Timing Of Delivery In Women Research Articles

343 Timing of delivery in women with pre-existing hypertension and stillbirth risk: A retrospective population-based study

343 Timing of delivery in women with pre-existing hypertension and stillbirth risk: A retrospective population-based study

Placental Pathology After Low-Impact Maternal Trauma [ID: 1380074

INTRODUCTION: Placental abruption is the most common cause of fetal death in cases of blunt trauma, and the majority of abruptions occur within 24 hours of the injury. Because of this potential complication, the observation time after trauma remains controversial. Our study aims to demonstrate the incidence of placental abruption and abnormal placental pathology at the time of delivery in women who have experienced low-impact trauma. METHODS: This was a retrospective cohort study of pregnant patients between the years of 2014 and 2020 at MedStar Washington Hospital Center who presented to triage for low-impact trauma identified by “trauma,” “IPV,” “fall,” or “MVA.” MedStar Health Research Institute IRB approved this study. Data from their evaluation during triage visit, mode of delivery, and placental pathology were assessed. Patients were de-identified and analyses included χ2 tests, linear regression, and multinomial logistic regression analyses, as appropriate (α=0.05). RESULTS: Of 184 patients identified, delivery data were available for 144 (79%). The mean time from trauma to delivery was 9 weeks. After delivery, the placental pathology was grossly assessed or sent to pathology, and 76.6% were intact with 7.6% noting an infarct when sent to pathology. Observation time did not predict placental infarction or calcification. The type of trauma did not correlate with mode of delivery (P=.629), prelabor preterm rupture of membranes (P=.746), placental infarct (P=.358), intact placenta (P=.834), or placental calcification (P=.288). CONCLUSION: Although a small percentage of patients who experienced low-impact trauma had infarction identified on placental pathology, no patients experienced clinical or pathologic placental abruption in 24 hours after trauma.

Gestational diabetes mellitus: The optimal time of delivery.

Gestational diabetes mellitus (GDM) is a common pregnancy complication strongly associated with poor maternal-fetal outcomes. Its incidence and prevalence have been increasing in recent years. Women with GDM typically give birth through either vaginal delivery or cesarean section, and the maternal-fetal outcomes are related to several factors such as cervical level, fetal lung maturity, the level of glycemic control still present, and the mode of treatment for the condition. We categorized women with GDM based on the latter two factors. GDM that is managed without medication when it is responsive to nutrition- and exercise-based therapy is considered diet- and exercise-controlled GDM, or class A1 GDM, and GDM managed with medication to achieve adequate glycemic control is considered class A2 GDM. The remaining cases in which neither medical nor nutritional treatment can control glucose levels or patients who do not control their blood sugar are categorized as class A3 GDM. We investigated the optimal time of delivery for women with GDM according to the classification of the condition. This review aimed to address the benefits and harms of giving birth at different weeks of gestation for women with different classes of GDM and attempted to provide an analytical framework and clearer advice on the optimal time for labor.

Timing of delivery in women with gestational diabetes mellitus: still an open question

Timing of delivery in women with gestational diabetes mellitus: still an open question

Timing of cesarean delivery in women with uncomplicated placenta previa

Objective The optimal timing of an elective cesarean delivery for uncomplicated placenta previa remains controversial. Although the present guidelines recommend an elective cesarean delivery between 360/7 and 376/7 weeks of gestation, data supporting this recommendation does not differentiate in outcomes between elective and emergent delivery, or between women with and without ante-partum hemorrhage. Recommendations regarding optimal timing of delivery are based on the risks and benefits associated with delivery at a certain gestational week, compared with a reference of 38 weeks. Therefore, the aim of this paper was to assess the maternal and neonatal adverse outcomes associated with elective delivery at different gestational weeks from 360/7 to 386/7 weeks compared with expectant management in women with uncomplicated placenta previa. Methods A retrospective cohort study in a single tertiary medical center of 251 women with a diagnosis of uncomplicated placenta previa, who delivered between 360/7 and 386/7 weeks of gestation, who delivered at our center between Jan 2011 and Dec 2019. Maternal and neonatal outcomes at each gestational week were compared with expectant management. Results At 360/7–366/7 weeks, the rate of composite maternal adverse outcome was similar for elective delivery and expectant management (10.5% vs 7.7%, p = .68). Similarly, at 370/7–376/7 the rate of composite maternal adverse outcome was comparable for elective cesarean delivery and expectant management (7.2% vs 6.4%, p = .54). Maternal bleeding was the main indication of an urgent cesarean delivery, and account for 86% of urgent cesarean delivery at 360/7–366/7, 76.4% of urgent cesarean delivery at 370/7–376/7, and for 70.6% of all urgent cesarean delivery at 380/7–386/7 weeks. This group of women who were delivered due to maternal bleeding had a history of maternal bleeding during 2nd and/or 3rd trimester in 75–92.3% of cases. Composite adverse neonatal outcome was similar for elective cesarean delivery at each gestational age compared with expectant management. The risk for lower 5-min APGAR score and hypoglycemia was higher for newborns that were delivered electively a 36th weeks of gestation compared with expectant management. Conclusion Our study suggests that the optimal time of delivery for women with an uncomplicated placenta previa is between 380/7 and 386/7 weeks of gestation, especially in women without ante-partum bleeding.

The Effect Of The Application Of The Upright Position On Duration Time Delivery

Background:Childbirth is a natural process in a woman's life cycle. The care given should also return to the body's physiology. The upright position is considered a position that helps the fetus decline faster, but so far there are still mothers who lie down during childbirth. Research objective:This study aims to determine the effect of the application of the upright position on the time of delivery in women giving birth in PMB, Pringsewu Regency. Method: This study uses a quasi-experimental design with a non-equivalent group pre-post test. The research subjects were mothers who gave birth normally in PMB Pringsewu Regency. The sample of this research is. The inclusion criteria in this study were normal mothers who were willing to be respondents in PMB Pringsewu Regency. Research analysis using Independent T test. Results ; showed that the first stage of time in the control group was 7.53 ± 0.84 hours, while the first stage of time in the intervention group was 4.85 ± 0.62. The second stage of time in the control group was 50.38 ± 6.24 minutes, while the second stage of the intervention group was shorter at 32.53 ± 5.30 minutes. The results of the statistical test showed that there was a significant difference so that there was an effect of applying the upright position to the length of time in the active phase of the first stage of labor and the second stage of labor in women giving birth at PMB Pringsewu (p value = 0.000). The application of an upright position in maternity makes the duration of labor faster than the lying position

O-240 Circulating AMH molecular forms throughout pregnancy of women with PCOS and controls: a systematic longitudinal follow-up

Abstract Study question Are circulating levels of molecular forms of AMH throughout pregnancy still higher in women with PCOS than in controls? Summary answer AMH and its molecular forms decrease significantly throughout pregnancy, remaining higher in women with PCOS, without modification in the proportion of AMH molecular forms. What is known already AMH injection in late gestational mice causes a “PCOS” phenotype in the offspring’s, possibly via a gestational hyperandrogenism. AMH could therefore play a role in the heritability of PCOS in women. Circulating AMH exists in different molecular forms, cleaved (active) and uncleaved. In normal women, serum AMH decreases during pregnancy. In women with PCOS, cross-sectional or partial longitudinal studies have shown higher AMH levels in the second trimester of pregnancy and at the time of delivery in women with PCOS compared to controls. To date, no longitudinal dynamic monitoring of AMH throughout pregnancy in women with PCOS has been performed. Study design, size, duration Systematic prospective quarterly longitudinal monocentric comparative follow up of 30 women with PCOS and 29 controls before and during pregnancy from April 2019 to September 2021. To demonstrate a high effect size with 90% power and 5% first-species risk, it was necessary to include 23 subjects per arm. With a calculated loss of follow-up rate of 20%, 29 patients must be recruited per group. Participants/materials, setting, methods Women aged 18 to 43y, with a pre-conception dosage of AMH, were included during the first trimester of a singleton pregnancy. PCOS group was defined according to the modified Rotterdam criteria. In the control group, the patients had normal ovarian reserve. During the first, second and third trimester of pregnancy, all women were tested for serum AMH and its molecular forms with a Beckman automatic analyser, and for serum estradiol, LH and androgen levels. Main results and the role of chance Before pregnancy, patients with PCOS had higher levels of AMH (58.9 vs. 18.3pmol/L; p = <0.001), LH (5.9 vs. 3.3IU/L; p = 0.004) and total testosterone (TT) (0.35 vs. 0.29ng/ml; p = 0.019) than controls. Within each group, the levels of AMH and cleaved AMH were significantly lower in the third trimester than before pregnancy. The serum AMH level in the third trimester remained significantly higher in women with PCOS than in controls (18.4 vs. 6.5pmol/L; p = 0.002). At all times, the amount of cleaved AMH was higher in women with PCOS than in controls. The proportion of AMH molecular forms was not different between women with PCOS and controls and did not change throughout pregnancy. The LH level, mostly undetectable, was significantly lower in the third trimester than before pregnancy in both groups. In the first trimester, it remained higher in women with PCOS (0.6 vs 0.4IU/L; p = 0.018). In each group, the TT level was significantly higher in the third trimester than before pregnancy. TT level remained higher in women with PCOS than in control women in the first (0.76 vs 0.55ng/ml; p = 0.022) and second trimesters 0.82 vs. 0.61ng/ml; p = 0.013). In the third trimester, it was no longer significantly different (0.97 vs 0.64ng/ml; p = 0.069). Limitations, reasons for caution Only free testosterone is active, and only TT was measured. Additional SHBG and albumin measurements are needed. Our control population is a population of infertile women who have no ovarian problem but who have undergone, for most of them, ART treatments to obtain pregnancy with a possible impact on implantation. Wider implications of the findings Elevated serum AMH level could be instrumental in the modification of the in-utero androgenic environment that is believed to promote the transmission of the syndrome. The impact of AMH could be different depending on the clinical or metabolic phenotype of the patients and needs to be explored further. Trial registration number NCT03483792

Optimal Timing of Delivery in Women with History of Stillbirth: A Decision Analysis

Patients with prior stillbirth have increased risk of subsequent stillbirth, with odds ratio 3.2 for previous unexplained stillbirth. This study sought to determine optimal timing of delivery in pregnancies with prior stillbirth by accounting for common neonatal morbidities associated with late preterm and early term delivery.

Racial Differences in Delivery Outcomes Among Women With Peripartum Cardiomyopathy

BackgroundPeripartum cardiomyopathy (PPCM) is a rare idiopathic cardiomyopathy associated with pregnancy that occurs more frequently among Black women. However, less is known about the association of race/ethnicity with outcomes at the time of delivery in women with PPCM. MethodsWe used data from the 2016-2018 National Inpatient Sample (NIS) database to identify women with a diagnosis of PPCM based on International Classification of Diseases, 10th revision (ICD-10) codes. Using adjusted logistic regression, the association of race with PPCM and adverse cardiovascular (CV) outcomes with PPCM was evaluated across racial/ethnic groups (White, Black, Hispanic, Asian/Pacific Islander). ResultsAmong 11,304,996 delivery hospitalizations, PPCM was present in 8735 (0.08%). After adjusting for CV risk factors (chronic hypertension, diabetes, and obesity) and socioeconomic factors (insurance status, hospital income, and residential income), Black and Native American women had greater adjusted odds of developing PPCM (adjusted odds ratio [aOR] 1.89; 95% confidence interval [CI] 1.66-2.15; aOR 1.60; 95% CI 1.02-2.50, respectively), compared with White women. In stratified analysis of CV events, however, Asian/Pacific Islander women with PPCM were the most likely to have CV complications (aOR 98; 95% CI 29-333 for pulmonary edema). ConclusionsIn the US, at the time of delivery hospitalization, Black and Native American women are the most likely to develop PPCM, despite adjustment for CV and socioeconomic risk factors, but Asian women have higher odds of having CV complications.

Outpatient Cervical Ripening With Misoprostol in Low-Risk Pregnancies.

ObjectiveTo determine if outpatient cervical ripening with daily misoprostol can reduce admission to delivery time in women with low-risk pregnancies at 39 or more weeks of gestation.Study designThis is a retrospective cohort study of a convenience sample of low-risk pregnancies that underwent elective outpatient cervical ripening compared to matched controls for parity (nulliparous vs. parous) and gestational age. Time from admission to delivery, induction agents, presence of tachysystole, mode of delivery, length of hospitalization, neonatal intensive care unit (NICU) admission, and low Apgar scores were compared.ResultsFifty-six patients who underwent outpatient cervical ripening with daily dosing of misoprostol were compared to 56 patients matched for parity and gestational weeks who underwent inpatient cervical ripening/induction of labor with misoprostol. We found the time from admission to delivery in the outpatient cervical ripening cohort was significantly lesser than the inpatient cohort (17.5 ± 11.5 hours outpatient vs. 26.6 ± 15.6 hours inpatient, P=0.001). More patients (N=18, 32%) were able to deliver within 12 hours of admission in the outpatient induction group compared to the inpatient group (N=8, 11%, P=0.010). There were no differences in frequency of cesarean delivery, uterine tachysystole with or without fetal heart rate changes, NICU admission, low Apgar scores, or low umbilical artery pH values between the two groups.ConclusionOutpatient cervical ripening with misoprostol may be a feasible alternative to inpatient cervical ripening in low-risk pregnancies, may help improve patient experience, and reduce the operational burden that elective induction confers upon labor and delivery units.

Timing of delivery and blood pressure cut-off in chronic hypertension during pregnancy: State of art and new proposals.

Pregnant women with chronic hypertension are recommended to deliver at 36-396/7 weeks. The American College of Cardiology and American Heart Association in 2017 lowered the blood pressure cut-off for stage I hypertension to 130/80mmHg. We performed a literature review on studies comparing elective induction of labor versus expectant management in pregnant women with chronic hypertension. In addition, we reviewed fetal and maternal outcomes in pregnant women with blood pressure of 120-139/80-89 or 130-139/80-89mmHg. We found two randomized clinical trials and one retrospective observational study comparing elective delivery of pregnant women with chronic hypertension versus expectant management. The randomized trials favored expectant management and the observational study favored induction of labor. We found 15 retrospective cohort studies analyzing maternal and fetal outcomes in pregnant women with blood pressure cut-off lower than 140/90mmHg. There was a consistent finding of increased risk of any hypertensive disorder of pregnancy, gestational diabetes mellitus, and small-for-gestational-age neonate. Randomized clinical trials are needed to assess the appropriate timing of delivery for women with stage I hypertension with a blood pressure cut-off of 130/80mmHg.

A prognostic model to guide decision-making on timing of delivery in late preterm pre-eclampsia: the PEACOCK prospective cohort study.

Pre-eclampsia affects around 2-3% of all pregnancies, and is associated with potential serious complications for the woman and the baby. Once diagnosed, progression of the syndrome can be unpredictable, and decisions around timing of delivery need to take into account evolving maternal complications and perinatal morbidity. Novel prognostic models and blood biomarkers for determination of need for delivery in pregnancies with pre-eclampsia are now emerging. The objective of the study was to establish a prognostic model to inform optimal timing of delivery in women with late preterm pre-eclampsia (34+ 0 to 36+ 6 weeks' gestation), comparing novel candidate biomarkers (e.g. placental growth factor) with clinical and routinely collected blood/urinary parameters [incorporated into the PREP-S (Prediction models for Risk of Early-onset Pre-eclampsia - Survival) model] to determine clinically indicated need for delivery for pre-eclampsia (or related complications) within 7 days of assessment. Prospective recruitment of women in whom blood samples for placental growth factor and soluble fms-like tyrosine kinase-1 testing was obtained, alongside clinical data, for use within the PREP-S model. Candidate variables were compared using standard methods (sensitivity, specificity, receiver operator curve areas). Estimated probability of early delivery from PREP-S was compared with actual event rates by calibration. The PEACOCK (Prognostic indicators of severe disEAse in women with late preterm pre-eClampsia tO guide deCision maKing on timing of delivery) study was a prospective cohort study, nested within the PHOENIX (Pre-eclampsia in HOspital: Early iNductIon or eXpectant management) trial. Women between 34+ 0 and 36+ 6 weeks' gestation, with a diagnosis of pre-eclampsia, in whom a plasma (ethylenediaminetetraacetic acid) blood sample for placental growth factor testing was obtained, alongside clinical data for the assessment of variables in a prognostic model. Clinically indicated need for delivery for pre-eclampsia within 7 days of assessment. Statistical analysis: both PREP-S and placental growth factor were assessed and compared using standard methods (sensitivity and specificity for placental growth factor thresholds of 100 pg/ml and < 12 pg/ml, and receiver operating characteristic areas for continuous measurements). The estimated probability of early delivery from PREP-S was compared with actual event rates for women with similar probabilities by calibration. Calibration using logistic regression was also used. Between 27 April 2016 and 24 December 2018, 501 women were recruited to the study. Although placental growth factor testing had high sensitivity (97.9%) for delivery within 7 days, the negative predictive value was only 71.4% and the specificity was low (8.4%). The area under the curve for the clinical prediction model (PREP-S) and placental growth factor in this cohort in determining need for delivery within 7 days was 0.64 (standard error 0.03) and 0.60 (standard error 0.03), respectively, and 0.65 (standard error 0.03) in combination. A high proportion of women in this cohort already had low placental growth factor concentrations at the time of confirmed diagnosis, which reduced the ability of the biomarker to further predict adverse outcomes. In this group of women with late preterm pre-eclampsia, placental growth factor measurement is not likely to add to the current clinical assessment to help plan care for late preterm pre-eclampsia regarding timing of delivery. Existing models developed in women with early-onset pre-eclampsia to predict complications cannot be used to predict clinically indicated need for delivery in women with late preterm pre-eclampsia. Further statistical modelling and subgroup analysis is being considered to assess if improved model performance in the whole cohort or a subgroup can be achieved. Addition of other biomarkers to the model may also be of use and will be explored. Current Controlled Trials ISRCTN01879376. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 30. See the NIHR Journals Library website for further project information.

Early delivery or expectant management for late preterm preeclampsia: A meta-analysis of randomized controlled trials.

Currently, there is no consensus regarding the timing of delivery in women with non-severe preeclampsia at the late preterm period. The aim of the present meta-analysis is to compare expectant management with immediate delivery in pregnant women with preeclampsia between 34+0 and 36+6 gestational weeks, in terms of maternal and neonatal outcomes. A search was conducted until October 1, 2020 and eligible studies were identified in MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (Central), the US Registry of clinical trials (www.clinicaltrials.gov), and sources of gray literature without limitations concerning the publication dates and languages. Randomized controlled trials, comparing planned delivery vs expectant management in women with preeclampsia at 34-37weeks were included. The primary outcomes were neonatal intensive care unit (NICU) admission and progression to eclampsia. Secondary outcomes were HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, severe preeclampsia, composite adverse maternal outcome (defined by the presence of any of the potential preeclampsia-related complications, ranging from severe hypertension to maternal death), neonatal respiratory disease, and respiratory distress syndrome. Relative risks (RRs) and mean differences with 95% CI were used for the estimation of the effect sizes; the quality of the evidence was assessed per GRADE guidelines. The electronic search yielded 10721 potential studies, of which six were fully reviewed and three (1773 participants) were included in the meta-analysis. Immediate delivery increased the risk for NICU admission, (RR 1.23, 95% CI 1.05-1.45) and decreased the risk for the composite adverse maternal outcome (RR 0.86, 95% CI 0.78-0.93). There were no differences for eclampsia (RR 0.55, 95% CI 0.16-1.85), HELLP syndrome (RR 0.58, 95% CI 0.25-1.33), severe preeclampsia (RR 0.27, 95% CI 0.02-3.52), respiratory disease of neonate (RR 1.04, 95% CI 0.75-1.44), and respiratory distress syndrome (RR 2.3, 95% CI 0.73-7.25). Immediate delivery of women with non-severe preeclampsia at the period of late prematurity decreases the risk of a composite adverse maternal outcome by 14%, at the cost of an increase in NICU admissions by 23%. The overall quality of the evidence for these outcomes is high, indicating a high degree of certainty for the results.

1127 Trial of labor and neonatal outcomes in pregnancies complicated by diabetes

Diabetes is associated with increased risk of both cesarean delivery and neonatal morbidity. We evaluated the impact of a trial of labor on the risk of neonatal respiratory morbidity and NICU admission among women with pre-gestational and gestational diabetes. Secondary analysis of women from the Consortium on Safe Labor Study (CSL) who delivered at 19 hospitals across the United States. Women with singleton, liveborn, non-anomalous infants with diabetes (gestational and pre-gestational) who delivered at or after 36 0/7 weeks were included. Women who received steroids for fetal benefit at any time during pregnancy were excluded. A trial of labor was defined as at least 2 cervical exams in the CSL database. Our primary outcome was neonatal respiratory morbidity, which included transient tachypnea of the newborn and respiratory distress syndrome. The secondary outcome was NICU admission. We tested for an interaction between labor and diabetes type. Multivariable logistic regression was used to assess the relationship between a trial of labor and neonatal outcomes. Analyses were also stratified by gestational age at delivery. Of the 11,510 women included, 8,755 (76%) had a trial of labor. The majority of women had GDM (81%). There was no interaction between a trial of labor and maternal diabetes type (p=0.47). Compared with pre-labor or scheduled cesarean, delivery after a trial of labor was associated with lower risks of both neonatal respiratory morbidity (0.52, 95%CI 0.41-0.65) and NICU admission (0.68, 95%CI 0.57 - 0.80) after adjusting for covariates (Table). The lower risks of respiratory morbidity and NICU admission associated with a trial of labor was seen at all gestational ages (Table). These data suggest that a trial of labor may reduce the risk of neonatal morbidity compared to scheduled or pre-labor cesarean delivery in pregnancies complicated by diabetes. Further studies are needed to determine optimal timing of delivery for women with gestational and pre-gestational diabetes.

Time of Delivery in Women with Coronavirus Disease.

Dear Editor, The Coronavirus Infection (COVID-19) is a pandemic disease which the first case of this infection was found in China, Wuhan, Hubei Province.[1] Pneumonia is a very sever complication seen in some special population including elderly people and pregnant women, due to the suppression of immunity system.[1]

Timing of Delivery in Women with Cardiac Disease.

Guidelines do not exist to determine timing of delivery for women with cardiovascular disease (CVD) in pregnancy. The neonatal benefit of a term delivery as compared with an early term delivery is well described. We sought to examine maternal outcomes in women with CVD who delivered in the early term period (370/7 through 386/7 weeks) compared with those who delivered later. This is a prospective cohort study examining cardiac and obstetric outcomes in women with CVD delivering between September 2011 and December 2016. The associations between gestational age at delivery and maternal, fetal, and obstetric characteristics were evaluated. Two-hundred twenty-five women with CVD were included, 83 (37%) delivered in the early term period and 142 (63%) delivered at term. While the early term group had significantly higher rates of any hypertension during pregnancy (18.1 vs. 7%, p = 0.01) and intrauterine growth restriction (22.9 vs. 2.8%, p < 0.001), there was no difference in high-risk cardiac or obstetric characteristics. No difference in composite cardiac morbidity was found (4.8 vs. 3.5%, p = 0.24). Women in the early term group were more likely to undergo cesarean delivery than women in the term group (43.4 vs. 24.7%, p = 0.004). There is no maternal benefit of an early term delivery in otherwise healthy women with CVD. Given the known fetal consequences of early term delivery, this study offers support to existing literature suggesting term delivery in these women. · Question of delivery timing in women with cardiac disease.. · No difference in cardiac morbidity, term versus early term.. · Term delivery in women with asymptomatic cardiac disease..

Timing of Repeat Cesarean Delivery for Women with a Prior Classical Incision.

This study aimed to compare neonatal outcomes for delivery at 36 weeks compared with 37 weeks in women with prior classical cesarean delivery (CCD). This was a secondary analysis of the prospective observational cohort of the Eunice Kennedy National Institute for Child and Human Development's Maternal-Fetal Medicine Unit Network Cesarean Registry. Data on cases of repeat cesarean delivery (RCD) in the setting of a prior CCD were abstracted and used for analysis. This study compared outcomes of women who delivered at 360/7 to 366/7 versus 370/7 to 376/7 weeks. The primary outcome was a composite of adverse neonatal outcomes that included neonatal intensive care unit (NICU) admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), hypoglycemia, mechanical ventilation, sepsis, length of stay ≥5 days, and neonatal death. A composite of maternal outcomes that included uterine rupture, blood transfusion, general anesthesia, cesarean hysterectomy, venous thromboembolism, maternal sepsis, intensive care unit admission, and surgical complications was also evaluated. There were 436 patients included in the analysis. Women who delivered at 36 weeks (n = 176) were compared those who delivered at 37 weeks (n = 260). There were no differences in baseline characteristics. Delivery at 37 weeks was associated with a reduction in composite neonatal morbidity (24 vs. 34%, adjusted odds ratio [aOR] = 0.61 [0.31-0.94]), including a decrease in NICU admission rates (20 vs. 29%, aOR = 0.63 [0.40-0.99]), hospitalization ≥5 days (13 vs. 24%, aOR = 0.48 [0.29-0.8]), and RDS or TTN (9 vs. 19%, aOR = 0.43 [0.24-0.77]). There was no difference in adverse maternal outcomes (7 vs. 7%, aOR = 0.98 [0.46-2.09]). Delivery at 37 weeks for women with a history of prior CCD is associated with a decrease in adverse neonatal outcomes, compared with delivery at 36 weeks. · Classical cesarean section may have increased risk of uterine rupture in future pregnancies.. · This study compares outcomes of delivery at 370/7 to 376/7 versus 360/7 to 366/7 weeks.. · Delivery at 370/7 to 376/7 weeks was associated with decreased neonatal morbidity..

Relationships between excessive gestational weight gain and energy and macronutrient intake in pregnant women.

ObjectiveThis study aimed to compare energy and macronutrient intake, birth weight, and anthropometric parameters (mid-upper arm circumference or tricipital skin-fold thickness) between women who had adequate and excessive gestational weight gain (GWG) during pregnancy.MethodsWe studied 115 pregnant women and divided them according to GWG into two groups: adequate GWG (n = 49) and excessive GWG (n = 66). We assessed the medical history, clinical examinations, and dietary habits through a detailed 7-day dietary recall using myfitnesspal software.ResultsWeight, body mass index, mid-upper arm circumference, and tricipital skin-fold thickness were significantly higher at the time of delivery in women with excessive GWG compared with those with adequate GWG. A lipid-based diet was a risk factor for excessive GWG (relative risk: 1.488, 95% confidence interval: 1.112–1.991), whereas a protein-based diet was a protective factor (relative risk: 0.6723, 95% confidence interval: 0.4431–1.020). We found no significant relationship between a carbohydrate-based diet and GWG. The total energy intake was significantly higher in the excessive GWG group than in the adequate GWG group.ConclusionsMainly a lipid-based diet in pregnant women might represent a risk factor for excessive GWG. However, a protein-based diet is a protective factor for excessive GWG.

Timing of Delivery in Women With Diabetes: A Population-Based Study

Introduction Women with diabetes, and their infants, have an increased risk of adverse events due to excess fetal growth. Earlier delivery, when fetuses are smaller, may reduce these risks. This study aimed to evaluate the week-specific risks of maternal and neonatal morbidity/mortality to assist with obstetrical decision making. Material and methods In this population-based cohort study, women with type 1 diabetes (n = 5889), type 2 diabetes (n = 9422) and gestational diabetes (n = 138 917) and a comparison group without diabetes (n = 2 553 243) who delivered a singleton infant at ≥36 completed weeks of gestation between 2004 and 2014 were identified from the Canadian Institute of Health Information Discharge Abstract Database. Multivariate logistic regression was used to determine the week-specific rates of severe maternal and neonatal morbidity/mortality among women delivered iatrogenically vs those undergoing expectant management. Results For all women, the absolute risk of severe maternal morbidity/mortality was low, typically impacting less than 1% of women, and there was no significant difference in gestational age-specific severe maternal morbidity/mortality between iatrogenic delivery and expectant management among women with any form of diabetes. Among women with gestational diabetes, iatrogenic delivery was associated with an increased risk of neonatal morbidity/mortality compared with expectant management at 36 and 37 weeks' gestation (76.7 and 27.8 excess cases per 1000 deliveries, respectively) and a lower risk of neonatal morbidity/mortality at 38, 39 and 40 weeks' gestation (7.9, 27.3 and 15.9 fewer cases per 1000 deliveries, respectively). Increased risks of severe neonatal morbidity following iatrogenic delivery compared with expectant management were also observed for women with type 1 diabetes at 36 (98.3 excess cases per 1000 deliveries) and 37 weeks' gestation (44.5 excess cases per 1000 deliveries) and for women with type 2 diabetes at 36 weeks' gestation (77.9 excess cases per 1000 deliveries) weeks. Conclusions The clinical decision regarding timing of delivery is complex and contingent on maternal-fetal wellbeing, including adequate glycemic control. This study suggests that delivery at 38, 39 or 40 weeks' gestation may optimize neonatal outcomes among women with diabetes.

829: Timing of cesarean delivery in women with more than one previous cesarean delivery

ACOG recommends performing repeat elective cesarean delivery (CD) at 39 weeks in women with one prior cesarean delivery, however there is uncertainty regarding timing of delivery for women with two or more previous CD. Our aim was to examine adverse maternal and neonatal outcomes of elective CD at gestational weeks 37 to 40+6 compared with pregnancy continuation in women with at least two previous cesareans. A retrospective cohort study of all women with at least two previous CD who delivered at term in Ontario, Canada between April, 2012 and March, 2017. Maternal and neonatal characteristics and outcomes were obtained from linked provincial and national databases. Multiple gestations and pregnancies with major fetal anomalies were excluded. Each gestational week of elective cesarean delivery was compared with ongoing pregnancy, culminating in cesarean delivery in labor, indicated CD not in labor or vaginal delivery. The primary outcome was a composite of adverse maternal outcomes. Secondary outcomes were composite adverse neonatal outcomes. During the 5-year study period 17,207 women were eligible for analysis. Elective CD from 39 weeks onwards was associated with the lowest adjusted risk of maternal composite adverse outcome (2.4% vs 6.9%, OR 0.36, 95% CI 0.2-0.65). This was primarily driven by lower rates of preeclampsia (0.4% vs 1.7%, p< 0.004), gestational hypertension (1.6% vs 3.6%, p=0.005) and uterine rupture, occurring in 1.7% of ongoing pregnancies. Elective CD at 37 weeks was associated with an increased risk of neonatal composite adverse outcome compared with ongoing pregnancies (OR 1.51, 95% CI 1.19-1.92). This risk was only decreased with elective CD at 39-39+6 weeks (10.3% vs 18.2%, OR 0.64, 95% CI 0.44-0.94). In women with two or more prior cesareans, the lowest rates of adverse maternal and neonatal outcomes were observed with elective CD between 39 to 39+6 weeks of gestation. This needs to be balanced against the risk of unplanned delivery prior to this gestational age.View Large Image Figure ViewerDownload Hi-res image Download (PPT)