Spontaneous Onset Of Labor Research Articles

A randomized clinical trial comparing intravaginal glyceryl trinitrate (nitric oxide donor) plus artificial sweeping of membrane versus artificial sweeping of membrane alone for cervical ripening at term pregnancies with unfavourable cervix

Abstract
 Introduction
 Significant amount of pregnant mothers is not undergoing spontaneous onset of labour at term. The policy of cervical ripening at term will reduce the risk and their complications associated with post date pregnancies. Artificial sweeping of membranes and nitric oxide donors are useful cervical ripening methods used across the world. This study was carried out to compare the efficacy of cervical ripening by administration of intravaginal Glyceryltrinitrate plus artificial sweeping of membranes versus artificial sweeping of membranes alone.
 Objectives
 To Compare of the efficacy,the spontaneous onset of labour rate, the labour outcome, the duration from induction to the delivery time of baby and adverse maternal and fetal outcomes of cervical ripening by administrating of intravaginal Glyceryltrinitrate combined with artificial sweeping of membranes versus artificial sweeping of membranes alone.
 Methodology
 This was a double blinded randomized clinical trial carried out in a major obstetric unit in Sri Lanka.Having excluded the subjects according to the exclusion criteria, rest of the sample was divided into cases and controls. Sample size was calculated as 114 for each arm. Approval of the proposal and ethical clearance have been obtained from the board of study and ethical review committee of postgraduate institute of medicine, University of Colombo, SriLanka respectively.Sample randomization done by using stratified block randomization technique with sealed envelope. Information leaflet was given and detailed written consent was taken from the subjects prior to the recruitment. Artificial sweeping of membranes together with intravaginal Glycery ltrinitrate was inserted for the cases and artificial sweeping of membranes alone was performed for the control group. Spontaneous onset of labour, improvement of the modified Bishop’s Score and labor outcome were assessed. Data were analyzed by using SPSS software.
 Results
 Mean age, parity and gestational age were matched in both intervention and control group. Results were analyzed by SPSS software using standard statistical tools. Spontaneous onset of labour within 24 hours were significantly increased (p

Cesarean Delivery After Nonmedically Indicated Induction of Labor: A Population-based Study Using Different Definitions of Expectant Management

(Acta Obstet Gynecol Scand. 2021;100:220–228) Induction of labor (IOL) has been associated with an increased risk of cesarean delivery (CD), when compared with spontaneous onset of labor. But when compared with expectant management, randomized controlled trials (RCTs) and observational studies have found that nonmedically indicated or “elective” IOL is associated with fewer CD. Expectant management is typically defined as all births at a later gestation, usually >41 weeks, regardless of mode of delivery. However, this definition may bias clinicians to favor IOL earlier or at full term when considering the risk of expectant management in the short term, or until the next appointment when IOL may be reconsidered. The aim of this study was to evaluate the risk of CD after elective IOL using the 2 definitions of expectant management.

Term prelabor rupture of the membranes with unfavorable cervix: Frequency and factors associated with spontaneous onset of labor after two days of expectant management

IntroductionIn case of term prelabor rupture of membranes (PROM), expectant management is a reasonable option. We aimed at assessing the frequency of spontaneous onset of labor after two days of term PROM and its associated factors. Material and MethodsWomen delivering at a tertiary center of a singleton in cephalic presentation, after a term PROM with an unfavorable cervix and with an expectant management period of at least two days were included during a 2-year period. Women were excluded in case of induction of labor before or at day 2(D2) or of spontaneous labor before D2. The frequency of spontaneous labor was assessed, then maternal characteristics at admission and at D2 were compared between women with a spontaneous onset of labor before D3, and women with an induced labor at D3. The maternal and neonatal outcomes were compared between the two groups. The factors associated with spontaneous labor in univariate analysis were tested in multivariable analysis. ResultsAmong the 11 608 women delivering at term, 933(8.4%) had a term PROM. Among them, 191 had an unfavorable cervix after D2 including 86(45%) women with a spontaneous labor onset between D2 and D3 and 105(55%) induced at D3. Maternal age below 35 years (reference ≥35years) and Bishop score of 3,4 and 5,6 at D2 (reference score 0–2) were significantly associated with spontaneous onset of labor, respectively aOR 2.62; 95%CI[1.26–5.45], aOR 2.38; 95%CI[1.18–4.78] and aOR 10.16; 95%CI[3.67–28.15]. DiscussionIn women with a term PROM and an unfavorable cervix, spontaneous labor still occurs in nearly half of women undelivered after two days of expectant management.

Obstetric Perineal Tears in Pregnant Adolescents and the Influencing Factors

The incidence and risk factors of obstetric perineal tear occurrence in vaginal delivery of adolescent pregnant patients are not well established. We aimed to describe the incidence of obstetric perineal tears in adolescents and the maternal obstetric risk factors associated with this situation. Retrospective cohort study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Adolescent pregnant patients (≤19 years) who delivered vaginally in our institution between January 2014 and January 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: The main outcome measures were the incidence of perineal tears, the degree of perineal tears, and the risk factors associated with severe perineal tears in adolescents. Severe perineal tears include third- and fourth-degree lacerations. A third-degree tear is defined as partial or complete disruption of the anal sphincter muscles, and a fourth-degree tear is defined as lacerations involving the rectal mucosa. A total of 3441 adolescents who had a vaginal delivery were included in the study. The rate of severe perineal tear was 5.8% (200/3441). Risk factors associated with obstetric laceration in adolescents in multivariate analysis were nulliparity (OR=1.72; 95% CI, 1.14-2.41; P=0.007), high birth weight (OR=4.1; 95% CI, 2.71-6.21; P < 0.001), and labor induction (OR=1.36; 95% CI, 1.01-1.85; P=0.02). Spontaneous onset of labor and previous delivery reduced the risk of severe perineal tear in adolescent pregnant patients (respectively, OR=0.68; 95% CI, 0.51-0.94; P=0.02 and OR=0.51; 95% CI, 0.33-0.79; P=0.007). In adolescents, the risk of severe perineal tear was associated with nulliparity, birth weight, and labor induction. The only possible modifiable risk factor was labor induction.

Population based cohort study of fetal deaths, and neonatal and perinatal mortality at term within a Somali diaspora

BackgroundSomali women deliver at greater gestational age with limited information on the associated perinatal mortality. Our objective is to compare perinatal mortality among Somali women with the population rates.MethodsThis is a retrospective cohort study from all births that occurred in Minnesota between 2011 and 2017. Information was obtained from certificates of birth, and neonatal and fetal death. Data was abstracted from 470,550 non-anomalous births ≥37 and ≤ 42 weeks of gestation. The study population included U.S. born White, U.S. born Black, women born in Somalia or self-identified as Somali, and women who identified as Hispanic regardless of place of birth (377,426). We excluded births < 37 weeks and > 42 weeks, > 1 fetus, age < 18 or > 45 years, or women of other ethnicities. The exposure was documented ethnicity or place of birth, and the outcomes were live birth, fetal death, neonatal death prior to 28 days, and perinatal mortality rates. These were calculated using binomial proportions with 95% confidence intervals and compared using odds ratios adjusted (aOR) for diabetes, hypertension and maternal body mass index.ResultsThe aOR [95%CI] for stillbirth rate in the Somali cohort was greater than for U.S. born White (2.05 [1.49–2.83]) and Hispanic women (1.90 [1.30–2.79]), but similar to U.S. born Black women (0.88 [0.57–1.34]). Neonatal death rates were greater than for U.S. born White (1.84 [1.36–2.48], U.S. born Black women (1.47 [1.04–2.06]) and Hispanic women (1.47 [1.05–2.06]). This did not change after analysis was restricted to those with spontaneous onset of labor. When analyzed by week, at 42 weeks Somali aOR for neonatal death was the same as for U.S. born White women, but compared against U.S. born Black and Hispanic women, was significantly lower.ConclusionsThe later mean gestational age at delivery among women of Somali ethnicity is associated with greater overall risk for stillbirth and neonatal death rates at term, except compared against U.S. born Black women with whom stillbirth rates were not different. At 42 weeks, Somali neonatal mortality decreased and was comparable to that of the U.S. born White population and was lower than that of the other minorities.

Trial of labor after cesarean in primiparous women with fetal macrosomia.

Spontaneous labor onset, epidural anesthesia and prior cesarean for non-arrest disorders are strong predictors of successful vaginal birth after cesarean in women delivering a macrosomic fetus. Lower rates of successful vaginal birth after cesarean in association with increasing birthweight were previously reported. We aimed to determine the factors associated with successful trial of labor after cesarean (TOLAC) among primiparous women with fetal macrosomia. A retrospective cohort study conducted during 2005-2019 at two university hospitals, including all primiparous women delivering a singleton fetus weighing ≥ 4000g, after cesarean delivery at their first delivery. A multivariate analysis was performed to evaluate the characteristics associated with TOLAC success (primary outcome). Of 551 primiparous women who met the inclusion criteria, 50.1% (n = 276) attempted a TOLAC and 174 (63.0%) successfully delivered vaginally. In a multivariate analysis, spontaneous onset of labor (aOR [95% CI] 3.68 (2.05, 6.61), P < 0.001), epidural anesthesia (aOR [95% CI] 2.38 (1.35, 4.20), P = 0.003) and history of cesarean delivery due to non-arrest disorder (aOR [95% CI] 2.25 (1.32, 3.85), P = 0.003) were the only independent factors associated with TOLAC success. Successful TOLAC was achieved in 82.0% (82/100) in the presence of all three favorable factors, 61.3% (65/106) in the presence of two factors and 38.6% (27/70) in the presence of one or less of these three factors (P < 0.001). Spontaneous onset of labor, epidural anesthesia and prior cesarean delivery due to non-arrest disorders were independently associated with higher vaginal birth after cesarean rate among women with fetal macrosomia, with an overall favorable success rate in the presence of these factors. These findings should be implemented in patient counseling in those contemplating a vaginal birth in this setting.

Spontaneous labor curve based on a retrospective multi-center study in Japan.

AimIn Japan, the criteria of the latent and active phases of the first stage of labor have not been decided. The Japan Society of Obstetrics and Gynecology (JSOG) Perinatal Committee conducted a study to construct a spontaneous labor curve in order to determine the point of onset of the active phase.MethodsThe participants were women who had spontaneous deliveries at four health facilities in Japan between September 1, 2011, and September 31, 2019. Spontaneous delivery was defined as the spontaneous onset of labor at term (37 weeks, 0 days to 41 weeks, 6 days) with vaginal delivery of a mature fetus in a cephalic position without uterotonic agents or epidural analgesia. The time points for each “cm” of dilation were collected starting from the time of full dilation retrogradely. The relationship between time since labor onset and cervical dilation was expressed as a curve using a smoothing B‐spline.ResultsA total of 4215 primiparous and 5266 multiparous women were included in this study. The spontaneous labor curve showed that in both primiparous and multiparous women, labor progress was slow until 5 cm cervical dilation, accelerating between 5 and 6 cm dilation, and steadily progressed after 6 cm dilation.ConclusionWe propose that the active phase of the first stage of labor be defined as starting at 5 cm dilation of the cervix, and that it be divided into an acceleration phase (5–6 cm dilation) and a maximal phase (>6 cm dilation).

Factors Associated with Successful Vaginal Birth After a Primary Cesarean Section in Women with an Optimal Inter-Delivery Interval.

PurposeWe sought to determine the success rate of VBAC and factors associated with achieving VBAC at a referral hospital in the Democratic Republic of Congo in women with a subsequent pregnancy greater than or equal to 18 months from their primary cesarean section (CS).Patients and MethodsPatients were included for participation if they had an inter-delivery interval (IDI) of at least 18 months from their primary CS, accepted TOLAC, and had no contraindications. Information was collected about patients’ demographics, obstetric history, and factors impacting their labor process. Descriptive analyses compared patients that had a successful VBAC and those who did not. Univariate and multivariate binary logistic regression models identified factors associated with a successful VBAC.ResultsAmong 231 eligible patients who attempted a VBAC, 57.6% (133) achieved VBAC. Participants had a mean age of 29 (SD 6), with the majority having a prior vaginal delivery (68.8%). VBAC was positively associated with a higher Bishop score (AOR 1.12, 95% CI 1.02, 1.23) and a spontaneous labor onset (AOR 3.06, 95% CI 1.52, 6.17). VBAC was negatively associated with a macrosomic fetus (AOR 0.21, 95% CI 0.08, 0.58).ConclusionTOLAC results in VBAC more than half the time and is associated with a spontaneous labor onset and a higher Bishop score. Women with a macrosomic fetus were more likely to have an unsuccessful VBAC, resulting in an RCS. An optimal IDI was not enough to ensure a successful VBAC. Upon patients’ arrival to the hospital, practitioners should re-evaluate their eligibility to attempt a VBAC based on their Bishop score and if they had a spontaneous labor onset to decrease the health risks of an RCS.

Effect of Intramuscular Administration of Dexamethasone on Shortening of the Duration of Induction of Labor

Abstract Background Induction of labor refers to iatrogenic stimulation of uterine contractions to accomplish delivery prior to the onset of spontaneous labor. Induction of labor is undertaken when both of the following criteria are met: Continuing the pregnancy is believed to be associated with greater maternal or fetal risk than intervention to deliver the pregnancy, and there is no contraindication to vaginal birth. Aim of the Work to evaluate the effect of intramuscular administration of dexamethasone on the duration of vaginal delivery in women undergoing induction of labor. Patients and Methods This double-blinded randomized controlled study was conducted on 60 termed pregnant women who were divided into two groups, Dexamethasone group: injected with 2 ml of the product (dexamethasone®) 12 hours before initiation of labor induction and placebo group: injected with 2 ml distilled water 12 hours before initiation of labor induction. The two groups were induced by the same standard protocol. Determination of interval between initiation of induction and beginning of active phase, duration of active phase, duration of 2nd stage and duration 3rd stage have been detected for both groups and statistically analyzed. Results There were significant statistical differences between the two studied groups as regard rate of cervical dilatation. There were high significant statistical differences between the two studied groups as regard duration between initiation of labor induction and beginning of active phase of labor, duration of active phase of labor and duration of second and third stage of labor. Conclusion an intramuscular injection of dexamethasone before labor induction is found to shorten the duration of labor induction by decreasing the interval between the initiation of induction and the beginning of the active phase, duration of active phase and duration of second stage of labor with no observed maternal or neonatal complications.

Epidural use among women with spontaneous onset of labour – an observational study using data from a cluster-randomised controlled trial

ObjectiveTo investigate whether the proportion of pregnant women who use epidural analgesia during birth differed between women registered at a maternity clinic randomised to Mindfetalness or to routine care. DesignAn observational study including women born in Sweden with singleton pregnancies, with spontaneous onset of labour from 32 weeks’ gestation. Data used from a cluster-randomised controlled trial applying the intention-to-treat principle in 67 maternity clinics where women were randomised to Mindfetalness or to routine care. ClinicalTrials.gov (NCT02865759). InterventionsMidwives were instructed to distribute a leaflet about Mindfetalness to pregnant women at 25 weeks’ gestation. Mindfetalness is a self-assessment method for the woman to use to become familiar with the unborn baby's fetal movement pattern. When practising the method in third trimester, the women are instructed to daily lie down on their side, when the baby is awake, and focus on the movements’ intensity, character and frequency (but not to count each movement). FindingsOf the 18 501 women with spontaneous onset of labour, 47 percent used epidural during birth. Epidural was used to a lower extent among women registered at a maternity clinic randomised to Mindfetalness than women in the routine-care group (46.2% versus 47.8%, RR 0.97, CI 0.94–1.00, p= 0.04). Epidural was more common among primiparous women, women younger than 35 years, those with educational levels below university, with BMI ≥25 and with a history of receiving psychiatric care or psychological treatment for mental illness. Conclusions and implications for practicePregnant women who were informed about a self-assessment method, with the aim of becoming familiar with the unborn baby's fetal movement pattern, used epidural to a lower extent than women who were not informed about the method. Future studies are needed to investigate and understand the association between Mindfetalness and the reduced usage of epidural during birth.

Effect of Membrane Sweeping on the Initiation of Spontaneous Labour

Background: Membrane sweeping causes induction of labour by release of prostaglandins, and other hormones. Aim: To determine efficacy of membrane sweeping on induction of spontaneous labour in post-date women. Study design: Randomized controlled trial. Place and duration of study: Department of Obstetrics &amp; Gynaecology, Health Bridge Hospital, Ghazi Road, Lahore from 1st January 2020 to 31st December 2020. Methodology: One hundred and fifty pregnantwomen with ≥40 weeks of gestationwere randomly divided into two groups of 75 pregnant women each. Group A were those who consented for undergoing membrane sweeping whereas group B did not undergo this process. Results: The mean age of the enrolled pregnant women was25.7±3.05 years. The mean duration of pregnancy in group A was 40.1±0.2 weeks and in group B was 40.2±0.1 weeks. Regarding spontaneous onset of labour, in group A, 38(50.6%) patients went into labour with sweeping of membranes and in group B, 10(13.4%) patients had spontaneous onset of labour. There were only two cases of infection reported in Group A and one in group B. Conclusion: Membrane sweeping for natural induction of spontaneous labour. Key words: Membrane sweeping, Labour induction, Efficacy

Myo-inositol: a potential prophylaxis against premature onset of labour and preterm birth.

The incidence of preterm birth (PTB), delivery before 37 completed weeks of gestation, is rising in most countries. Several recent small clinical trials of myo-inositol supplementation in pregnancy, which were primarily aimed at preventing gestational diabetes, have suggested an effect on reducing the incidence of PTB as a secondary outcome, highlighting the potential role of myo-inositol as a preventive agent. However, the underlying molecular mechanisms by which myo-inositol might be able to do so remain unknown; these may occur through directly influencing the onset and progress of labour, or by suppressing stimuli that trigger or promote labour. This paper presents hypotheses outlining the potential role of uteroplacental myo-inositol in human parturition and explains possible underlying molecular mechanisms by which myo-inositol might modulate the uteroplacental environment and inhibit preterm labour onset. We suggest that a physiological decline in uteroplacental inositol levels to a critical threshold with advancing gestation, in concert with an increasingly pro-inflammatory uteroplacental environment, permits spontaneous membrane rupture and labour onset. A higher uteroplacental inositol level, potentially promoted by maternal myo-inositol supplementation, might affect lipid metabolism, eicosanoid production and secretion of pro-inflammatory chemocytokines that overall dampen the pro-labour uteroplacental environment responsible for labour onset and progress, thus reducing the risk of PTB. Understanding how and when inositol may act to reduce PTB risk would facilitate the design of future clinical trials of maternal myo-inositol supplementation and definitively address the efficacy of myo-inositol prophylaxis against PTB.

MATERNAL AND PERINATAL OUTCOMES OF CORONAVIRUS DISEASE COVID 19 INFECTION IN PREGNANCY – A RETROSPECTIVE STUDY.

Purpose: To study maternal and perinatal outcomes of COVID –positive pregnant women in a tertiary healthcare centre. Materials And Methods: This was a retrospective statistical analysis of records of COVID positive women who delivered at our institution between May 2020 to December 2020. Results: There were 44 COVID positive pregnant women during the study period of which 40 (90.9%) were term pregnancies and 4 (9.09%) preterm pregnancies. There were 17 (38.63%) women who had spontaneous onset of labour, 14 (31.8%) were induced and 13(29.5%) had elective LSCS. 14(31.8%) women had normal vaginal delivery,26(59.09%) had LSCS and 4(9.09%) had instrumental delivery. Most women 39(88.6%) were asymptomatic and 5(11.3%) presented with mild symptoms. 30 patients (68.18%) had underlying medical disorders. There were 5 (11.3%) babies with low birth weight (&lt;2.5kg) , APGAR scores at 5 min was &gt;7 for all babies. Six (15.7%) babies required NICU admission and 2 (4.5%) were COVID positive. Conclusion: Majority of the COVID positive women were asymptomatic . Majority of the patients had an underlying comorbidity.None underwent ICU admission. Risk of preterm delivery and NICU admission was similar to COVID negative patients. Risk of vertical transmission exists. Fetal outcomes in terms of APGAR scores at 5 min, birth weight was found to be good.

Associations between duration of active second stage of labour and adverse maternal and neonatal outcomes: A cohort study of nulliparous women with spontaneous onset of labour

ObjectiveTo investigate associations between the duration of the active second stage of labour and adverse maternal and neonatal outcomes. MethodThis cohort study is based on data from a cluster randomised controlled trial (RCT) undertaken at 14 Norwegian birth clinics in Norway from 2014 to 2017. The final sample involved 6804 nulliparous women with a singleton fetus, cephalic presentation, spontaneous onset of labour at term, vaginal delivered and with an active second stage of labour. The women were grouped to active second stage of labour ≤ 60 min and active second stage of labour > 60 min. Binary logistic regression was used to estimate crude and adjusted odds ratios (ORs) of the maternal and neonatal outcomes with an associated 95% confidence intervals (CIs), comparing women in the two groups. ResultsThere was an increased risk of postpartum haemorrhage > 1000 ml with an adjusted OR 1.31 (95% CI: 1.01–1.69) when the active second stage of labour exceeded 60 min. There was no significant difference in the risk of obstetric anal sphincter injuries (adjusted OR 0.93 [95% CI: 0.65–1.39]), Apgar scores < 7 at 5 min age (adjusted OR 1.13 [95% CI: 0.65–1.97]) or admission to the neonatal intensive care unit (adjusted OR 1.46 [95% CI: 0.61–3.51]) between the study groups. ConclusionWomen with an active second stage of labour that exceeds 60 min had an increased risk of postpartum haemorrhage > 1000 ml. We found no association between duration of active stage of labour and obstetric anal sphincter injuries or adverse neonatal outcomes.

The effect of mode of delivery and duration of labour on subsequent pregnancy outcomes: a retrospective cohort study.

To assess whether delivery mode and duration of labour in a first labour of spontaneous onset is associated with gestational length, delivery mode and neonatal outcome in the subsequent pregnancy. Retrospective analysis of prospectively collected data. 15 Maternity units in North West London (1988-2000). 30 840 women with spontaneous onset of labour in pregnancy 1 and a subsequent birth reported in the same database. Assessment of outcomes by mode of delivery in pregnancy 1, restricting the analysis to the difference in the gestational length between pregnancy 1 and 2. Gestational length, mode of delivery and neonatal unit admission in pregnancy 2. Caesarean section (CS) in the first or second stage of labour in pregnancy 1 was associated with pregnancy 2 being a median of 5 and 8 days shorter and a preterm birth rate of 6.0% and 10.1%, respectively, whereas following a normal or instrumental vaginal birth in pregnancy 1, the median duration was similar, with preterm delivery rates of 4.5% and 3.9%. In all, 56.2% of women with a CS in pregnancy 1 had a repeat CS and 12.5% of their babies were admitted to a neonatal unit, compared with 5.3% of women with vaginal birth. Longer labours were associated with shorter gestations in pregnancy 2. Compared with vaginal birth, an emergency CS in the first-term pregnancy is associated with a shorter gestational length, increased rate of repeat CS and increased risk of NNU admission in the next pregnancy. An emergency caesarean section in the first-term pregnancy affects the duration and outcome of the next pregnancy.

Meal patterning and the onset of spontaneous labor.

There is a lack of consensus in the literature about the association between meal patterning during pregnancy and birth outcomes. This study examined whether maternal meal patterning in the week before birth was associated with an increased likelihood of imminent spontaneous labor. Data came from 607 participants in the third phase of the Pregnancy, Infection, and Nutrition Study (PIN3). Data were collected through an interviewer-administered questionnaire after birth, before hospital discharge. Questions included the typical number of meals and snacks consumed daily, during both the week before labor onset and the 24-hour period before labor onset. A self-matched, case-crossover study design examined the association between skipping one or more meals and the likelihood of spontaneous labor onset within the subsequent 24hours. Among women who experienced spontaneous labor, 87.0% reported routinely eating three daily meals (breakfast, lunch, and dinner) during the week before their labor began, but only 71.2% reported eating three meals during the 24-hour period before their labor began. Compared with the week before their labor, the odds of imminent spontaneous labor were 5.43 times as high (95% CI: 3.41-8.65) within 24hours of skipping 1 or more meals. The association between skipping 1 or more meals and the onset of spontaneous labor remained elevated for both pregnant individuals who birthed early (37-<39weeks) and full-term (≥39weeks). Skipping meals later in pregnancy was associated with an increased likelihood of imminent spontaneous labor, though we are unable to rule out reverse causality.

Modelling the cost of place of birth: a pathway analysis

BackgroundIn New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown.ObjectivesThe objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective.MethodsThis was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year.Findings496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth, $AUD4979 for a birth centre birth and $AUD5463 for a hospital birth.ConclusionThe findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective.

Timing of elective termination of Pregnancy in Preterm Premature Rupture of membranes, prospective randomized controlled trial.

Background: Rupture of membranes is associated with high incidence of maternal and fetal morbidities as well as the neonatal morbidity and mortality resulting from prematurity if preterm birth ensues.Aim: This study aimed to evaluate maternal and neonatal outcomes of elective delivery at 34 versus 36 weeks of gestations in pregnancies complicated by preterm premature rupture of membranes and had been managed expectantly.Materials and Methods: This is a prospective randomized controlled trial which was conducted at Ain Shams University Maternity hospital between March and August 2019. 140 women pregnant between 30 and 32 weeks and diagnosed with preterm premature rupture of membranes were admitted to receive conservative management and then they were randomly divided into 2 equal groups regarding time of elective delivery either late delivery at 36 weeks or early delivery at 34 weeks.Results: The incidence of intrauterine infections was comparable between both groups. The rate of chorioamnionits was 8.6% in the late delivery group versus 4.3% in the early delivery group while endometritis was diagnosed in 2.9% in the late delivery group and 1.4% in the early delivery group. The incidence of spontaneous onset of preterm labor, cord prolapse and placental abruption was similar in both groups. Neonates of the late delivery group had significantly more Apgar score at 5 minutes (6.4±1.0 versus 5.0±0.9, p 0.05).Conclusion: Early delivery at 34 weeks does not reduce the rate of chorioamnionitis, but does increase the likelihood of respiratory distress syndrome and the rate of neonatal intensive care unit admissions. Our findings support the practice of conservative management in pregnant women with ruptured membranes if there is no contraindication to extending the pregnancy.

Association Between Physical Activity And The Onset Of Spontaneous Labor

PURPOSE: To determine whether prenatal physical activity (any, recreational, or occupational) the week before delivery was associated with increased risk of spontaneous labor (SL) onset. METHODS: We used data from 541 women participating in the third Pregnancy, Infection, and Nutrition Study (PIN3) who reported SL onset and for whom antenatal physical activity was not contraindicated. An interviewer-administered questionnaire measured labor triggers, gestational age at birth, and physical activity (frequency, duration, and intensity) performed both within the week and 24-hour period prior to labor onset. A self-matched, case-crossover design examined the association between activity in the 0 to 24 hours preceding SL onset compared to the week (24 hours to 7 days) before onset of labor. RESULTS: Among these women who experienced SL, 92% (any), 57% (recreational), and 25% (occupational) reported performing physical activity during the week before their labor began, whereas 71% (any), 33% (recreational), and 9% (occupational) reported performing physical activity during the 24-hour period before their labor began. Compared with the week before their labor, the immediate odds of SL were decreased within 24 hours of performing ≤30 minutes of any physical activity [(OR30 minutes: 0.74; 95% CI: 0.74-1.00); (Figure 1)]. The immediate odds of SL were also decreased within 24 hours of ≤45 minutes of occupational physical activity (OR45 minutes: 0.39; 95% CI: 0.18-0.85). However, the immediate odds of SL were increased within 24 hours of performing ≥30 minutes of recreational physical activity (OR30 minutes: 1.54; 95% CI: 1.09-2.15). CONCLUSION: Any and occupational physical activity were associated with a decreased likelihood of SL within 24 hours, while recreational physical activity was associated with an increased likelihood of SL. Future research should assess the potential for reverse causality.

Outcome of High Foetal Station in Primigravida With Vertex Presentation at Term - A Clinical Study in a Tertiary Care Center

Introduction: There is an uncertain relationship between foetal station and mode of delivery. The rise in the rates of caesarean section in unengaged head in primigravida is due to the reason that high foetal station which is considered as a threat to normal progress of labor and so immediately considered as an indication to early caesarean section. A vigilant attitude and timely intervention can help in decreasing chances of C-section and help such cases deliver vaginally. Aims and Objectives: To study the outcome of unengaged head in full term primigravida in labor. 1. To evaluate the causes of unengaged head and analyse progress of labour. 2. To assess maternal and foetal outcome. Material and Methods: 124 Primigravidae at term with unengaged foetal head in labor were undertaken in the study after they met eligibility criteria. After history taking and clinical examination, course of their labor was monitored partographically to study the maternal and neonatal outcome. Results: Out of 124 patients, 84 (67.74%) patients had vaginal delivery while in 40 (32.26%) Lower Segment Caesarean Section (LSCS) was performed. Out of 84 vaginal deliveries, 64 patients had full term normal deliveries while 20 patients needed assisted instrumental deliveries. Thus, out of 124 deliveries, 64 (51.61%) had normal vaginal deliveries, 20 (16.12%) instrumental deliveries and 40 (32.25%) Caesarean sections. Conclusion: We can imply that primigravida at term with high foetal station with spontaneous onset of labor are not all for immediate caesarean section. Watchful expectancy, vigilant intrapartum partographic monitoring can result into normal vaginal delivery with minimal maternal and foetal complications.