ABSTRACT
OBJECTIVE: Parturients with symptoms to COVID-19 have an increased risk for neonatal adverse outcomes and for any adverse outcome compared to the asymptomatic COVID-19 positive parturients and to the COVID-19-negative parturients. The purpose of this study was to determine the effect of COVID-19 on obstetric outcomes based on symptom status of parturients at or near term. METHODS: Retrospective cohort study of parturients diagnosed with COVID-19 between 26 March and 30 September 2020. Maternal and neonatal outcomes were assessed by comparing three groups of parturients: COVID-19 negative, asymptomatic COVID-19, and symptomatic COVID-19. RESULTS: A total of 2299 COVID-19-negative parturients and 172 patients with confirmed diagnosis of COVID-19 delivered during the study period. The median gestational age at the time of delivery was 39 (interquartile range 39-40) weeks. The most common symptom was cough (28/56, 50%). Gestational diabetes mellitus was significantly less common in COVID-19-negative than in COVID-19-positive patients. There was no significant increase in cesarean delivery in women who were COVID-19 positive and the incidence of preterm deliveries was not significantly different among the three groups. Of the 172 cases of COVID-19, only one parturient needed mechanical ventilation, and there were no maternal deaths in this group. There were no cases of severe neonatal asphyxia or neonatal death. Composite maternal adverse outcomes were not significantly different between the three groups. The aOR for composite neonatal adverse outcome and overall composite adverse outcome comparing COVID-19 positive to negative parturients was 2.1 (95% confidence interval [CI], 1.1-3.8; p = .02) and 1.6 (95% CI, 1.1-2.3; p = .02), respectively. CONCLUSIONS: An increased risk for neonatal adverse outcomes and for any adverse outcome was found in the symptomatic COVID-19 group compared to the asymptomatic COVID-19-positive parturients and to the COVID-19-negative parturients.
Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Pregnancy , Infant, Newborn , Humans , Female , Infant , SARS-CoV-2 , Pregnancy Outcome/epidemiology , COVID-19/complications , COVID-19/epidemiology , Pregnancy Trimester, Third , Retrospective Studies , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/diagnosisABSTRACT
OBJECTIVE: To determine the safety and efficacy of labor induction with low-dose vaginal prostaglandin E2 (PGE2) in grandmultiparous women with a previous cesarean delivery. METHODS: We conducted a retrospective cohort study of 219 grandmultiparous women with a previous cesarean delivery (study group) who underwent induction of labor with low dose PGE2. These patients were compared to 1376 grandmultiparous women without a previous cesarean section (control group) who underwent induction of labor with low dose PGE2. The primary outcome was uterine rupture and secondary outcomes included mode of delivery, post-partum hemorrhage (PPH) and a low 5-min Apgar score (≤7). RESULTS: One patient in the study group as well as one patient in the control group were diagnosed with uterine rupture (0.4% versus 0.07%). In the study group, vaginal delivery was achieved in 204 (93.16%) patients, whereas 15 (6.84%) patients had emergent cesarean delivery. Five minutes Apgar score ≤7 was recorded in two cases (0.9%) in the study group. Patients in the study group had a significantly higher rate of cesarean delivery (6.84%, versus 3.4%, respectively, p < 0.001) as well as operative vaginal delivery (4.56% versus 2% respectively, p < 0.05) compared to the control group. There were no significant differences between the groups regarding the rate of PPH (0.91% versus 0.90%, p = 0.2) or 5-min Apgar score ≤7 (0.91% versus 0.22%, p = 0.28). CONCLUSIONS: Low dose PGE2 is a relative safe method for induction of labor in grandmultiparous women with a previous cesarean section.
Subject(s)
Dinoprostone/administration & dosage , Dinoprostone/adverse effects , Labor, Induced/methods , Oxytocics/administration & dosage , Oxytocics/adverse effects , Parity , Vaginal Birth after Cesarean , Administration, Intravaginal , Adult , Case-Control Studies , Dose-Response Relationship, Drug , Female , Humans , Labor, Induced/adverse effects , Labor, Induced/statistics & numerical data , Middle Aged , Parity/drug effects , Pregnancy , Pregnancy Outcome/epidemiology , Retrospective Studies , Treatment Outcome , Uterine Rupture/epidemiology , Vaginal Birth after Cesarean/adverse effects , Vaginal Birth after Cesarean/methods , Vaginal Birth after Cesarean/statistics & numerical dataABSTRACT
OBJECTIVE: The aim of this study was to assess the safety of labor induction with vaginal prostaglandin E2 (PGE2) in grandmultiparous women. METHODS: We conducted a retrospective cohort study of 1376 grandmultiparous women who underwent induction of labor with low dose PGE2. The primary outcome was uterine rupture and secondary outcomes included mode of delivery, postpartum hemorrhage and five minutes Apgar score. RESULTS: One case was diagnosed with uterine rupture (0.07%). Vaginal delivery was achieved in 1329 (96.6%) patients, whereas 47 (3.4%) patients had emergent cesarean delivery. Five minutes Apgar score ≤7 was recorded in three cases (0.2%). There was no correlation between parity and cesarean delivery rate or low Apgar score. There were no significant differences between the grandmultiparous and great-grandmultiparous patients regarding cesarean delivery rate (3.1 vs. 5%, P = 0.12), operative vaginal delivery rate (2 vs. 2.3%, P = 0.74) or postpartum hemorrhage rate (0.8 vs. 1.1%, P = 0.6). CONCLUSIONS: Low dose PGE2 is a safe and efficient method for induction of labor in grandmultiparous and great-grandmultiparous women.
