Delivery In Women Research Articles

Optimal Timing of Delivery for Women with Hormone Receptor-Positive Breast Cancer [30E

INTRODUCTION: Data are limited regarding the optimal management of breast cancer in pregnancy. We aimed to compare strategies for the management of estrogen or progesterone hormone receptor-positive (HR+) tumors, and to determine the optimal gestational age for induction in regards to chemotherapy status and maternal-fetal outcomes. METHODS: A decision-analytic model was designed comparing 32 different strategies for scheduled delivery between 24-39 weeks gestation, with chemotherapy induction either at 24 weeks or delayed until after delivery. Baseline estimates of stage-specific mortality and the impact of delayed chemotherapy on survival rates were obtained from the literature. Our model included the risk of intrauterine fetal demise, spontaneous delivery, respiratory distress syndrome, cerebral palsy, and neonatal demise at each gestational age. RESULTS: For women receiving antenatal chemotherapy, delivery at 39 weeks yielded the highest maternal and overall QALYs at all cancer stages. For women with stage I disease deferring chemotherapy until after delivery, no significant increase in 5-year mortality occurred until after 30-31 weeks gestation; induction at 37 and 38 weeks yielded the highest quality-adjusted life years (QALYs) from the maternal and societal perspectives, respectively. For women with stage II and III disease deferring chemotherapy, overall QALYs were maximized at 37 and 31 weeks, respectively. In univariate and multivariate sensitivity analyses, our model remained robust across reasonable ranges for all variables of interest. CONCLUSION: For women with operable HR+ breast cancer diagnosed in early pregnancy, antenatal chemotherapy and delivery at term are recommended; however, delaying chemotherapy until the postpartum period is reasonable for early stage disease.

Study on the dynamic variations and influencing factors of serum lipid levels during pregnancy and postpartum

Objective: To study the variations and influencing factors of serum triglycerides and cholesterol levels during pregnancy and postpartum. Methods: A retrospective study was performed among 5 020 healthy singleton (95.10%, 4 774/5 020) and twin (4.90%, 246/5 020) women who had delivery in Women's Hospital, Zhejiang University School of Medicine from January 2011 to December 2016. Serum triglycerides and cholesterol levels during pregnancy and postpartum of all the cases were collected. Both singleton and twin pregnant women were divided into advanced age and appropriate age groups, and then data of serum sample were assigned to 3 groups according to the gestation weeks, which were second trimester pregnancy (24-28 gestation weeks) , third trimester pregnancy (32-41 gestation weeks) and postpartum (within 72 hours after delivery) . The serum triglycerides and cholesterol levels in each groups were compared. Results: (1) Serum triglycerides and cholesterol levels during the second trimester pregnancy, third trimester pregnancy and postpartum were higher than levels of non-pregnancy in both singleton and twin groups (all P<0.05) . (2) Serum triglycerides and cholesterol levels in the third trimester pregnancy group were higher than those of second trimester pregnancy group in both advanced age and appropriate aged women regardless singleton or twin pregnancy (all P<0.05) . The 95%CI of serum lipid levels in each group during second and third trimester pregnancy were as follows: in appropriate aged singleton group, the triglycerides levels were 1.07-4.13 and 1.52-7.21 mmol/L, and the cholesterol levels were 2.77-12.11 and 4.44-9.36 mmol/L. In advanced aged singleton group, the triglycerides levels were 1.28-4.61 and 1.70-7.80 mmol/L, and the cholesterol levels were 4.35-8.40 and 4.46-9.35 mmol/L; in appropriate aged twin group, the triglycerides levels were 1.39-7.16 and 1.90-9.29 mmol/L, and the cholesterol levels were 4.99-12.16 and 4.52-10.07 mmol/L; in advanced aged twin group, the triglycerides levels were 1.61-5.32 and 1.94-9.29 mmol/L, and the cholesterol levels were 5.24-8.10 and 4.53-8.86 mmol/L. (3) Serum lipids levels rapidly decreased during postpartum compared to the third trimester pregnancy. The 95%CI of blood lipid levels in each group were as follows: in appropriate aged singleton group, the triglycerides level was 0.90-5.64 mmol/L and the cholesterol level was 4.70-8.52 mmol/L; in advanced aged singleton group, the triglycerides level was 0.87-5.43 mmol/L and the cholesterol level was 4.68-9.04 mmol/L; in appropriate aged twin group, the triglycerides level was 1.20-8.21 mmol/L and the cholesterol level was 4.66-8.45 mmol/L; in advanced aged twin group, the triglycerides level was 1.32-6.61 mmol/L, and the cholesterol level was 5.01-7.94 mmol/L. (4) Serum triglycerides and cholesterol levels in twin pregnant women were significantly higher than in singleton during the second trimester and third trimester pregnancy both in advanced age and appropriate age groups (all P<0.05) . During postpartum, there was no difference in serum lipid levels between the singleton and twin pregnant women in appropriate age group (triglycerides: P=0.982; cholesterol: P=0.759, respectively) . While the serum lipid levels in twin pregnant women were significantly higher than those of singleton women in advanced age group (triglycerides: P=0.000; cholesterol: P=0.000, respectively) . Conclusions: The standard of serum lipid levels of non-pregnant adults is not suitable for assessing that in pregnant women. Regardless of singleton or twin pregnancy, serum triglyceride and cholesterol levels during pregnancy elevate with the increasing gestational week and then rapidly decrease during postpartum. Age and twins are the influencing factors of the elevated physiological lipid levels during pregnancy.

Optimal Timing of Delivery in Women with Higher Order Cesareans: A Cohort Study.

To evaluate whether a planned early term delivery or a planned 39-week delivery is associated with differences in perinatal outcomes in women undergoing a higher order cesarean (HOC). This cohort study included women with singleton gestations with a history of three or more prior cesareans who delivered at one of two urban tertiary care hospitals. One center routinely delivered HOC at 39 weeks' gestation and the other at 37 weeks. Maternal and neonatal morbidities were compared using bivariable and multivariable analyses. The policy of 37-week delivery was associated with a decrease in unscheduled deliveries (15.3 vs. 41.1%; p < 0.001). Planned delivery at 37 weeks was associated with a decreased incidence of composite maternal morbidity (1.6 vs. 7.9%; p = 0.002) and 5-minute Apgar score less than 7 (0.4 vs. 6.4%; p < 0.001), but these differences were not significant after controlling for potential confounders (adjusted odds ratio [aOR]: 0.30, 95% confidence interval [CI]: 0.08-1.17; aOR: 0.13, 95% CI: 0.01-1.30, respectively). There were no other differences in perinatal outcomes. Compared with planned delivery at 39 weeks, a policy of planned delivery at 37 weeks was associated with a reduction in unscheduled deliveries, but there were no measured differences in perinatal outcomes.

Complications and Outcomes of Pregnancy and Cesarean Delivery in Women With Neuropathic Bladder and Lower Urinary Tract Reconstruction

To determine the outcomes of pregnancy and cesarean delivery (CD) in women with neuropathic bladder (NB) and pediatric lower urinary tract reconstruction (LUTR) as these women often have normal fertility and may become pregnant. We reviewed consecutive patients with NB due to spinal dysraphism who underwent LUTR, became pregnant, and had a CD at our institution from July 2001 to June 2016. We collected data on demographics, hydronephrosis, symptomatic urinary tract infection, continence, and catheterization during pregnancy. CD data included gestational age, abdominal or uterine incisions, and complications. We identified 18 pregnancies in 11 women. Fifteen live newborns were delivered via CD (53.3% term births). Thirteen of 15 patients (86.7%) developed new (10) or worsening (3) hydronephrosis. Six of 13 patients (46.2%) underwent nephrostomy tube placement. Eight of 15 patients (53.3%) developed difficulty catheterizing (66.7% via native urethra, 44.4% via catheterizable channel); 50.0% of patients required an indwelling catheter. Five of 15 patients (33.3%) developed urinary incontinence during pregnancy. Ten of 15 patients (66.7%) had a urinary tract infection (30.0% febrile). A urologist was present for all CDs: 5 were scheduled, 10 occurred emergently. Complications occurred in 40.0% (5 cystotomies, 1 bowel deserosalization, 1 vaginal laceration). All cystotomies occurred during emergent CD. Three patients (20.0%) developed urinary fistulae after emergent CD. Women with NB and LUTR have high rates of complications during pregnancy and CD, despite routine involvement of urologists. Women with prolonged labor, previous CD, or those with a history of noncompliance developed the worst complications. Based on our experience, a urologist should always be present and participate in the CD.

Complement C3a, But Not C5a, Levels in Amniotic Fluid Are Associated with Intra-amniotic Infection and/or Inflammation and Preterm Delivery in Women with Cervical Insufficiency or an Asymptomatic Short Cervix (≤ 25 mm)

BackgroundWe aimed to estimate whether elevated levels of complement C3a and C5a in amniotic fluid (AF) are independently associated with increased risks of intra-amniotic infection and/or inflammation (IAI) and spontaneous preterm delivery (SPTD) in women with cervical insufficiency or a short cervix (≤ 25 mm).MethodsWe conducted a retrospective cohort study of 96 consecutive women with cervical insufficiency (n = 62) or a short cervix (n = 34) at 17 to 27 weeks, and who underwent an amniocentesis. AF was cultured and analyzed for C3a and C5a by enzyme-linked immunosorbent assay kits. The primary outcome measures were IAI (defined as a positive AF culture and/or an elevated AF interleukin-6 level [≥ 7.6 ng/mL]) and SPTD at < 32 weeks.ResultsIn multivariable analysis, AF level of C3a was the only variable significantly associated with IAI, whereas C5a level in AF and serum C-reactive protein level were not associated with IAI. Using SPTD at < 32 weeks as the outcome variable in logistic regression, elevated AF levels of C3a were associated with increased risk of SPTD at < 32 weeks after adjusting for other baseline confounders, whereas elevated AF levels of C5a were not.ConclusionIn women with cervical insufficiency or a short cervix, elevated AF level of C3a, but not C5a, is independently associated with increased risks of IAI and SPTD at < 32 weeks. These findings suggest that subclinical IAI or SPTD in the context of cervical insufficiency is related to activation of complement system in AF.

Prophylactic Negative Pressure Wound Therapy and Wound Complication After Cesarean Delivery in Women With Class II or III Obesity: A Randomized Controlled Trial.

To compare the occurrence of superficial surgical site infections in obese women using prophylactic negative pressure therapy with standard dressings after cesarean delivery. We conducted a randomized controlled, nonblinded, two-center study of prophylactic negative pressure therapy compared with standard surgical dressings placed at the time of primary closure at cesarean delivery in obese women with body mass indexes (BMI) of 35 or higher (ie, class II and III obesity). Our primary outcome was occurrence of a superficial surgical site infection. We assumed a superficial surgical site infection occurrence rate of 20% and intended to recruit 400 women. However, after low enrollment of 166 women over 24 months, an interim analysis for futility was conducted and the decision was made to halt the study. Women were recruited between January 5, 2015, and January 7, 2017, from two sites. The mean BMI on admission was 44.9 (±8) for the prophylactic negative wound therapy group and 43.4 (±7) for the standard dressing group. There were no differences in the occurrence of observed superficial surgical site infections between women using prophylactic negative pressure wound therapy (12/80 [15%]) compared with women who received the standard dressing (8/81 [10%], P=.35, relative risk 1.52, 95% CI 0.66-3.52). There were no differences in the occurrence of composite wound complications between women using prophylactic negative pressure wound therapy (25/80 [31%]) compared with women who received the standard dressing (24/81 [30%], P=.87). In this randomized controlled trial that did not achieve full anticipated enrollment, we did not observe a decrease in superficial surgical site infections after cesarean delivery in obese women with the use of prophylactic negative pressure wound therapy. ClinicalTrials.gov, NCT02390401.

Frequency of Vaginal Delivery in Women with Previous Cesarean Section : A Single Referral Center Experience

Frequency of Vaginal Delivery in Women with Previous Cesarean Section : A Single Referral Center Experience

Predictors of intimate partner violence among pregnant women

To identify predictive factors of intimate partner violence (IPV) among pregnant women. In a cross-sectional study, 250 pregnant, married women attending three women's hospitals in South Korea for prenatal care were enrolled between July 1 and August 31, 2016. The women answered structured questionnaires assessing conflict negotiation coping, social support, and IPV, which was measured by 18 questions in three domains: psychological, physical, and sexual violence. Participants who reported experience in response to more than one question were deemed to have encountered IPV. Binomial logistic regression analysis was used to investigate predictive factors of IPV. Overall, 85 (34.0%) participants had experienced IPV. Likelihood of IPV was linked with younger age (adjusted odds ratio [aOR] 0.90, 95% confidence interval [CI] 0.83-0.94; P=0.012), unemployment (aOR 1.98, 95% CI 1.07-3.70; P=0.031), and graduate school education (aOR 7.32, 95% CI 1.68-31.84; P=0.008). The likelihood of IPV increased as the social support score decreased (aOR 0.92, 95% CI 0.88-0.95; P<0.001). Efforts to screen for IPV and to intervene to reduce the impact of such violence on pregnant women's delivery outcomes should be a maternal health priority in South Korea.

Incidence and Risk Factors That Predict Chronic Hypertension after Delivery in Women with Hypertensive Disorders of Pregnancy

Background: hypertensive disorders of pregnancy (HDP) are important disorders complicating 5% to 10% of all pregnancies and they are a leading cause of maternal and fetal morbidity and mortality and associated with subsequent development of chronic hypertension. Aim of the work: this study aimed to determine the incidence and risk factors that predict chronic hypertension after delivery in women with hypertensive disorders of pregnancy. Patients and Methods: this cohort prospective study was conducted at Ain Shams University, Maternity Hospital. This study included a sample of 207 pregnant women with hypertensive disorders of pregnancy, followed up for persistence of hypertension after 3 months postpartum. Results: the subjects were categorized into case group (n=25, 12.1%) included patients diagnosed as chronic hypertension at the postpartum period and the control group (n =182, 87.9%) included the rest of the study subjects. Clinical and demographic factors were evaluated. By multivariate regression analysis, age, gestational age at diagnosis, parity, preeclampsia and early onset hypertension with end-organ dysfunction were predictors of progression to chronic hypertension. Conclusion: 12.1% of women diagnosed with HDP continued with persistent hypertension after delivery and some clinical and demographic risk factors such as old maternal age at HDP, lower gestational age at diagnosis, multiparous women, preeclampsia and hypertension with end-organ dysfunction were predictors of progression to chronic hypertension. Recommendations: further studies on a larger scale of patients are needed to confirm the current results.

The Impact of Self-Reported Sleep on Caesarean Delivery in Women Undergoing Induction of Labour: A Prospective Study

216 women admitted for labour induction were recruited to evaluate sleep duration and other sleep measures on Caesarean delivery risk. The Pittsburgh Sleep Quality Index, Berlin (Obstructive Sleep Apnoea (OSA), Epworth Sleepiness Scale, International Restless Leg Syndrome, Insomnia Symptom Questionnaires were applied. Short sleep duration was defined as reported night sleep length in the previous month below the study population median of 6 hours. After binomial analysis, Caesarean delivery after labour induction is associated with short sleep duration (RR 1.8, 95% CI 1.1-2.9, P = 0.018), nulliparity, Bishop Score, prepregnant BMI and birth weight at P < 0.05. After adjustment for nulliparity, Bishop Score, prepregnant BMI and birth weight, short sleep duration remains independently predictive of Caesarean delivery AOR 2.4, 95% CI 1.1-5.0, P = 0.026. Women at high risk for OSA has a non-significant result on binomial analysis, RR 1.6, 95% CI 1.0-2.7, P = 0.073. In a sensitivity analysis which includes OSA in the multivariable logistic regression model, OSA’s predictive effect is attenuated AOR 1.2, 95% CI 0.4-3.2, P = 0.782 whilst short sleep duration remains significant AOR 2.3 95% CI 1.0-5.1, P = 0.039. Other evaluated sleep measures are not predictive of Caesarean delivery.

Anesthetic Considerations for Labor and Delivery in Women With Cerebrospinal Fluid Shunts

Abstract Background The anesthetic management of labor and delivery in pregnant women with cerebrospinal fluid shunts can be challenging. We conducted a literature review to understand the anesthetic implications in pregnant women with cerebrospinal fluid shunts. Methods We searched PubMed, EMBASE, and Medline databases to identify reports of pregnant women with cerebrospinal fluid shunts during the 30-year period from 1985 to 2015. Twenty-four studies reporting anesthetic techniques for labor and delivery were included in the analyses. Results A total of 97 women with 130 pregnancies were included. Ventriculo-peritoneal shunts (77%) were the most common type of shunt. Twenty-eight (29%) women had shunt malfunction during pregnancy, with 20 (71%) requiring shunt revision. Overall, 73 women (56%) delivered vaginally and 23 (40%) received epidural analgesia. Fifty-seven women (44%) underwent cesarean delivery and general anesthesia was used in 45% of cases. Conclusion This review suggests that shunt malfunctions occurred commonly during pregnancy. The presence of neurological symptoms warrants careful evaluation of shunt function. Anesthetic management for labor and delivery varied and was dependent on shunt function. Epidural analgesia appears to be safe in women with functional shunts.

Recurrent Preterm Delivery in Women Receiving 17-P is Not Influenced by Prior Spontaneous Preterm Delivery Etiology [8Q

INTRODUCTION: To compare rates of recurrent preterm delivery (PTD) in women receiving 17-P therapy for prior spontaneous PTD (sPTD) due to either Preterm Premature Rupture of Membranes (PPROM) or preterm labor (PTL). METHODS: Study sample derived from a national database of women receiving 17-P therapy as part of a PTD prevention program. Inclusion criteria: women meeting SMFM criteria recommendations for 17-P administration, documented history of prior sPTD, singleton gestation and receiving at least 4 weekly 17-P injections. Demographic and clinical risk factors for PTD as well as pregnancy outcomes were compared between those with prior history of sPTD with PTL vs PPROM. Rank and chi-square tests were used to compare study groups, with P-values &lt; .05 considered statistically significant. RESULTS: 2,084 women with prior sPTD were studied: 450 with prior PPROM, 1,634 with prior PTL. There were no significant differences between prior PPROM vs prior PTL study groups for race, ethnicity and pre-pregnancy BMI &lt; 20 or &gt;30. The number of previous PTDs (1.3 ± 0.6 vs 1.3 ± 0.6), gestational age of the most recent PTD (31.8 ± 4.6 vs 31.5 ± 4.5 weeks) and the total number of 17-P injections (18.7 ± 2.4 versus 18.9 ± 2.3) were also similar. Overall, with 17-P therapy, there were no significant differences between study groups for PTD at &lt; 37.0, &lt; 35.0 and &lt; 32.0 weeks or sPTD &lt; 37.0 weeks. CONCLUSION: In women receiving 17-P therapy, recurrent PTD and sPTD rates are not affected by the etiology of the prior sPTD.

Risk of Primary Cesarean Delivery in Women With Pregnancy-Associated Hypertension [7C

INTRODUCTION: Despite the lack of evidence supporting cesarean delivery (CD) in the setting of pregnancy-associated hypertension (PAH), women with this diagnosis continue to have high CD rates. The aim of this study is to determine whether the higher rate of primary CD among women with PAH can be explained by the presence of other known CD risk factors. METHODS: A retrospective cohort study of singleton, vertex, nulliparous women delivering between 34 and 42 weeks using the 2013 US National Vital Statistics Report dataset. Rates of primary CD in women with and without PAH were compared. Multivariate logistic regression predicted CD after controlling for known risk factors, including advanced maternal age (AMA), race/ethnicity, gestational age, pre-pregnancy BMI, US residency, insurance type, prenatal care, diabetes, and eclampsia. RESULTS: We analyzed 1,103,999 women, including 94,332 women diagnosed with PAH. The unadjusted CD rate in women with PAH was 41.3% compared to 26.9% in those without PAH (p &lt; 0.01). Each analyzed risk factor was significantly associated with CD (Table). However, even after controlling for these risk factors, the predicted probability of CD in a woman with PAH would be 37.2% vs 26.5% without PAH (p &lt; 0.01). PAH remained an independent predictor for CD (aOR 1.68 [95% CI 1.65-1.71]). CONCLUSION: After controlling for other risk factors, diagnosis of PAH alone is a significant risk factor for CD, likely reflecting a widespread practice that is not supported by the most recent clinical evidence. Women with PAH may therefore represent an important target population for efforts that aim to reduce primary CD rates.

Are There Predictable Blood Pressure Patterns After Delivery in Women With Preeclampsia? [20B

INTRODUCTION: There is limited data on blood pressure(BP) patterns after delivery among women diagnosed with preeclampsia. We sought to investigate immediate postpartum BP trajectories and the impact of fluid balance on these patterns. METHODS: Prospective cohort of women with preeclampsia from 2005-2009. Group-based trajectories were created using latent-class models based on all individual BPs from delivery to 48 hours postpartum. Fluid balance was defined as input minus output from admission until 24 hours postpartum. Odd ratios were calculated for association between BP group, fluid balance, mode of delivery, length of labor, and disease severity. RESULTS: 96 women were evaluated. A model identifying four distinct patterns best fit the BP trajectories (class 1 (n=28):initial decrease in BP followed by rise at discharge, class 2(n=11):persistently elevated BPs, class 3(n=25):rising BPs until discharge, class 4(n=32):normal BP control). There was a statistically significant association between maternal age (p=0.0004) and initial weight(p=0.0005), parity(p=0.02), history of hypertension(p=0.035) or preeclampsia(0.024), and gestational age at delivery(p=0.018) with BP group. Women with a fluid balance greater than 500 cc and cesarean delivery after more than 12 hours of labor were more likely to be in group 3 vs 4(OR 3.97, p=0.03; OR 8.4, p=0.001). Severity of disease(p=0.36) was not associated with BP group. CONCLUSION: There are distinct patterns of BP immediately postpartum. Persistent hypertension is associated with age, chronic hypertension, fluid balance, length of labor, and mode of delivery. Future investigations should evaluate whether diuresis, as a modifiable factor, can alter patterns of BP and expedite resolution of hypertension in the postpartum period.

Maternal and Fetal Outcomes of Admission for Delivery in Women With Congenital Heart Disease

Women with congenital heart disease (CHD) may be at increased risk for adverse events during pregnancy and delivery. To compare delivery outcomes between women with and without CHD. This retrospective study of inpatient delivery admissions in the Healthcare Cost and Utilization Project's California State Inpatient Database compared maternal and fetal outcomes between women with and without CHD by using multivariate logistic regression. Female patients with codes for delivery from the International Classification of Diseases, Ninth Revision, from January 1, 2005, through December 31, 2011, were included. The association of CHD with readmission was assessed to 7 years after delivery. Cardiovascular morbidity and mortality were hypothesized to be higher among women with CHD. Data were analyzed from April 4, 2014, through January 23, 2017. Noncomplex and complex CHD. Maternal outcomes included in-hospital arrhythmias, eclampsia or preeclampsia, congestive heart failure (CHF), length of stay, preterm labor, anemia complicating pregnancy, placental abnormalities, infection during labor, maternal readmission at 1 year, and in-hospital mortality. Fetal outcomes included growth restriction, distress, and death. Among 3 642 041 identified delivery admissions, 3189 women had noncomplex CHD (mean [SD] age, 28.6 [7.6] years) and 262 had complex CHD (mean [SD] age, 26.5 [6.8] years). Women with CHD were more likely to undergo cesarean delivery (1357 [39.3%] vs 1 164 509 women without CHD [32.0%]; P < .001). Incident CHF, atrial arrhythmias, ventricular arrhythmias, and maternal mortality were uncommon during hospitalization, with each occurring in fewer than 10 women with noncomplex or complex CHD (<0.5% each). After multivariate adjustment, noncomplex CHD (odds ratio [OR], 9.7; 95% CI, 4.7-20.0) and complex CHD (OR, 56.6; 95% CI, 17.6-182.5) were associated with greater odds of incident CHF. Similar odds were found for atrial arrhythmias in noncomplex (OR, 8.2; 95% CI, 3.0-22.7) and complex (OR, 31.8; 95% CI, 4.3-236.3) CHD, for fetal growth restriction in noncomplex (OR, 1.6; 95% CI, 1.3-2.0) and complex (OR, 3.5; 95% CI, 2.1-6.1) CHD, and for hospital readmission in both CHD groups combined (OR, 3.6; 95% CI, 3.3-4.0). Complex CHD was associated with greater adjusted odds of serious ventricular arrhythmias (OR, 31.8; 95% CI, 4.3-236.3) and maternal in-hospital mortality (OR, 79.1; 95% CI, 23.9-261.8). In this study of hospital admissions for delivery in California, CHD was associated with incident CHF, atrial arrhythmias, and fetal growth restriction and complex CHD was associated with ventricular arrhythmias and maternal in-hospital mortality, although these outcomes were rare, even in women with complex CHD. These findings may guide monitoring decisions and risk assessment for pregnant women with CHD at the time of delivery.

Route of Delivery in Women With Stillbirth: Results From the Stillbirth Collaborative Research Network.

To describe delivery management of singleton stillbirths in a population-based, multicenter case series. We conducted a retrospective chart review of 611 women with singleton stillbirths at 20 weeks of gestation or greater from March 2006 to September 2008. Medical and delivery information was abstracted from medical records. Both antepartum and intrapartum stillbirths were included; these were analyzed both together and separately. The primary outcome was mode of delivery. Secondary outcomes included induction of labor and indications for cesarean delivery. Indications for cesarean delivery were classified as obstetric (abnormal fetal heart tracing before intrapartum demise, abruption, coagulopathy, uterine rupture, placenta previa, or labor dystocia) or nonobstetric (patient request, repeat cesarean delivery, or not documented). Of the 611 total cases of stillbirth, 93 (15.2%) underwent cesarean delivery, including 43.0% (46/107) of women with prior cesarean delivery and 9.3% (47/504) of women without prior cesarean delivery. No documented obstetric indication was evident for 38.3% (18/47) of primary and 78.3% (36/46) of repeat cesarean deliveries. Labor induction resulted in vaginal delivery for 98.5% (321/326) of women without prior cesarean delivery and 91.1% (41/45) of women with a history of prior cesarean delivery, including two women who had uterine rupture. Among women with a history of prior cesarean delivery who had spontaneous labor, 74.1% (20/27) delivered vaginally, with no cases of uterine rupture. Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced or whether they had a prior cesarean delivery. However, 15% underwent cesarean delivery, often without a documented obstetric indication.

Prediction of Delivery in Women with Threatening Preterm Labour using Phosphorylated Insulin-Like Growth Factor Binding Protein-1 and Cervical Length using Transvaginal Ultrasound.

Preterm delivery remains a challenge in Obstetrics as it is responsible for significant cause of perinatal morbidity and mortality. At present there is no standard test for prediction of preterm labour for timely referral to a center with NICU facilities. To evaluate the effectiveness of the cervical phosphorylated insulin like growth factor binding protein-1(phIGFBP-1), cervical length measurement and combination of phIGFBP-1 with cervical length for Predicting Preterm Labour (PTL). It was a observational prospective study done from January 2014 to April 2015 in Department of Obstetrics and Gynaecology, NDMC Medical College and Hindu Rao Hospital, Delhi, India. A total of 100 women with singleton pregnancy, between 24 and 36 weeks of gestation with complaint of uterine contractions were randomly selected. These women were subjected to detect phIGFBP-1 in cervical secretions and cervical length measurement by Transvaginal Sonography (TVS). Result of the test, cervical length and time lapse between test and delivery was noted and the results were analysed. The cervical length less than 25 mm was used as a cut off point for predicting pre-term delivery. Data was analysed using SPSS software version 20.0. The Negative Predictive Value (NPV) of phIGFBP-1 and cervical length was similar (95.2% vs 94.05%) respectively for prediction of preterm labour within one week of admission and 93.92% vs 94.80% at 37 weeks of gestational age. Combined test had higher NPV of 96.38% at 34 weeks of gestation and 94% within two days of admission. Positive Predictive Value (PPV) was low for both the test and combining the two-test did not have any advantage as far as PPV was concerned. Receiver Operating Characteristic (ROC) curve showed that the combined test had a superior result in predicting PTL compared to either phIGFBP-1 or cervical length. The combined test had steepest ROC curve at < 34 weeks of gestation (AUC-0.83 with 95% CI). The phIGFBP-1 test and cervical length have an almost equivalent ability to predict preterm delivery independently. The combined use of phIGFBP-1 and TVS for cervical length shows an increase in efficacy in predicting preterm labour.

Burden of severe maternal morbidity and association with adverse birth outcomes in sub-Saharan Africa and south Asia: protocol for a prospective cohort study.

The AMANHI morbidity study aims to quantify and describe severe maternal morbidities and assess their associations with adverse maternal, fetal and newborn outcomes in predominantly rural areas of nine sites in eight South Asian and sub-Saharan African countries. AMANHI takes advantage of on-going population-based cohort studies covering approximately 2 million women of reproductive age with 1- to 3-monthly pregnancy surveillance to enrol pregnant women. Morbidity information is collected at five follow-up home visits - three during the antenatal period at 24-28 weeks, 32-36 weeks and 37+ weeks of pregnancy and two during the postpartum period at 1-6 days and after 42-60 days after birth. Structured-questionnaires are used to collect self-reported maternal morbidities including hemorrhage, hypertensive disorders, infections, difficulty in labor and obstetric fistula, as well as care-seeking for these morbidities and outcomes for mothers and babies. Additionally, structured questionnaires are used to interview birth attendants who attended women's deliveries. All protocols were harmonised across the sites including training, implementation and operationalising definitions for maternal morbidities. Availability of reliable data to synthesize evidence for policy direction, interventions and programmes, remains a crucial step for prioritization and ensuring equitable delivery of maternal health interventions especially in high burden areas. AMANHI is one of the first large harmonized population-based cohort studies being conducted in several rural centres in South Asia and sub-Saharan Africa, and is expected to make substantial contributions to global knowledge on maternal morbidity burden and its implications.

Study on the dynamic changes of D-dimer during pregnancy and early puerperium

Objective: To explore the dynamic changes of D-dimers during pregnancy and early puerperium(within 3 days postpartum). Methods: A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women's Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy(≤12 gestation weeks), middle pregnancy(12-28 gestation weeks), late pregnancy(>28 gestation weeks), 1 postpartum(within 48 hours postpartum)and 2 postpartum(48- 72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student's t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration ≤0.5 mg/L was used as the normal range. Results: (1)D-dimers concentrations during pregnancy were higher than the non-pregnant women(P<0.01), but there was no statistical difference between early pregnancy and late pregnancy(P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group(P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups.(2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48- 72 hours after vaginal delivery, ≤48 hours after cesarean section, 48- 72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89- 19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95% CI of the study population after cesarean section. Conclusions: D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

Maternal Morbidities and Perinatal Outcomes of Delivery in Women with Preterm Prelabor Rupture of the Membranes (PPROM)

Objective: This study was done to evaluate the maternal morbidities and perinatal outcomes of delivery in women with preterm pre-labor rupture of the membranes who delivered before and after 34 week along a period of five years in Al-Arish General Hospital.