Single Pregnancy Research Articles

Effect of birth rank, and placentome subtype on expression of genes involved in placental nutrient transport in sheep

Placental function is a key determinant of fetal growth and development that can be influenced by maternal and fetal environmental factors. The molecular mechanisms by which the placenta senses and responds to environmental cues are poorly understood. This exploratory study aimed to characterize the effect of birth rank (single vs. twin) and placentome morphologic subtype on expression of genes involved in nutrient transport, angiogenesis, immunity and stress response. Cotyledonary tissue was collected from type A, B and C placentomes from five single and six twin fetuses at 140 days of gestation. GLUT1 and GLUT3 were the most highly expressed genes consistent with the high demand for glucose to support fetal growth. Expression of BCKDHβ and IGF-2 was 1.3- and 1.5-fold higher, respectively, and PCYT1A was 3-fold lower in singles compared to twins (P < 0.05) while no other differences in gene expression were observed between birth ranks. Expression of EAAT2 and LAT2 was higher while PCYT1A was lower in A compared to B type cotyledons. Expression of GUCY1B1/3 and IGF-1 was higher while CD98 and LAT2 were lower in type B compared to C cotyledons (P < 0.05). Compared to type C cotyledons, expression of EAAT2, IGF-1, IGF-2, LAT1 was higher, while TEK was lower in type A cotyledons. The effects of birth rank on placental gene expression in this study indicated that placental nutrient transport and/or function differs between single and twin pregnancies in sheep. Differences in gene expression between the placentome subtypes suggests that changes in placentome morphology are associated with shifts in amino acid transport and metabolism, oxidative stress and angiogenesis and/or blood flow. This study highlights that placental gene expression differs in response to birth rank and placentome morphologic subtype which suggests that both maternal and fetal factors may influence placental function in sheep. These associations provide insights into gene pathways for more targeted future investigations as well as potential adaptations to improve placental efficiency to support fetal growth in twin pregnancies.

Assisted reproductive technology, risk of gestational diabetes, and perinatal outcomes in singleton pregnancies.

To evaluate the impact of assisted reproductive technology (ART) on the risk of gestational diabetes mellitus (GDM) in single pregnancies. We retrospectively collected clinical and anthropometric data of 219ART- and 256 age- and body mass index (BMI)-matched women with spontaneous conception screened for GDM. The primary outcome was to evaluate GDM prevalence in ART women. There were no differences in age, BMI, and family history of diabetes in the two groups of women. ART-women were more frequently primiparous, whereas the prevalence of previous GDM was higher in SC-women. The prevalence of GDM in thewhole cohort was 36.1% and was higher in ART-women (52.3% vs. 23.4%; p<0.0001). In the whole cohort, on multivariate analysis, family history of diabetes (OR 1.67; 95% CI: 1.03-2.69), previous GDM (OR 7.05; 95% CI: 2.92-17.04), pre-pregnancy obesity (OR 2.72; 95% CI 1.21-6.13), and ART (OR 4.14; 95% CI 2.65-6.48) were independent risk factors for GDM. Among ART-women, age over 40years was associated with GDM. Preterm delivery was more common in ART-women; gestational week at delivery, birth weight, ponderal index, and Apgar score were lower in ART-women than in SC-women, both in the whole cohort and in GDM women. Among women undergoing ART treatment, at least one in two develops GDM. ART appears to be an independent risk factor for GDM in single pregnancies, particularly above the age of 40. ART treatment seems to be associated with an increased rate of preterm delivery and lower neonatal birth weight and Apgar score, especially in GDM women. The study was not registered as it is an observational retrospective evaluation.

Incidence of complications among in vitro fertilization pregnancies.

The use of assisted reproductive technology has increased in Romania in the past several years. Although most of these pregnancies are uncomplicated, in vitro fertilization is associated with an increased risk for adverse perinatal outcomes primarily caused by the increased risks of prematurity, gestational diabetes mellitus, and hypertensive disorders. Infertility can be caused by a variety of factors, including both male and female factors, and in some cases, the cause remains unknown. In our clinic, the etiology of infertility was known in most cases and was equally distributed between male and female factors. Women with gestational hypertension were significantly older. Patients with twin pregnancies were significantly younger than those with a single pregnancy. The prevalence of preterm newborns was 2.5 times higher than the global prevalence for prematurity.

Effect of the maternal childbirth experience on a subsequent birth: a retrospective 7-year cohort study of primiparas in Finland

ObjectiveTo study the effect of the childbirth experience on the likelihood and interval to a subsequent live birth.DesignRetrospective analysis of a 7-year cohort.SettingChildbirths in Helsinki University Hospital delivery units.ParticipantsAll parturients...

Aorta pathology and pregnancy-related risks in adult congenital cardiac disease: does the aorta dilate during pregnancy?

Aortic dilatation and pregnancy are major concerns in women with aortopathy (AOP). This single-centre retrospective analysis focuses on the evolution of aortic diameters during and after pregnancy in women with Marfan syndrome (MS), Turner syndrome (TS) and bicuspid aortic valve (BAV) aortopathy. Thirty-eight women who had one or more single pregnancies were included. The ascending aorta was measured during pregnancy and postpartum. During pregnancy, a significant increase of diameters of the sinus aortae (median 1.4 mm; [-1.3; 3.8]) and ascending aorta (median 2.1 mm; [0.0; 4.0]) was noted. Systemic hypertension gives dilation of the aorta, but it did not influence the overall trajectory during pregnancy. Significant aortic dilatation is noted during pregnancy in women with underlying AOP, even persisting in the long term. Pre-existing systemic hypertension is associated with larger aortic diameters prior to pregnancy. More research on a larger study population however is needed.

Do the Pregnant Women Want to Use the Labor Mirror during Childbirth?

The labor mirror is an instrument used by the pregnant woman to observe the descent of the fetus and to improve pushing effort in vaginal delivery. The aim of the study was to determine the views of pregnant women about labor mirror use, which is not common in Turkiye. The study was of the cross-sectional descriptive type. Women who did not have any pregnancy-related complications or comorbidities, 37–42 weeks of gestation, had a single pregnancy and volunteered were included in the sample (n=359). Questionnaire form was used in data collection. All of the participants stated that they had never heard of the labor mirror before. While 18.1% agreed with the statement "If I am offered a labor mirror for use during labor, I will be pleased", one of the positive statements regarding the use of the labor mirror during childbirth, it was determined that they did not agree with the other positive statements. It is recommended that the use of the labor mirror in Turkey be evaluated and detailed studies should be carried out in order to increase the pushing efficiency at birth and improve the mother's birth experience.

Incidence of Pregnancy-Associated Venous Thromboembolism: Second Nationwide Study.

Pregnancy is a transient risk factor for venous thromboembolism (VTE). This second nationwide study aimed to inspect trend changes in the incidence rate of pregnancy-associated VTE (PA-VTE) during the study period (2014-2018) compared with that reported in a previous study (2006-2010). Using the Korean Health Insurance Review and Assessment Service database, we retrospectively identified all PA-VTE events using both diagnostic and medication codes. Of the 124,228 VTE events, 510 (0.4%) cases of PA-VTE were identified in 499 women (median age: 34 years; range: 20-49 years). The incidence rate of PA-VTE/10,000 deliveries (PA-VTE/104D) in this second study (2.62) was 3.2 times higher than that in the first study (0.82). In the second study, the PA-VTE/104D ratio of women in their 40s (5.46) was three times higher than that of women in their 20s (1.80) (relative risk: 3.03; 95% confidence interval: 2.04-4.51; p < 0.01). The incidence rate for women in their 40s in the second study was 2.3 times higher than that in the first study. PA-VTE/104D cases occurred more frequently in multiparous than in primiparous women, in cesarean section cases compared with vaginal delivery, and in multiple rather than single pregnancies. Most PA-VTE cases occurred during the postpartum period (321/510, 62.9%), of which pulmonary embolism was the most frequently occurring type (231/321, 72%). Advanced maternal age, cesarean section, multiparity, and multifetal pregnancies increased the risk of PA-VTE. Obstetricians need to be cautious of VTE, particularly during the postpartum period, in high-risk pregnant patients.

Study on the correlation between maternal serum uric acid and foetal birth weight in Naqu, Tibet

In high-altitude regions, low birth weight is mainly caused by hypoxia. We aimed to determine whether maternal serum uric acid (SUC) level was associated with decreased foetal birth weight. The relevant data of individual pregnant women who delivered between 37 and 40 weeks in the People’s Hospital of Naqu City, Tibet were retrospectively collected. The correlation between maternal SUC and birth weight was examined using multivariate linear regression analysis and subgroup analysis. The results showed that there was a significant negative correlation between SUC and birth weight in pregnant women with proteinuria, female foetuses, and primiparas. Fitting smoothing curve analysis showed that there was a negative linear correlation between SUC and birth weight in primiparas and female foetuses. Maternal SUC is negatively associated with foetal birth weight in a single pregnancy with proteinuria, primipara, or female foetuses in the Naqu region of Tibet, China. IMPACT STATEMENT What is already known on this subject? Preeclampsia associated with hyperuricaemia can affect foetal birth weight, foetal birth weight in plains area is negatively correlated with maternal hyperuricaemia. What do the results of this study add? Maternal SUC was negatively correlated with foetal birth weight, especially in primipara, mothers with proteinuria, and pregnant girls. What are the implications of these findings for clinical practice and/or further research? The results suggest that attention should be paid to SUC in pregnant women, especially in primipara, mothers with proteinuria, and pregnant girls, in the prevention of low birth weight infants in Naqu Plateau area of Tibet.

Maternal serum 25-hydroxy vitamin D level in first-trimester pregnancy loss

Aim: Pregnancy loss (abortus) is defined as loss of fetal cardiac beat or expulsion of pregnancy material before 20 weeks.It has many causes such as chromosomal abnormalities, uterine anomalies, infections, and unknown causes. Vitamin D has become one of the new topics of research in many medical fields, as it has relations with other diseases besides bone diseases. In some studies of recurrent pregnancy loss, a low vitamin D level was found. In our study, vitamin D levels were measured in the first-trimester pregnancy loss and normal pregnancy group. Methods: Patients, single pregnancies with a positive fetal heartbeat, who applied to the pregnant outpatient clinic for the first examination of pregnancy were included in the study, and vitamin D levels were measured at this time. The patients were followed up to the 12th gestational week using the hospital automation system. The groups of normal pregnancy and abortus groups were determined. 25-hydroxy (25-OH) vitamin D levels between 2-96 ng/ml can be detected, while over 30 ng/ml is sufficient, 20-29.99 ng/ml is insufficient, and &lt;20 ng=''/ml is defined as a low 25(OH)D3 level. Results: 66 patients were included in the pregnancy loss group, in the follow-up, 63 patients were in the normal pregnancy group. The mean vitamin D level of the individuals included in the study was measured as 7.45�4.64 ng/ml. Levels of vitamin D were 10.04�6.19 in the normal course group and 4.8�1.73 ng/ml in the intrauterine exitus group (p&lt;0.05). At='' a='' vitamin='' D='' level='' of='' 6,87='' ng=''/ml, pregnancy loss was expected with 90% sensitivity and 64% specificity. Conclusion: It is still an important issue to determine the most appropriate level and preconceptional starting and the appropriate dose for maximum benefit for mother and baby, especially in the reproductive period and pregnant. Therefore, large-scale randomized controlled studies of high quality are needed.

Semen parameters and male reproductive potential are not adversely affected after three or more months of recovery from COVID-19 disease.

The male reproductive system may be a potential target for SARS-CoV-2 since the presence of ACE and TMPRS2 receptors. After a first report of the presence of SARS-CoV-2 in semen of COVID-19 patients, several papers reported that SARS-CoV-2 was not detected in the semen. However, some evidences indicated that COVID-19 disease could impair semen parameters. During the infection, or in a short period after, a reduction in sperm concentration and motility and an increase in DNA fragmentation were observed, even in asymptomatic patients. There is no conclusive data exploring whether this damage changes with time. We investigated whether COVID-19 disease has a negative impact on semen parameters and male reproductive potential after recovery. In this longitudinal retrospective study, we enrolled 20 men who had COVID-19 disease. We compared sperm parameters in samples collected before COVID-19 and after infection (8.3 ± 4.8 months). We also evaluated the reproductive potential in pre- and post-COVID-19 infertility treatments of 8 self-controlled couples as well as in 40 cycles after COVID-19 infection of the male partner. For most patients, we obtained results of more than one semen analysis before and after COVID-19. After adjusting for age, days of sexual abstinence, frequency of ejaculations and presence of fever, we found no significant difference over time in any semen parameter. The interval between COVID-19 infection and subsequent infertility treatments was 10.7 ± 7.5 months. There were no differences in the embryological and clinical outcomes of infertility treatments performed before and after male infection. One couple obtained a single pregnancy in the post COVID-19 IUI. Normal fertilization (65%), cleavage (99%) and blastocyst development (40%) rates in treatments performed after male infection were within the expected range of competencies. A total of 5 singleton and 1 twin clinical pregnancies were obtained, and 6 healthy children were born. A total of 10 blastocysts have been cryopreserved. Our data are reassuring that COVID-19 disease has no negative effect on semen quality and male reproductive potential when semen samples are collected three months or more after infection.

Comparative study of etiological factors of single early pregnancy loss with that of recurrent pregnancy loss

Aim and Objective: Investigating for pregnancy loss is usually recommended only after two or more pregnancy losses. But women with single pregnancy loss seek explanation, in practice. This study is conducted in order to determine the identifiable causes and their proportion in women with single early pregnancy loss and to compare with that of women with recurrent pregnancy loss (RPL). Materials and Methods: This cross-sectional analytical study is undertaken between January 2021 and January 2022. Group A included 50 women with single early pregnancy loss and Group B included 50 women with RPL. The recommended investigations for etiological factors are done in both groups except karyotyping, and thrombophilia screening is done in those with unknown etiology. Statistical analysis: Etiological factors are expressed as proportions, and comparison between two groups is done by unpaired t-test and Mann–Whitney test. Results: Socio demographic factors and gestational age are similar in both the groups. Significantly more number of women with single early pregnancy loss (60%) had known etiological factors than women with RPL (48%) (P = 0.038). Endocrine causes are commonest in both the groups (single early pregnancy loss 36%, RPL 22%; P = 0.023). Out of the women with unknown causes, approximately 25% of women are positive for thrombophilia in each group. Conclusion: Significant proportion of women with single early pregnancy loss have treatable etiological factors like those of RPL. Hence evaluation should be undertaken to achieve optimum outcomes during the next pregnancy and prevent RPL. Clinical significance: Assessing the women with first pregnancy loss aids the obstetrician to avert pregnancy loss in further pregnancies by apt management according to etiology.

Breastfeeding Success and Newborn Health before and during the COVID-19 Pandemic:A Single-Centre Comparative Study

Introduction: Due to the SARS-CoV-2 pandemic, adjustments in patient and visitor traffic were made in hospitals to limit viral exposure. The primary objective of our study was to compare the breastfeeding success of healthy newborns in a maternity ward during the 2020 lockdown period compared with the same period in the previous year. Material and Methods: Single-center comparative study based on prospectively collected data. All neonates born alive, from a single pregnancy, and with a gestational age greater than 36 weeks were considered for this study. Results: 309 infants born in 2020 and 330 born in 2019 were included. Among women who desired to exclusively breastfeed, the rate of exclusive breastfeeding at discharge from the maternity ward was higher in 2020 than in 2019 (85 vs. 79%; p = 0.078). After logistic regression analysis adjusted for potential confounders (i.e., maternal BMI, parity, mode of delivery, gestational age, and size at birth), study period remained significantly and independently associated with exclusive breastfeeding at discharge (OR [95% CI] = 1.645 [1.005; 2.694]; p = 0.046). Newborns born in 2020 were less likely to have weight loss ≥10% than those born in 2019 (OR [95% CI] = 2.596 [1.148; 5.872]; p = 0.017) but had similar need for phototherapy (p = 0.41). Conclusion: The success of exclusive breastfeeding during the 2020 lockdown period was increased compared with the same period in 2019.

Management of Deliveries at the University Gynecology-Obstetrics Department of the institute of social hygiene hospital of Dakar

Objectives: Describe the epidemiological profile of patients, specify the characteristics of the delivery and evaluate the maternal and perinatal prognosis at the Maternity Hospital Institute of Social Hygiene in Dakar. Materials and Methods: This was a retrospective and descriptive study conducted over a period of six months from January 1 to June 30, 2019, involving all women who gave birth in the Gynecology-Obstetrics Department of the Institut d&#39;Hygiène Sociale Hospital in Dakar. Results: During the study period, we collected 689 delivery records, i.e., 8.2% of the department&#39;s overall activities and 69% of emergency activities. The epidemiological profile of the patients was that of a woman with an average age of 27 years, married (96%), with an average parity of 2, and residing outside the Southern Health District of Dakar (58%). More than half of the patients (58.1%) had received at least 4 prenatal consultations. The majority of parturients had a single pregnancy (97%) at term (72%). Uterine height measurement and fetal heart rate assessment were normal in 59% and 95.5% of the sample respectively. The vaginal touch revealed ruptured membranes in 34.5% of the patients with amniotic fluid that was mostly clear (68.1%) and a vertex presentation (96%). Clinical pelvimetry allowed the diagnosis of 19% of moderately narrowed pelvises and 2% of surgical pelvises. Slightly more than half of the parturients (56.6%) were in the latent phase of labor. We recorded 130 labor events (18.9%), 67 uterine events (9.7%), 76 directions of labor (11%), and 45 labor inductions (6.5%). In our series, 55.4% of the patients had benefited from labor monitoring by cardiotocograph and complications were found in 25.5% of the patients. These were mainly cases of non-reassuring fetal status (71.8%). More than half of the parturients (55.3%) had given birth by vaginal delivery. Caesarean sections and instrumental extractions represented 44.6% and 0.1% of deliveries respectively. Complications recorded (6.8%) were dominated by retroplacental hematoma (4%) and eclampsia (1.1%). We recorded 98% live births. Most newborns (87.4%) had an Apgar score of 7 or more at the first minute. We recorded 82% eutrophic, 13.3% hypotrophic, and 4.7% macrosomic newborns. Among the newborns transferred to neonatology (9.8%), 17.4% died during hospitalization. Stillbirth was estimated at 20‰ live births. Conclusion: Childbirth constitutes the main emergency activity at the Maternity Hospital of the Institute of Social Hygiene of Dakar with low maternal and perinatal morbidity and mortality.

PlGF (Placental Growth Factor) testing in clinical practice – identifying the optimal threshold

Accurate diagnosis of preterm preeclampsia (PE) may improve the management of affected pregnancies. Previous studies have demonstrated that reduced levels of Placental growth factor (PlGF) levels (< 100 pg/mL) provide superior diagnostic performance to evaluate pregnant individuals with suspected hypertension. A single cut-off may not provide optimal test interpretation, since PlGF levels vary considerably across gestational age (GA) range. Our group recently generated centile curves for PlGF levels by combining data from Toronto and Cambridge, UK. We compared the diagnostic accuracy of GA-specific percentile values of PlGF, vs. a single cutoff of 100 pg/mL, in the setting of diagnostic testing for suspected preeclampsia in a single high-risk pregnancy center. Secondary analysis of published data in 979 high-risk pregnant women with singleton pregnancies evaluated between 2017-2019 at Mount Sinai Hospital, Toronto, Canada. PlGF testing was performed between 20+0 and 35+6 weeks of gestation. We compared the diagnostic accuracy of PlGF< 100 pg\mL vs. PlGF< 2.5% for GA. Primary outcomes were prediction of early-onset PE and preterm birth (PTB)< 32 weeks’ gestation. Overall, 374 (38.2%) had a normotensive pregnancy, 244 (24.9%) developed gestational hypertension19.3%, 189 () developed late-onset PE, and 172 (17.6%) developed early-onset PE. PlGF< 2.5% for GA provided better sensitivity with comparable specificity for diagnosis of early-onset PE and PTB< 32 weeks, when compared to a single threshold of 100 pg\mL, thereby improving the area under the ROC curve (Figure 1). Table 1 compares adjusted odds ratios (aOR) for maternal and fetal outcomes, between PlGF interpretation methods. Compared to PlGF< 100 pg\mL., PlGF < 2.5% for GA increased aOR for early-onset PE and PTB< 32 weeks (58.2 vs to 95.1 and 15.7 vs. 20.6 respectively). Low PlGF levels in high-risk pregnant women are strongly associated with adverse pregnancy outcomes. Adopting a PlGF < 2.5% for GA interpretation approach provides better diagnostic accuracy for the diagnosis of early-onset PE and PTB< 32 weeks.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Факторы риска угрозы прерывания беременности во втором триместре и исходы гестации у женщин с привычным невынашиванием в анамнезе

Aim: To identify risk factors for the threat of termination of pregnancy in the second trimester in women with recurrent pregnancy loss (RPL), as well as to assess the course and outcomes of gestation. Design: Continuous longitudinal clinical and epidemiological study. Materials and methods. A survey was conducted of 155 women in the second trimester with a single spontaneous pregnancy, who were divided into two groups: the main group consisted of 82 patients with signs of threat of termination at the time of examination and with RPL, the control group consisted of 73 women with uncomplicated pregnancy and without RPL. The medical and social characteristics of women of the studied groups were studied. The course of pregnancy, the postpartum period, and the condition of the newborn were evaluated on the basis of medical documentation. Results. The identified risk factors were ranked as follows. The most significant medical and social risk factors for the threat of interruption in the second trimester in women with RPL are arterial hypotension in the anamnesis, chronic endometritis in the anamnesis, chronic arterial hypertension in the anamnesis, surgical interventions on abdominal organs in the anamnesis, chronic salpingoophoritis in the anamnesis, burdened maternal family history of premature birth, forced labor work in the anamnesis and at the time of the present pregnancy, uterine fibroids in the anamnesis, age over 30 years, the threat of early termination of pregnancy in the anamnesis, the presence of conflicts in the family in the anamnesis and at the time of this pregnancy, the use of alcoholic beverages before and in the early stages of pregnancy, frequent neuropsychiatric stress at work in the anamnesis and at the time of this pregnancy, rare consumption of meat during this pregnancy, surgical interventions on the pelvic organs in the anamnesis, belonging to the category of employees, higher education. Conclusion. Timely identification and elimination of modifiable risk factors for the threat of termination in the second trimester in women with RPL will contribute to the prevention of adverse gestational outcomes. Keywords: habitual miscarriage, threat of interruption, risk factors.

Neonatal near miss and mortality and associated factors: cohort study of births in the city of Rio de Janeiro, RJ, Brazil.

The aim of this study was to investigate factors associated with neonatal near miss and mortality of the live birth cohort in the city of Rio de Janeiro, Brazil, in 2015. Population-based retrospective cohort of live births (LB) of single pregnancy with 0-27 days of follow-up. Data were obtained from the Brazilian Live Birth and Mortality Information Systems. Logistic regressions with the analytical strategy of hierarchical determination were used for cases of near miss and deaths separately. The cohort was composed of 85,850 LB. For every one thousand LB, about 16 were cases of near miss and six died. Maternal level of education, skin color, and age and adequacy of prenatal care were associated with neonatal near miss; for deaths, presentation of LB at delivery, birth weight, gestational age, and five-minute Apgar score are added. Besides confirming the effect of low birth weight, prematurity, and asphyxia on neonatal death, socioeconomic vulnerability markers - low education level and brown or black skin colors - were associated with neonatal death and near miss. Absent or inadequate prenatal care showed a strong association with both outcomes, being stronger for neonatal death. Investments in the quality of prenatal care and reduction of disparities in health care are necessary in Rio de Janeiro.

The single pregnancy predicting model of 1 minute Apgar score less than 7 after preterm birth: A retrospective study.

Preterm delivery is greatly associated with perinatal mortality and morbidity, while there is no objective way to identify high-risk newborns currently. This study aimed at discovering the risk factor for Apgar score less than 7 at 1 minute of preterm neonates born with vaginal delivery. A retrospective study was performed in single pregnancy women with a vaginal delivery before 37 weeks of gestation. All the preterm infants were categorized into three types: very preterm birth (28 to 32 weeks), moderate preterm birth (32 to 34 weeks) and late preterm birth (34 to 37 weeks). Risk factors were identified through logistic regression analysis in every category of newborns mentioned above. And the receiver operating characteristic analysis was used in continuous variables to determine the best threshold of the outcome. On the basis of the selected factors, the predicting models are created and its prognosticating ability is compared by the area under the curve. A nomogram was established for the proved best model. A total of 981 cases were investigated, of whom 55 were found with 1 min Apgar scores less than 7. The nomogram was set for the predicting model with larger area under the receiver operating characteristic curve, of which is 0.742(95% confidence interval = 0.670-0.805) in very preterm birth, with the variables of first and second labor stage(> = 1.6 hours), birthweight and MgSO4(magnesium sulfate), and is 0.807(95% confidence interval = 0.776-0.837) in late preterm birth, with the variables of second labor stage(> = 1.23 hours), birthweight, a history of previous cesarean delivery, fetal distress and placental abruption. The combination of first and second labor stage, newborn weight and MgSO4 use can predict 74.2% of 1 minute Apgar score < 7 in very preterm neonates. And 80.7% high-risk infants can be identified when second labor stage, newborn weight, VBAC (vaginal birth after cesarean) and the occur of placental abruption and fetal distress were combined in the predicting model for late preterm birth. These predicting models would bring out great assistance towards obstetricians and reduce unnecessary adverse fetal outcomes.

Assessment of the birth status of children born by elective caesarean section before and after 39 weeks of gestation following in vitro fertilization.

The collected material presents 512 mothers with children whose pregnancies were ended by caesarean section at the Department of Obstetrics, Women's Diseases and Oncological Gynecology Central Clinical Hospital of the Ministry of Internal Affairs in Warsaw in the years 2004-2016. The study group consisted of 362 mothers in pregnancies following in vitro fertilization and 150 mothers in spontaneous pregnancy, without the use of assisted reproductive technology. For the purposes of the project, only single pregnancies ending within weeks 37 to 41 of pregnancy were selected. Planned delivery by elective cesarean section (ECS) currently takes place after the 39th week of pregnancy, in line with current common recommendations. This is related to studies finding an overall better birth condition of newborns in the general population, and especially regarding the maturation of the lungs. Currently, there are no specific recommendations regarding cesarean section and the timing of delivery in pregnancies resulting from in vitro fertilization. The aim of this study was to assess the optimal time of an elective cesarean section at full term in an IVF pregnancy. Consistent with findings in the general population and prevailing recommendations, the expected result would be the better condition of the baby born by ECS following the 39th week of gestation. However, our statistical analysis of the collected material shows that the group delivered by ECS prior to the end of 39 weeks of pregnancy may have fewer respiratory system interventions and higher Apgar scores. Nevertheless, results lack statistical significance. In conclusion these findings may indicate a need for a bigger database.

Obstetric anesthesia clinic childbirth course combined with labor epidural analgesia is associated with a decreased risk of postpartum depression : a prospective cohort study

BackgroundPostpartum depression (PPD) is a serious complication commonly seen in postnatal women. In this paper, an investigation was conducted to see if obstetric anesthesia clinic childbirth course combined with labor epidural analgesia (LEA) was associated with a decreased risk of PPD.MethodsSix hundred fifty-five nulliparous women were enrolled in this prospective cohort study. The parturients were divided into 4 groups, with Group C being the control group, Group AC received the obstetric anesthesia clinic childbirth course only, Group LEA received LEA only, and Group AC + LEA received both the obstetric anesthesia clinic childbirth course and LEA. Maternal and neonatal variables in the perinatal period were recorded. PPD at 6 weeks was assessed using the Chinese version of the Edinburgh Postpartum Depression Scale (EPDS), where a score ≥ 10 is the threshold for PPD. Multivariate logistic regression analysis was performed to assess the association between obstetric anesthesia clinic childbirth course combined with LEA and postpartum depression.ResultsA total of 124 maternities had EPDS ≥10 points, the incidence of PPD was 18.9%。The incidence of PPD and EPDS scores were significantly lower in Group AC + LEA than in Group C (12.1% vs 26.8%, P < 0.05; 6 (5, 7) vs 7 (5, 11), P < 0.05). Received an anesthesia clinic childbirth course combined with LEA was associated with a decreased risk of PPD (OR 0.273, 95% CI, 0.100–0.743, P = 0.013). Multivariate logistic regression analysis identified 5 other independent factors for PPD, including maternal SAS score in the delivery room, W-DEQ score in the delivery room, living in a confinement center, EPDS score at 1st week postpartum and perinatal care satisfaction .ConclusionsReceived an obstetrics anesthesia clinic childbirth course combined with LEA for nulliparous women with a single term cephalic pregnancy was associated with a decreased risk of PPD at 6 weeks.Trial registrationChinese Clinical Trial Registry, ChiCTR2000039163. Registered on 20/10/2020.

The rate of cesarean delivery changes after internal audit based on the Robson Ten Group Classification System in Lebanon.

To evaluate the efficiency of the Robson classification as an internal clinical audit and feedback of the high rate of cesarean delivery at Hotel Dieu de France, a tertiary referral hospital. A pre-post study was conducted, with a retrospective approach in 2018 and 2019, identified as the pre-period (before the implementation of the Robson classification), and with a prospective approach in 2020 and 2021, labeled the post-period. The total number of deliveries during the study period was 2560; 1305 patients were included in the pre-period and 1255 patients delivered in the post-period. No significant differences between the two groups were found. No significant difference was found in the overall rate of cesarean delivery between the first and second periods (57.86% vs 56.72%; P= 0.2). However, a significant decrease in the absolute contribution of groups 3 and 4 (multiparous women without a previous uterine scar with a single cephalic pregnancy, ≥37 weeks of gestation, with spontaneous labor or induced labor) in the overall rate of cesarean delivery was remarked (P= 0.02 and 0.01, respectively). The Robson classification seems to be appropriate to monitor and audit the rate of cesarean delivery, but not sufficient to decrease the rate and change the practice.