Evaluation of the effectiveness of simulation in shoulder dystocia management training: A randomized controlled trial

Adverse perinatal outcomes associated with macrosomia in nulliparous women: A multicenter cohort study.

Type 1 diabetes (T1D) increases the risk of pregnancy complications due to hyperglycemia and vasculopathy, leading to higher rates of preeclampsia and obstetric interventions. A contemporary reassessment of maternal and obstetric outcomes in women with T1D is needed, considering care for women with T1D in Sweden is inequitable. This study aimed to investigate maternal and obstetric outcomes among women with T1D in Sweden. In this population-based cohort study, data from the Swedish Medical Birth Register were used to compare maternal and obstetric outcomes among women with and without T1D. The study included all primiparous women with singleton births beyond 22+0 gestational weeks and a planned vaginal delivery between 2010 and 2022 (N=558 546). Logistic regression analyses were performed, and results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Among the study population, 2749 women had T1D and 555 797 did not. After adjustment, women with T1D had increased odds of preeclampsia (aOR 5.57; 95% CI 5.07-6.16), induction of labor (aOR 6.62; 95% CI 6.11-7.18), cesarean section (aOR 4.71; 95% CI 4.35-5.11), and shoulder dystocia (aOR 11.81; 95% CI 9.20-15.17). Elevated risks were also observed for vacuum extraction, prolonged labor, fetal distress, and postpartum endometritis. Women with T1D face substantially higher risks of pregnancy complications and birth interventions compared with women without T1D. These findings underscore the importance of tailored preconception and perinatal care, as well as targeted interventions to improve maternal and obstetric outcomes in T1D.

With implementation of newborn screening (NBS) for Duchenne muscular dystrophy (DMD), creatine kinase-muscle (CK) values will be reported on newborns. Maternal, labor, delivery, and newborn factors may elevate CK levels, raising concern for DMD. Predictive modeling could aid hyperCKemia interpretation while awaiting diagnostic confirmation. In this single-center, prospective cohort study, parents of 8365 newborns were offered DMD-NBS. Electronic health records provided data on candidate predictors of hyperCKemia defined by values > 97th or 99th percentiles, or 2000 ng/mL in babies with normal DMD sequences. Exposures included maternal, newborn and perinatal factors. Associations between predictors and hyperCKemia were evaluated using univariate logistic regression. A multivariable prediction model for the 97th percentile was derived using backward stepwise logistic regression and externally validated in a cohort of 2672 newborns. HyperCKemia > 97th percentile was the main outcome. Univariate analyses revealed associations between hyperCKemia and maternal ethnicity, primiparity, labor and delivery complications, oxytocin induction or augmentation, duration of ruptured membranes, forceps or vacuum-assisted delivery, neonatal resuscitation, sex, gestational age, birth weight, and Apgar scores. Lower odds of hyperCKemia were associated with later hour-of-life at sample collection and birth by cesarean section. The final model included parity, shoulder dystocia, forceps or vacuum-assisted delivery, gestational age, neonatal resuscitation, Apgar score (1 min), and time of sample collection. Elevated CK levels may be used for DMD-NBS. Multiple perinatal factors are associated with transient non-DMD hyperCKemia. Our model considers the potential combined impact of such factors and generates a non-disease likelihood for preliminary hyperCKemia interpretation.

Neonatal encephalopathy requiring therapeutic hypothermia over 5years in a national Irish birth cohort: Relevance of the obstetric data.

Gestational diabetes mellitus (GDM) is associated with complications such as fetal macrosomia, shoulder dystocia, and prolonged labor, making cesarean section an important delivery option to reduce maternal and neonatal risks. This study aims to identify factors associated with cesarean delivery in women with GDM and to develop a predictive model for clinical risk assessment. This retrospective cross-sectional study included 2,276 GDM patients who were delivered at a tertiary hospital from January 2020 to December 2023. Data on age, BMI, gravidity, abortion history, and family history of diabetes were collected. Patients were grouped by delivery mode. ANOVA/Kruskal-Wallis, chi-square test, Pearson correlation, and stepwise logistic regression were used to identify independent predictors. Two prediction models were developed and evaluated using ROC curves. Among all included GDM patients, 200 (8.79 %) underwent cesarean section. The average age and BMI were 30.8±3.9years and 23.658±4.221, respectively. Cesarean section rates increased with rising BMI (p<0.05). Significant differences among BMI groups were observed in age, number of pregnancies, miscarriage history, family history of diabetes, HbA1c, hemoglobin (HGB), and platelet count (PLT) (all p<0.05). BMI was correlated with adjusted BMI, HbA1c, HGB, and PLT. Logistic regression identified six independent predictors of cesarean section: BMI, adjusted BMI, HGB, PLT, prothrombin time (PT), and D-dimer. Model one showed good predictive ability (AUC=0.792). After optimization, Model two (including BMI grouping, number of miscarriages, and HbA1c) performed better (AUC=0.842). A multi-parameter model demonstrates strong potential for predicting cesarean risk in GDM patients and may assist clinical decision-making.

Background: Gestational diabetes mellitus (GDM) is a significant pregnancy complication linked to adverse maternal and fetal outcomes. The rising prevalence of GDM is emerging as a public health challenge. We aimed to explore the association between GDM and adverse pregnancy outcomes in India. Methods: A systematic search was performed to identify eligible studies on gestational diabetes mellitus (GDM) and adverse pregnancy outcomes in India based on inclusion &amp; exclusion criteria. The data was analyzed using R Studio. This systematic review and meta-analysis followed PRISMA guidelines and was registered with PROSPERO. Results: Women with GDM had higher odds of exposure to adverse maternal outcomes such as cesarean section, postpartum hemorrhage, gestational hypertension, and large-for-gestational-age births. Similarly, GDM significantly increased the odds of adverse fetal and neonatal outcomes, including preterm birth, macrosomia, stillbirth, hypoglycemia, hyperbilirubinemia, congenital malformations, and shoulder dystocia. These findings highlight the increased risk burden posed by GDM on both maternal and fetal health outcomes. Conclusion: GDM poses a substantial risk to both maternal and fetal health, contributing to multiple complications. Early detection and effective management strategies are crucial to mitigating adverse pregnancy outcomes in affected women

The impact of late-pregnancy glycemic control on pregnancy outcomes, especially in women with normal oral glucose tolerance test (OGTT) in mid-pregnancy, remain unclear. This study aimed to explore the potential benefits of maintaining glycemic levels within the target range during late pregnancy for improving pregnancy outcomes. A prospective cohort study (2018–2022) categorized participants into four groups based on the results of OGTT in mid-pregnancy and late-pregnancy fasting blood glucose (FBG) level: (1) Persistent normoglycemic group (PNG): normal OGTT, FBG < 5.3 mmol/L; (2) Late-pregnancy isolated hyperglycemia group (LPIHG): normal OGTT, FBG ≥ 5.3 mmol/L; (3) Gestational diabetes mellitus (GDM) with target glycemic control group (GDM-TC): GDM diagnosis, FBG < 5.3 mmol/L; (4) GDM with suboptimal glycemic control group (GDM-SC): GDM diagnosis, FBG ≥ 5.3 mmol/L. Associations with adverse perinatal outcomes were assessed using multivariate logistic regressions and population attributable fractions (PAF). A total of 35,378 pregnant women were included. The average age and pre-pregnancy BMI of all participants were 32.04 ± 3.85 and 21.86 ± 3.34 kg/m2. Of the participants, 15.43% were diagnosed with GDM. Among those with GDM, 9.27% had elevated FBG (≥ 5.3 mmol/L) in third trimester, whereas 2.01% of participants with a normal OGTT showed high FBG levels in late pregnancy. Compared to PNG, the risk of premature birth was significantly higher in the LPIHG, GDM-TC, and GDM-SC groups, with odds ratios (ORs) of 3.228 (2.503–4.162), 1.267 (1.097–1.463), and 1.883 (1.354–2.619) respectively. More importantly, significantly higher risks of adverse pregnancy outcomes, including cesarean section, macrosomia, and large-for-gestational age (LGA), were found in LPIHG and GDM-SC groups, with ORs of 1.335 (1.130–1.578) and 1.529 (1.272–1.838) for cesarean section; 1.579 (1.200-2.076) and 1.921 (1.474–2.504) for macrosomia; 1.477 (1.165–1.873) and 2.121 (1.699–2.648) for LGA. Given optimal late-pregnancy glycemic control, the respective PAF estimates were 0.8% (cesarean section), 5.0% (premature birth), 1.2% (macrosomia), and 1.1% (LGA) for non-GDM women; and 4.8% (cesarean section), 5.3% (premature birth), 10.0% (macrosomia), 11.0% (LGA), and 9.6% (shoulder dystocia) for GDM women. This study suggests that the optimal late-pregnancy glycemic control is significantly associated with improved perinatal outcomes, even in women with normal OGTT in second trimester.

Induction of labor versus standard care for suspected large-for-gestational-age fetuses: A systematic review and meta-analysis.

By implementing a new, real-time reporting surveillance system to capture patients born in an extensive regional healthcare system, the authors evaluated the incidence of brachial plexus birth injury (BPBI). They hypothesized that the true incidence of BPBI is higher than previously reported. A prospective surveillance system was established in obstetric units and affiliated tertiary-level neonatal ICUs (NICUs) at 2 sites within the authors' healthcare system to ensure the capture of every BPBI. If the infant was born at either site, this reporting system was used so that the patient underwent evaluation by a brachial plexus surgeon at birth and allowed for continuous follow-up by a multidisciplinary brachial plexus team to prevent losses to follow-up. A total of 392 patients were captured by the reporting system between November 2021 and November 2024. After analysis of the flagged patients, 236 (60.2%) patients had isolated shoulder dystocia; 108 (27.5%) had simultaneous shoulder dystocia and BPBI; 18 (4.6%) had BPBI alone; 11 (2.8%) had shoulder dystocia and a fracture; 10 (2.5%) had BPBI, shoulder dystocia, and a fracture; 3 (0.8%) had isolated humeral or clavicular fracture; 3 (0.8%) had BPBI and a fracture; and 3 (0.8%) had none of the above. Three patients were excluded from analysis due to loss to follow-up. Based on the 9776 live births at the 2 sites during the study period, the incidence of patients diagnosed with a BPBI at birth (n = 142) was calculated to be 14.5 per 1000 live births; 35 patients exhibited persistent BPBI symptoms beyond 2 months of age, resulting in an incidence of 3.6 per 1000 live births for persistent BPBI. This surveillance system more precisely identifies the incidence of BPBI than previously reported. It reveals the common frequency with which children encounter neuropraxia at birth. This study highlights the need for multidisciplinary institutional implementation of surveillance mechanisms to properly capture each BPBI for appropriate and timely intervention.

Brachial paralysis is an injury caused by stretching of nerve trunks or root avulsion due to traction mechanisms or trauma. A descriptive, retrospective, cross-sectional study with a quantitative approach was carried out in children aged 0 to 5 years with Brachial plexus injuries who underwent physiotherapy treatment at the Orthopedic center of Viana in the year 2021, with the aim of evaluating the injuries of the plexus. brachialis in children, a clinical and physiotherapeutic approach in 85 children who received the treatment. Results: The age that prevailed was 0 to 2 years old (72%) male 64.7%, the highest origin was the municipality of Viana; The main causes of PBO found were shoulder dystocia (41.1%), macrosomia (23.5%), and delayed deliveries (12.9%). The Erb-Duchenne lesion predominated in the study (81.1%). The techniques used in the physiotherapeutic treatment were infrared rays, exercises to reach, grab and manipulate objects, muscle stretching and strengthening; massage therapy; Wrist splint, sensory stimulation, among others, were rehabilitated (91.7%) of the children.

Several studies compared induction of labor to expectant management in singleton pregnancies with suspected large-for-gestational-age (LGA) or macrosomic fetuses. However, the most appropriate management, including the option of induction of labor, and at what gestational age, remains unclear. To evaluate the effects of labor induction for pregnancies with LGA or macrosomic fetuses on mode of delivery, and maternal and perinatal morbidity, and to evaluate the best gestational age for such induction if beneficial. A systematic literature search of electronic databases was conducted through November 1, 2025. Randomized controlled trials (RCTs) including term singleton pregnancies with suspected large-for-gestational-age (LGA) or macrosomic fetuses comparing induction of labor (IOL) with expectant management were included. The primary outcome was cesarean delivery, with secondary maternal and neonatal outcomes assessed. Pooled estimates were initially calculated using a fixed-effects model; random-effects analyses using a restricted maximum likelihood (REML) estimator were subsequently performed and heterogeneity was assessed using the I² and τ² statistics. Five randomized trials including 4083 pregnant individuals were analyzed. Baseline characteristics were comparable between groups. Most participants underwent induction at 38 weeks with the largest RCT (71% of the total sample of this meta-analysis), inducing labor at 38 0/7 to 38 4/7 weeks, for LGA > 90th percentile. For the primary outcome, IOL was associated with significant lower risk of cesarean delivery (27.9% vs 31.9%; risk ratio 0.87, 95% confidence interval 0.79 to 0.96) with no heterogeneity. Among secondary outcomes, induction of labor reduced the incidence of macrosomia ≥4000 g (RR 0.53, 95% CI, 0.48 to 0.59) and ≥4500 g (RR 0.22, 95% CI, 0.12 to 0.39). Shoulder dystocia (RR 0.73, 95% CI, 0.50 to 1.03) and fetal fracture (RR 0.35, 95% CI, 0.12 to 1.05) showed a trend toward risk reduction without reaching statistical significance in random-effects analyses. Phototherapy was more frequent following induction of labor (RR 1.62, 95% CI, 1.17 to 2.25), whereas other neonatal and maternal outcomes did not differ significantly between groups. Induction of labor between 38 0/7 to 38 4/7 weeks for suspected LGA (EFW >90th percentile) or macrosomic fetuses may be a reasonable management option, as it is associated with significant reductions in cesarean delivery, and a potential reduction in shoulder dystocia, and neonatal fractures, compared to expectant management. As the strongest evidence derives from induction at 38 0/7 to 38 4/7 weeks, counseling should emphasize this gestational window. Approximately 25 inductions of labor for EFW >90th percentile at 38 0/7 to 38 4/7 weeks would be required to prevent 1 cesarean delivery.

Pregestational diabetes mellitus (PGDM) is increasing in prevalence among pregnant individuals and is associated with adverse outcomes. Prior work suggests that offspring sex influences placental responses and may impact risk for adverse outcomes. We sought to assess the impact of offspring sex on adverse pregnancy and neonatal outcomes in individuals with PGDM.We conducted a retrospective cohort study of 503 pregnant individuals with PGDM and known offspring sex with care at a major urban academic center between 1998 and 2016. We assessed two co-primary composite outcomes: (1) a composite adverse pregnancy outcome of small for gestational age (SGA), hypertensive disorder of pregnancy (HDP), and stillbirth and (2) a composite adverse neonatal outcome of large for gestational age (LGA), hypoglycemia, hyperbilirubinemia, shoulder dystocia, and respiratory distress syndrome (RDS). Secondary outcomes of spontaneous preterm birth (PTB) and admission to the neonatal intensive care unit (NICU) were assessed. Mixed effects logistic regression models, accounting for multiple pregnancies and adjusting for first trimester body mass index (BMI), insurance, parity, and maternal race/ethnicity, were analyzed.Of the 503 pregnant individuals with PGDM, 67% had a diagnosis of type 2 DM and 33% had type 1 DM. The composite adverse pregnancy outcome occurred in 79 of 258 (31%) pregnancies with a female fetus and 76 of 245 (31%) pregnancies with a male fetus. The composite neonatal outcome occurred in 163 of 245 males (67%) and 154 of 258 females (60%). Male infants had significantly higher odds of requiring admission to the NICU (adjusted odds ratio 1.79 [95% confidence interval: 1.13, 2.80], p = 0.01). There were no observed sex differences in the incidence of spontaneous PTB.We identified high rates of both composite outcomes in pregnancies with PGDM, regardless of fetal sex. The significantly higher rate of NICU admission among males suggests an increased risk of neonatal morbidity in males exposed to PGDM. · A high incidence of adverse outcomes was observed in PGDM pregnancies.. · Male neonates are at greater risk of NICU admission.. · In individuals with type 2 DM, a trend toward increased risk of LGA was observed in male neonates..

The Hook & Roll Maneuver for Resolution of Shoulder Dystocia.

BackgroundThis study aimed to assess frequency and causes of neonatal intensive care unit (NICU) admissions in neonates with shoulder dystocia (SD).MethodsA retrospective analysis of 116 SD cases at a tertiary perinatal center was performed (2007 – 2023). Maternal and neonatal parameters were evaluated in relation to NICU admission.ResultsSeventeen neonates (14.7%) were admitted to the NICU. All showed respiratory distress; five required cardiopulmonary resuscitation, two of them received therapeutic hypothermia for hypoxic-ischemic encephalopathy. Compared to non-admitted infants, NICU neonates had significantly lower umbilical artery pH and base deficit, lower Apgar scores, and higher rate of birth injuries. They also had a significantly longer median head-to-body delivery interval (HBDI, 5.0 vs. 2.0 minutes, p < 0.0001). No neonatal deaths occurred before discharge.ConclusionSD can lead to severe postnatal adaptation problems in newborns, requiring timely and structured interdisciplinary management. Our findings suggest that a HBDI of ≥ five minutes serve as a clinically applicable parameter to identify neonates at increased risk of NICU admission and appears to be associated with a higher likelihood of brachial plexus injury. Furthermore, greater fetal size, reflected by higher birth weight and body surface area, was related to the occurrence of birth injuries overall, underscoring the relevance of both extraction time and fetal dimensions for postnatal outcomes after SD.

BackgroundGestational Diabetes Mellitus (GDM) presents significant risks to both maternal and foetal health during pregnancy.PurposeThis observational study aimed to investigate the association between clinical parameters and adverse pregnancy outcomes in women with GDM.MethodsA cohort of 2174 GDM-diagnosed women was analysed, with 1705 experiencing no adverse outcomes and 469 developing complications such as preeclampsia, large for gestational age (LGA) infants, preterm birth, and shoulder dystocia. Clinical data, including maternal age, glucose levels, gestational age, body mass index (BMI), and treatment methods, were collected and analysed.ResultsAdvanced maternal age, higher parity, increased weekly weight gain, and abnormal fasting glucose levels were associated with adverse pregnancy outcomes in women with GDM. In particular, early onset of GDM, elevated weekly weight gain, and abnormal fasting glucose levels were linked to an increased risk of developing preeclampsia and delivering LGA infants. However, no significant associations were found regarding shoulder dystocia. Furthermore, maternal age and weekly weight gain were identified as risk factors for preterm birth.ConclusionThis study shows that in addition to well-known risk factors, abnormal fasting glucose levels are significantly linked to developing adverse pregnancy outcomes in women with GDM. Our data suggested that close monitoring of fasting glucose levels and controlling weight gain may significantly reduce the risk of adverse outcomes in pregnancies complicated by GDM.

Abstract Objective Gestational diabetes mellitus (GDM) screening is often repeated in the third trimester when large for gestational age (LGA) and/or polyhydramnios are diagnosed. We evaluated outcomes for individuals who did versus did not rescreen, and also for individuals who passed or did not pass rescreening. Methods A retrospective cohort study from January 2011 to March 2024 of term, singleton pregnancies diagnosed with LGA and/or polyhydramnios after a normal GDM screen at 24–30 weeks was performed. Non‐inferiority analyses were performed for the comparison between those who did not rescreen and those who did rescreen (passed or did not pass) using a mixed model. In non‐inferiority analyses, if the lower bound of a one‐sided 95% confidence interval (CI) is within the non‐inferiority limit (margin of error), the test is significant, allowing non‐inferiority to be declared. The lower bound of the 95% CI and corresponding p values were reported. Outcomes in individuals who passed and who did not pass rescreening were compared using a logistic regression model. Odds ratios with respective 95% CI and p values are reported. Results Of the 1665 pregnant individuals who met the inclusion criteria, 1317 did not rescreen and 348 rescreened. In individuals who were rescreened, 13.8% were diagnosed with GDM, of which 20.8% required medication. Outcomes were not worse for those who did not rescreen than for those who did rescreen, including birthweight (BW) (3758 vs. 3813 g, −123.65, p &lt; 0.01), BW ≥ 4000 (31.9% vs. 34.1%, −0.32, p &lt; 0.01), cesarean delivery (21.0% vs. 28.0%, 3.15, p &lt; 0.01), or shoulder dystocia (5.2% vs. 6.6%, −1.47, p &lt; 0.01). Outcomes for individuals who did rescreen did not differ whether they passed or failed, aside from an increase in neonatal hypoglycemia (7.0% vs. 22.9%, 3.95 [95% CI, 1.76–8.84], p &lt; 0.01). Conclusion Pregnant individuals who did not rescreen for GDM following the diagnosis of LGA and/or polyhydramnios in the third trimester do not appear to have worse birth outcomes than those who did rescreen. Additionally, individuals diagnosed with GDM after rescreening were not at an increased risk for adverse perinatal outcomes. This study demonstrates that rescreening all individuals with LGA and/or polyhydramnios may not be warranted.

Beyond Obesity, The impact of excessive gestational weight gain on obstetrical Outcomes: A Belgian retrospective study.

Outcomes of Maternal Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Scoping Review of Evidence and Reporting Trends.

BACKGROUND: In order to end preventable neonatal morbidity and mortality, every newborn should receive skilled care at birth, with evidence-based practices, in a humane, respectful, and supportive environment. To address safety concerns during planned deliveries in hospitals, the Safe Delivery Checklist was developed by the World Health Organization. Therefore, this study aimed to determine the effectiveness of the Labor and Delivery Management Program on neonatal clinical outcomes of vaginal delivery. MATERIALS AND METHODS: The present study was a clinical trial study that was conducted on 470 mothers with vaginal delivery in hospitals in Ahvaz in 1402. Subjects were randomly assigned to two control and intervention groups. In the intervention group, care and delivery were performed based on the World Health Organization childbirth checklist. Finally, the data were analyzed using SPSS version 22 software (IBM, SPSS Inc, Chicago, Illinois, USA). RESULTS: The results of the Chi-square test of the two intervention and control groups in terms of the frequency of neonatal hospitalization in the neonatal intensive care unit ( P = 0.001), the frequency of shoulder dystocia ( P = 0.039), and the frequency of first-minute Apgar scores less than 7 in newborns ( P = 0.031) show that the frequency of these outcomes was higher in the control group than in the intervention group, and these differences were reported to be statistically significant ( P = 0.001), but the frequency of fifth-minute Apgar scores less than 7 in newborns had almost the same distribution in both groups and no statistically significant difference was reported ( P = 0.413). CONCLUSION: Based on the results of the study on the effectiveness of the World Health Organization childbirth program, it is recommended that this program be used in maternity hospitals and centers providing childbirth facilities to improve the health of newborns.