses with gastroschisis complicated by secondary bladder herniation

at mean 34+1 weeks lead to emergency CS. One of these fetuses was growth-retarded (−36%) and was delivered at 29+5 weeks and had a subsequent normal development. Spontaneous onset of labor started in 17% at mean 34+6 weeks. Closing or closed gastroschisis was correctly diagnosed prenatally in 10%. In 2 of these cases, closed gastroschisis with subsequent short bowel syndrome occurred already before viability; the other cases could be delivered prior to irreversible bowel damage. Conclusions: The intense surveillance of fetuses with gastroschisis seems to be important for detecting cases at risk for fetal distress and may thereby reduce the risk of intrauterine fetal death. Especially in complicated cases, for example growth retardation, the CTG surveillance may be of utter importance. In addition correct diagnosis of closing/closed gastroschisis is possible and may prevent the risk of vanishing bowel.

OP12.10: Sonographic shape of the portal vein‐portal sinus anastomosis and birth weight

at mean 34+1 weeks lead to emergency CS. One of these fetuses was growth-retarded (−36%) and was delivered at 29+5 weeks and had a subsequent normal development. Spontaneous onset of labor started in 17% at mean 34+6 weeks. Closing or closed gastroschisis was correctly diagnosed prenatally in 10%. In 2 of these cases, closed gastroschisis with subsequent short bowel syndrome occurred already before viability; the other cases could be delivered prior to irreversible bowel damage. Conclusions: The intense surveillance of fetuses with gastroschisis seems to be important for detecting cases at risk for fetal distress and may thereby reduce the risk of intrauterine fetal death. Especially in complicated cases, for example growth retardation, the CTG surveillance may be of utter importance. In addition correct diagnosis of closing/closed gastroschisis is possible and may prevent the risk of vanishing bowel.

Why women request cesarean section without medical indication?

Objective. To understand the reasons of the cesarean delivery on maternal request (CDMR) without medical indication would help to reduce the rates of unnecessary cesarean-delivery (CD). The objective of this study is to determine the basal knowledge of women regarding normal delivery (ND) and CD and also to assess their attitudes about CDMR, and to find out the reasons influencing those attitudes.Methods. The study included 400 women who completed a 45-item questionnaire that assessed their basal knowledge of ND, CD, and their attitudes and beliefs about the mode of delivery and CDMR.Results. Mean age of the study population was 32 ± 10.2 years (range 18–66). Majority of the women would choose the ND because of its ‘being completely natural’ (89%) and no anesthesia and operative risk related with ND (76%). Only 33% of the women indicated that ND might cause genital organ prolapse and/or stress urinary incontinence and just 26% and 24% of the women would choose CD to prevent pelvic organ prolapse and stress urinary incontinence, respectively. On the other hand, 50% and 54% of the women would indicate that they could choose CD in order to prevent labor pain and to minimize the risk of fetal distress during the labor. Furthermore, 47% of the women had an opinion that that CD could be performed by maternal request without medical indication. Educational level had no effect of CDMR although more educated women had more accurate knowledge about the some risk and benefits of ND and CD. Binary logistic regression analysis revealed that fear of labor pain (p = 0.02, OR: 15.0, CI: 0.494–0.966), maternal age (p = 0.01, OR: 6.3,CI: 1.00–1.05), and knowledge about the relation between the ND and pelvic organ prolapse/urinary incontinence (p < 0.001, OR: 4.8, CI: 0.549–0.966) were the independent prognostic variables for the CDMR .Conclusion. Although majority of the women had wrong idea or no idea about the risks and benefits of CD, nearly half of them indicated that women can always demand CDMR. This study shows that basal knowledge of the women should be improved by education.