Spontaneous Onset Of Labor Research Articles

Satisfaction and dissatisfaction with pain relief and birth experience among induced and spontaneous-onset labours ending in vaginal birth: A prospective cohort study.

To assess pain relief and overall birth experience in induced vs. spontaneous-onset labours and to clarify variables among induced parturients determining satisfaction and dissatisfaction. A prospective study of 2042 women. 575 women with induced and 1467 with spontaneous-onset labour answered multiple questions in a questionnaire regarding the experience of birth giving. Satisfaction was numerically assessed via a visual analogue scale (VAS 0-10). Induction of labour (IOL) did not worsen the average experience of pain relief, but the proportion of women dissatisfied with pain relief was slightly higher after IOL compared with spontaneous-onset labour (SOL). IOL was associated with lower satisfaction with overall birth experience compared with SOL (VAS 8.0 vs. 8.4; p<0.001). Among IOL parturients incorrect timing of pain relief was strongly associated with dissatisfaction with pain relief, as were deficient information and induction with misoprostol. Epidural blockade was the most important factor preventing dissatisfaction with pain relief. Unsatisfactory overall experience of birth was associated with deficient pain relief, its incorrect timing or deficient information, as well as vacuum extraction as the mode of delivery. Induction of labour is a risk factor of dissatisfaction regarding pain relief and overall birth experience. The strongest impact on dissatisfaction among induced parturients concerning pain relief was delayed timing of effective labour analgesia. Poor pain relief, its incorrect timing and deficient information on pain relief were strong predictive factors of dissatisfaction with the overall birth experience.

Neonatal mortality in NHS maternity units by timing and mode of birth: a retrospective linked cohort study

ObjectivesTo compare neonatal mortality in English hospitals by time of day and day of the week according to care pathway.DesignRetrospective cohort linking birth registration, birth notification and hospital episode data.SettingNational...

Fetus in fetu as a differential diagnosis of fetal abdominal tumors

Fetus-in-fetu (FIF) is a rare condition in which an abnormal parasitic twin grows inside the body of its co-twin. Fetal Medicine specialists should be suspicious of dealing with FIF when ultrasound imaging shows a heterogenous mass inside the fetal abdomen. We present a case of a 21-year-old pregnant woman who presented an abnormal ultrasound at 31 weeks gestation that revealed a fetus with an intra-abdominal mass. The fetal ultrasound evaluation was suggestive of FIF. The patient had a vaginal delivery after spontaneous onset of labour at the end of pregnancy. An exploratory laparotomy of the newborn was performed four days after birth and allowed removal of an incomplete fetus with distorted head and limbs enveloped by a semi-transparent sac-like capsule placed in retroperitoneum and fed by a small branch of the aorta. The autopsy confirmed the diagnosis of a FIF. The newborn was discharged healthy.

Single cell profiling at the maternal–fetal interface reveals a deficiency of PD-L1+ non-immune cells in human spontaneous preterm labor

The mechanisms that underlie the timing of labor in humans are largely unknown. In most pregnancies, labor is initiated at term (≥ 37 weeks gestation), but in a signifiicant number of women spontaneous labor occurs preterm and is associated with increased perinatal mortality and morbidity. The objective of this study was to characterize the cells at the maternal–fetal interface (MFI) in term and preterm pregnancies in both the laboring and non-laboring state in Black women, who have among the highest preterm birth rates in the U.S. Using mass cytometry to obtain high-dimensional single-cell resolution, we identified 31 cell populations at the MFI, including 25 immune cell types and six non-immune cell types. Among the immune cells, maternal PD1+ CD8 T cell subsets were less abundant in term laboring compared to term non-laboring women. Among the non-immune cells, PD-L1+ maternal (stromal) and fetal (extravillous trophoblast) cells were less abundant in preterm laboring compared to term laboring women. Consistent with these observations, the expression of CD274, the gene encoding PD-L1, was significantly depressed and less responsive to fetal signaling molecules in cultured mesenchymal stromal cells from the decidua of preterm compared to term women. Overall, these results suggest that the PD1/PD-L1 pathway at the MFI may perturb the delicate balance between immune tolerance and rejection and contribute to the onset of spontaneous preterm labor.

Analysis of factors increasing the risk of prelabour rupture of membranes and its effect on fetomaternal outcome

Perinatal morbidity and mortality due to prelabour rupture of membranesPROM) is 18-20% and 21.4% respectively. Multiple risk factors are associated with the development of PROM. Limited data is available on the risk factors of term PROM and relation of its duration with adverse maternal and fetal outcomes from India. To assessfactors increasing the risk of PROM and effect of duration of rupture of membranes on fetomaternal outcome. Five hundred and ten patients presented with term PROM in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh (M.P.) from December 2018 to February 2019 were studied. After the detailed history, sociodemographic details, risk factors for PROM and neonatal outcomes were recorded. PROM was more common in women with age 21-25years (73.3%), who were housewife (92.5%), were underweight (21.37%), were from the rural area (58.4%), belong to lower SES (62.8%) and were primigravida (59.2%). Majority were leaking for 13-24 hours (70.2%). Majority (85.64%) of patients had spontaneous onset of labour in less than 24 hours of PROM and 28(14.35%) went into spontaneous labour after 24 hours of PROM. Most common risk factor was malpresentation (46.52%) followed by history of PROM (30.04%), Polyhydramnios (13.19%), multiple pregnancy (10.99%) and febrile illness (6.96%). Out of 312 women who had vaginal delivery, labour was induced in 87.82% women. The most common indication for Caesarean section was previous 1 LSCS (13.1%), followed by fetal distress (8.6%), breech presentation (7.3%) and cephalopelvic disproportion (2.9%). Most of the women presenting with PROM were delivered vaginally (61.2%), while 38.8% women underwent caesarean section. Out of 529 babies, 6.24% were admitted in NICU. Majority of the neonates were admitted for 3 days (39.39%). PROM is associated with poor fetomaternal outcome and timely diagnosis and prompt management is required for better outcome.

Women’s subjective perceptions and background factors associated with poor maternal childbirth experience among induced and spontaneous onset of labour: a two-year tertiary hospital cohort study

BackgroundWomen undergoing induction of labour (IOL) more often have poor childbirth experience compared to women with spontaneous onset of labour (SOL). For understanding and optimizing childbirth experience in IOL, we investigated the subjective maternal reasons and perceptions leading to poor childbirth experience in IOL compared to SOL, as well as the background factors and delivery outcomes associated with the poor experience.MethodsTwo-year retrospective cohort study included 836/19442 deliveries (4.3%) with poor childbirth experience in induced or spontaneous onset at term in Helsinki University Hospital. Poor childbirth experience occurred in 389/5290 (7.4%) cases of IOL and in 447/14152 (3.2%) of SOL. Childbirth experience was measured after delivery using Visual Analog Scale (VAS) score, with poor experience defined as VAS < 5. The primary outcome of the study were the maternal reasons for poor childbirth experience. The parameters were collected in the hospital database and statistical analyses were performed by using Mann–Whitney U-test and t-test.ResultsThe subjective maternal reasons for poor childbirth experience were pain (n = 529, 63.3%), long labour (n = 209, 25.0%), lack of support by care givers (n = 108, 12.9%), and unplanned caesarean section (CS) (n = 104, 12.4%). The methods of labour analgesia were similar among the women who expressed pain as the main reason compared with those who didn’t. When comparing the reasons according to the onset of labour, IOL group more often reported unplanned CS (17.2% vs. 8.3%; p < 0.001) and lack of support by the care givers (15.4% vs. 10.7%; p = 0.04), while SOL group more often named pain (68.7% vs. 57.1%; p = 0.001) and rapid labour (6.9% vs. 2.8%; p = 0.007). In multivariable logistic regression model, IOL was associated with lower risk for pain compared to SOL (adjusted OR 0.6, 95%CI 0.5–0.8; p < 0.01). Primiparas more often reported long labour (29.3% vs. 14.3%; p < 0.001) and concern over own or baby’s wellbeing (5.7% vs. 2.1%; p = 0.03) compared to multiparas. Women who feared childbirth more often reported lack of support compared to women with no fear (22.6% vs. 10.7%; p < 0.001).ConclusionThe main reasons for poor childbirth experience were pain, long labour, unplanned CS and the lack of support by care givers. The childbirth experience is complex and could be optimized by information, support and presence of care givers especially in induced labour.

Gestational diabetes mellitus and time in active labor: A population-based cohort study.

Women with gestational diabetes mellitus (GDM) have higher rates of adverse perinatal outcomes compared with women without GDM, including an increased risk for having labor induced and for cesarean section. The findings from previous studies analyzing duration of labor in women with GDM are contradictory. The aim of the study was to evaluate the impact of GDM on time in spontaneous and induced active labor. This was a population-based cohort study including 247 524 primiparous women who gave birth to a singleton fetus with cephalic presentation, ≥34+0 (completed gestational weeks + additional days) between January 2014 and May 2020 in Sweden. Data was obtained from the Swedish Pregnancy Register. Time in active labor was compared between women with GDM and without GDM with a spontaneous labor onset or induction of labor using Kaplan Meier survival analysis and Cox regression analysis. Women with GDM had significantly longer time in active labor, both with a spontaneous onset and induction of labor compared to women without GDM. Women with GDM had a decreased chance of vaginal delivery at a certain time-point compared to women without GDM, with adjusted hazard ratio of 0.92 (0.88-0.96) and 0.83 (0.76-0.90) for those with spontaneous onset and induction of labor, respectively. Women with GDM had increased risk for time in active labor ≥12 h both in spontaneous labor onset (adjusted odds ratio 1.14 [1.04-1.25]) and in induction of labor (adjusted odds ratio 1.55 [1.28-1.87]). Women with GDM seem to spend a longer time in active labor, both in spontaneous and induced active labor compared to women without GDM. To be able to individualize care intrapartum, there is a need for more studies demonstrating the impact of hyperglycemia during pregnancy on outcomes during childbirth.

Association of oxytocin augmentation and duration of labour with postpartum haemorrhage: A cohort study of nulliparous women

ObjectiveBoth duration of labour and use of oxytocin for augmentation are known risk factors for postpartum haemorrhage but distinguishing between the significance of these factors is complex. In this study, we aimed to investigate the association between both labour duration and oxytocin augmentation, for postpartum haemorrhage. DesignA cohort study based on a secondary analysis of a cluster-randomised trial. Participants and settingTerm nulliparous women with a single foetus in cephalic presentation, spontaneous onset of active labour and a vaginal birth. The participants were originally included in cluster-randomised trial conducted in Norway from December 1, 2014, to January 31, 2017, that aimed to compare the frequency of intrapartum caesarean sections when adhering to the WHO partograph versus Zhang's guideline. MeasurementsThe data were analysed through four statistical models. Model 1 investigated the effect of oxytocin augmentation as a dichotomous variable (yes/no); Model 2 investigated the effect of the duration of oxytocin augmentation; Model 3 investigated the effect of the maximum dose of oxytocin; and Model 4 investigated the effect of both the duration of augmentation and the maximum dose of oxytocin. All four models included duration of labour divided into five time-intervals. We used binary logistic regression to estimate the odds ratios of postpartum haemorrhage, defined as blood loss of ≥ 1000 ml, including a random intercept for hospital and mutually adjusting for oxytocin augmentation and labour duration in addition to maternal age, maternal marital status, maternal higher education level, maternal smoking habits in the first trimester, maternal body mass index and birth weight. FindingsModel 1 found a significant association between the use of oxytocin and postpartum haemorrhage. In Model 2, oxytocin augmentation of ≥ 4.5 h was associated with postpartum haemorrhage. In Model 3, we found an association between a maximum dose of oxytocin of ≥ 20 mU/min and postpartum haemorrhage. Model 4 showed that a maximum dose of oxytocin ≥ 20 mU/min was associated with postpartum haemorrhage both for those augmented < 4.5 h and for those augmented ≥ 4.5 h. Duration of labour was associated with postpartum haemorrhage in all models if lasting ≥ 16 h. Key conclusionsWe found both oxytocin augmentation and labour duration to be associated with postpartum haemorrhage. Oxytocin doses of ≥ 20 mU/min and a labour duration of ≥ 16 h showed an independent association. Implication for practiceThe potent drug oxytocin should be carefully administered, as doses of ≥ 20 mU/min were associated with an increased risk of PPH, regardless of the duration of oxytocin augmentation.

FETOMATERNAL OUTCOME IN SPONTANEOUS VERSUS INDUCED LABOR

Background and Objectives: The medical induction of labour at term gestation has always been controversial and is based on conicting evidences.The present study is an attempt to assess the feto-maternal outcome of induced labour compared to spontaneous onset labour. Type of study:It was a prospective comparative study conducted at a tertiary care hospital, Lalla Ded Hospital Srinagar. Materials and methods:Atotal of 200 patients participated in this study. 100 women who had indicated induction of labour (study group) were compared with 100 women with spontaneous onset labour in active phase with cervix atleast 4 cm dilated (control group). Results: Vaginal delivery was 66% in the study group compared to 88% in the control group. Induced labour was associated with a signicantly higher caesarean section rates (P&lt; 0.001 ). Maternal complications include primary postpartum haemorrhage, perineal lacerations and puerperal pyrexia. The study group had longer duration of hospital stay compared to the control (P &lt;0.001).The neonatal Apgar scores at 1 and 5 min were comparable between both groups and showed no statistically signicant difference. Conclusion:Induction of labour is associated with increased risk of caesarean delivery

Lunar Cycle, Climate, and Onset of Parturition in Domestic Dromedary Camels: Implications of Species-Specific Metabolic Economy and Social Ecology.

Given energy costs for gestating and caring for male offspring are higher than those of female newborns, external environmental conditions might be regarded as likely to affect the timing of delivery processes differentially depending on the sex of the newborn calf to be delivered. The aim of the present paper is to evaluate the association between environmental stressors such as the moon phase and weather-related factors and the onset of labor in female dromedaries. A binary logistic regression model was developed to find the most parsimonious set of variables that are most effective in predicting the probability for a gravid female dromedary to give birth to a male or a female calf, assuming that higher gestational costs and longer labor times are ascribed to the production of a male offspring. Although the differences in the quantitative distribution of spontaneous onset of labor across lunar phases and the mean climate per onset event along the whole study period were deemed nonsignificant (p > 0.05), a non-negligible prediction effect of a new moon, mean wind speed and maximum wind gust was present. At slightly brighter nights and lower mean wind speeds, a calf is more likely to be male. This microevolutionary response to the external environment may have been driven by physiological and behavioral adaptation of metabolic economy and social ecology to give birth to cooperative groups with the best possible reduction of thermoregulatory demands. Model performance indexes then highlighted the heterothermic character of camels to greatly minimize the impact of the external environment. The overall results will also enrich the general knowledge of the interplay between homeostasis and arid and semi-arid environments.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

Impact of COVID-19 pandemic on preterm delivery.

Controversies exist on whether the pandemic lockdown has resulted in a lower rate of preterm deliveries. A higher stillbirth rate was also reported. This retrospective observational study aimed to examine the rate of preterm delivery and stillbirth in a tertiary hospital in Hong Kong during COVID-19 pandemic. Data from 8787 singleton pregnancies at Queen Mary Hospital between April 2018 to September 2021 were retrieved from the clinical management system and obstetric database. Rates of preterm delivery (<37 weeks), low birth weight infants (<2500 g), and stillbirth in the pre-pandemic (April 2018 to September 2019) and pandemic (April 2020 to September 2021) periods were compared. Total numbers of singleton deliveries during the pre-pandemic and pandemic periods were 5064 and 3723, respectively. Background demographics were comparable, except 3 were higher rates of cesarean sections (30.7% vs. 25.8%; p < 0.05) and hypertensive disorders (1.4% vs. 0.7%; p < 0.05) in the pandemic cohort. Moreover, more women with a spontaneous onset of labor had a history of preterm delivery (3.5% vs. 2.4%; p < 0.05) during the pandemic. Rates of low birth weight infants (8.7% vs. 7.4%; p = 0.03) and spontaneous preterm deliveries (2.6% vs. 1.7%; p = 0.01), particularly spontaneous moderate-to-late preterm delivery (32-36 weeks) (1.9% vs. 1.2%; p = 0.01) were significantly higher during COVID-19. However, no statistical difference was found in stillbirth rates (0.2% vs. 0.4%; p = 0.17). Rates of spontaneous preterm delivery and low birth weight babies increased significantly during the COVID-19 pandemic. This could be related to an increase in maternal stress, or a change in behavioral patterns for pregnant women.

Self-management, care needs and clinical management of primiparous mothers during early labour – a qualitative content analysis

BackgroundChildbearing women face the problem of managing spontaneous onset of labour without professional support. It is their responsibility to diagnose and react to early labour and subsequently recognise the right time to seek support. Institutional guidelines of clinics aim to admit childbearing women when in established labour. This explains why women in early labour are often advised to stay at home, which can be overwhelming and dissatisfying. This study aims to understand the self- and clinical management of early labour and care needs of first-time mothers during early labour.MethodsA qualitative approach was used involving four focus group discussions with a total of N = 18 mothers. Included were primiparous women who had given birth at term within the last 6 months and who experienced spontaneous onset of labour. Elective caesarean section or induction of labour were thereby exclusion criteria. The interviews followed a semi-structured, literature-based guide. Content analysis was applied.ResultsThirteen codes were summarised within three themes: ‘self-management’, ‘care needs’ and ‘professional management’. Various coping strategies and measures such as positive thinking or taking a bath helped women in managing early labour at home. The need for reassurance, professional guidance and pain management led them to seek professional support, which was initially accompanied by a feeling of inhibition. This negative emotion was mostly unjustified since many women felt well cared for and taken seriously in their needs.ConclusionCoping strategies and professional care help women going through early labour. Yet, there still exists insecurity about the justified timing in seeking professional support. An individual assessment of the women’s coping resources and their needs is required to promote shared decision making and give high-standard care.

Overall childbirth experience: what does it mean? A comparison between an overall childbirth experience rating and the Childbirth Experience Questionnaire 2

BackgroundIn clinical settings and research studies, childbirth experience is often measured using a single-item question about overall experience. Little is known about what women include in this rating, which complicates the design of adequate follow-up, as well as the interpretation of research findings based on ratings of overall childbirth experience. The aim of this study was to examine which known dimensions of childbirth experience women include in the rating on a single-item measure.MethodsRatings of overall childbirth experience on a 10-point numeric rating scale (NRS) from 2953 women with spontaneous or induced onset of labour at two Swedish hospitals were evaluated against the validated Childbirth Experience Questionnaire 2 (CEQ2), completed on one of the first days postpartum. The CEQ2 measures four childbirth experience domains: own capacity, perceived safety, professional support and participation. Internal consistency for CEQ2 was evaluated by calculating Cronbach’s alpha. NRS ratings were explored in relation to CEQ2 using empirical cumulative distribution function graphs, where childbirth experience was defined as negative (NRS ratings 1–4), mixed (NRS ratings 5–6) or positive (NRS ratings 7–10). A multiple linear regression analysis, presented as beta coefficients (B) and 95% confidence intervals (CI), was also performed to explore the relationship between the four domains of the CEQ2 and overall childbirth experience.ResultsThe prevalence of negative childbirth experience was 6.3%. All CEQ2-subscales reached high or acceptable reliability (Cronbach’s alpha = 0.78; 0.81; 0.69 and 0.66, respectively). Regardless of overall childbirth experience, the majority of respondents scored high on the CEQ2 subscale representing professional support. Overall childbirth experience was mainly explained by perceived safety (B = 1.60, CI 1.48–1.73), followed by own capacity (B = 0.65, CI 0.53–0.77) and participation (B = 0.43, CI 0.29–0.56).ConclusionsIn conclusion, overall childbirth experience rated by a single-item measurement appears to mainly capture experiences of perceived safety, and to a lesser extent own capacity and participation, but appears not to reflect professional support. CEQ2 shows good psychometric properties for use shortly after childbirth, and among women with induced onset of labour, which increases the usability of the instrument.

Women’s experience of early labour in a free-standing birth centre: Midwifing embodied labour

IssueWomen who present at hospital labour wards in early labour must often meet measurable diagnostic criteria before admission. BackgroundEarly labour is a phase of neurohormonal, emotional, and physical changes that are often not measurable. When admission to birthplace is based on results of diagnostic procedures, women’s embodied knowledge may be disregarded. AimTo describe the early labour experience of women with spontaneous onset of labour in a free-standing birth centre, as well as midwifery care when women arrived in labour. MethodologyAn ethnographic study was conducted in 2015 in a free-standing birth centre after receiving ethics approval. The findings for this article were drawn from a secondary analysis of the data, which included interview data with women and detailed field notes of midwives’ activities related to early labour. FindingsThe women in this study were instrumental in the decision-making process to stay at the birth centre. Observational data showed that vaginal exams were rarely conducted when women arrived at the birth centre and were not a deciding factor in admission. DiscussionThe women and midwives co-constructed early labour based on the lived experience of women and the meaning that this experience held for both. ConclusionGiven the growing concern about the need for respectful maternity care, this study provides examples of good practice in listening to women, as well as an illustration of the consequences of not doing so.

More than time: travel time to the delivery ward and maternal outcomes – onset of labour, postpartum haemorrhage and obstetric anal sphincter injury

BackgroundClosing delivery units increases travel time for some women. Whether increased travel time is associated with maternal outcomes is important for understanding the consequences of such closures. Previous studies are limited in measuring travel time and restricted to the outcome of caesarean section. MethodsOur population-based cohort includes data from the Swedish Pregnancy Register for women giving birth between 2014 and 2017 (N = 364,630). We estimated travel time from home to the delivery ward using coordinate pairs of actual addresses. The association between travel time and onset of labour was modelled using multinomial logistic regression, and logistic regression was used for the outcomes postpartum haemorrhage (PPH) and obstetric anal sphincter injury (OASIS). FindingsOver three-quarters of women had ≤30 min travel time (median 13.9 min). Women who travelled ≥60 min arrived to care sooner and laboured there longer. Women with further to travel had increased adjusted odds ratio (aOR) of having an elective caesarean section (31–59 min aOR 1.11; 95% confidence interval [CI] 1.07–1.16; ≥60 min aOR 1.25; 95% CI 1.16–1.36) than spontaneous onset of labour. Women (at full term with spontaneous onset) living ≥60 min away had reduced odds of having a PPH (aOR 0.84; 95% CI 0.76–0.94) or OASIS (aOR 0.79; 95% CI 0.66–0.94). InterpretationLonger travel time increased the odds of elective caesarean section. Women with furthest to travel arrived sooner and spent more time in care; although they had a lower risk of PPH or OASIS, they also tended to be younger, have a higher body mass index and were Nordic born.

Offspring school performance at age 12 after induction of labor vs non-intervention at term: A linked cohort study.

The incidence of induction of labor, for both medical reasons and as an elective procedure, has been rising and a further increase in induction of labor following the ARRIVE trial may be expected. The effects of induction of labor at term on childhood neurodevelopment, however, are not well studied. We aimed to study the influence of elective induction of labor for each week of gestation separately from 37 to 42 weeks on offspring school performance at 12 years of age after uncomplicated pregnancies. We performed a population-based study among 226 684 liveborn children from uncomplicated singleton pregnancies, born from 37+0 to 42+0 weeks of gestation in cephalic presentation in 2003-2008 (no hypertensive disorders, diabetes or birthweight ≤p5) in the Netherlands. Children with congenital anomalies, of non-white mothers and born after planned cesarean section were excluded. Birth records were linked with national data on school achievement. We compared, using a fetus-at-risk approach and per week of gestation, school performance score and secondary school level at age 12 in those born after induction of labor to those born after non-intervention, ie spontaneous onset of labor in the same week plus all those born at later gestations. Education scores were standardized to a mean of 0 and a standard deviation of 1 and adjusted in the regression analyses. For each gestational age up to 41 weeks, induction of labor was associated with decreased school performance scores compared with non-intervention (at 37 weeks -0.05 SD, 95% confidence interval [CI] -0.10 to -0.01 SD; adjusted for confounding factors). After induction of labor, fewer children reached higher secondary school level (at 38 weeks 48% vs 54%; adjusted odds ratio [aOR] 0.88, 95% CI 0.82-0.94). In women with uncomplicated pregnancies at term, consistently, at every week of gestation from 37 to 41 weeks, induction of labor is associated with lower offspring school performance at age 12 and lower secondary school level compared with non-intervention, although residual confounding may remain. These long-term effects of induction of labor should be incorporated in counseling and decision making.

Experience on trial of labor and vaginal delivery after two previous cesarean sections: A cohort study from a limited-resource setting.

To determine the success rate of trial of labor after two cesarean sections (TOLA2C) in the low-resource setting of the Democratic Republic of Congo (DRC) and to describe factors associated with success and related complications. A prospective cohort study was conducted from 2015 to 2020 in a teaching hospital. Patients who underwent TOLA2C were followed across prenatal visits, onset of spontaneous labor, and delivery. Demographics and clinical characteristics were documented. Pearson and Fisher χ2 tests were used. Predictors of successful vaginal delivery were determined by logistic regression (P˂0.05). Among 532 patients, the success rate of TOLA2C was 405 (76.1%). Factors associated with success included birth spacing ≥24 months (adjOR: 2.02 ; 95% CI 1.14-3.56; P=0.015), previous vaginal delivery (adjOR: 5.02; 95% CI 2.71-9.31; P˂0.001), intercalated vaginal delivery (adjOR: 5.15; 95% CI 2.28-11.65; P˂0.001), cervical dilation >6 cm (adjOR: 2.37; 95% CI 1.92-6.05; P=0.031) and/or complete dilation on arrival in the delivery room (adjOR: 1.96; 95% CI 1.33-11.45; P=0.047) and oxytocin stimulation (adjOR: 4.24; 95% CI 1.82-9.91; P˂0.001). No association with hemorrhage, uterine rupture, transfer to neonatology, or maternal-neonatal deaths was observed. TOLA2C is possible in a low-resource setting with a high success rate and low rates of complications. Patient selection and obstetrical team competency are required.

Effectiveness of multiple versus once-only membrane sweeping at term in preventing prolonged pregnancy: A randomised controlled trial

BackgroundBetween 4 and 18% of pregnancies are prolonged. Prolonged pregnancy is associated with adverse maternal and perinatal outcomes. ObjectivesTo compare the effectiveness of once-only versus multiple (weekly) membrane sweeping in reducing the incidence of prolonged pregnancy. Materials and methods: This randomised controlled trial was conducted over a two-year period, from January 2018 to December 2019, at the Federal Medical Centre and Diete-Koki Memorial Hospital, both in Yenagoa, Bayelsa State, Nigeria. Seven hundred and eighty-six women were equally randomized into two groups: once-only and multiple membrane sweeping, initiated at 39 weeks’ gestational age, but 742 women were included in the analysis. Data obtained was analysed using the Statistical Package for Service Solutions for Windows® version 20, SPSS Inc.; Chicago, USA). Associations between categorical independent and outcome variables were assessed, where applicable, using Chi square test at 95% confidence interval. A P-value of <0.05 was considered statistically significant. ResultsThere were no statistically significant differences between the two groups in terms of time interval between membrane sweeping and delivery (P = 0.85), spontaneous onset of labour (P = 0.21), induction of labour (P = 0.21) and Caesarean section rate (P = 0.68). The maternal complications of vaginal bleeding and pre-labour rupture of membranes following membrane sweeping in the two groups were also comparable (P = 0.45 each). All the women were satisfied and membrane sweeping was acceptable to all of them. ConclusionOnce-only membrane sweeping at 39 weeks’ gestational age is as effective as multiple membrane sweeping for the prevention of prolonged pregnancy. Multiple membrane sweeping does not confer any added advantage/benefit over a single sweep.

The Relationship Between Uterine Activity, Oxytocin Dosing, Labor Progress, and Mode of Birth in Nulliparas with Obesity: Minimal Usefulness of Montevideo Unit Measurement.

Maternal obesity and cesarean birth disproportionately affect Black parturients; thus, prevention of cesarean birth is a key modifiable factor to improve pregnancy outcomes and reduce disparities. The primary driver of unplanned cesarean birth among people with higher body mass index is prolonged labor duration. However, strategies to optimize outcomes in these situations have not been established. We aimed to evaluate the influence of oxytocin augmentation on uterine activity and labor progression in nulliparas with obesity. This secondary analysis involved nulliparas with obesity (BMI ≥30kg/m2) who had spontaneous labor onset followed by oxytocin augmentation and an intrauterine pressure catheter. Using Linear Mixed Models, we evaluated relationships between uterine activity measured in Montevideo units (MVU), oxytocin dose, and rate of cervical dilation normalized by labor duration. In this diverse sample (35.6% Caucasian, 16.11% African American, 40.2% Hispanic) of nulliparas with obesity (n = 87; BMI 35.54 ± 4.38kg/m2), 31% ended labor with cesarean birth. Among those with vaginal birth, only 13% had MVU ≥200 prior to the final 2hours of labor. MVUs were only minimally responsive to oxytocin dose and were not associated with labor progression nor birth route. MVU measurements may not be useful to diagnose labor arrest in nulliparas with obesity. Optimizing care for birthing people with obesity is essential for improving perinatal outcomes and for reducing racial health disparities.