Are reduced fetal movements "merely" a maternal perception or truly a reflection of umbilical cord complications? A clinical trial.

OBJECTIVE: To characterize obstetric outcomes and the association with umbilical cord (UC) complications among women complaining of reduced fetal movements (RFMs). METHODS: This retrospective cohort compared women with a perception of RFMs within 2 weeks prior to delivery with women who reported no changes in fetal movements in terms of maternal characteristics and neonatal outcomes. A primary outcome of UC complications at delivery was defined. Multivariable regression analysis was performed to identify independent associations with RFMs and UC complications. RESULTS: In all, 46 103 women were included, 2591 (5.6%) of whom reported RFMs and 43 512 (94.4%) in the control group. Compared with controls, the RFM group was more likely to be nulliparous (42.6% vs 32.2%, P < 0.001), smokers (6.4% vs 5.4%, P = 0.029), or obese (body mass index >30) (16.4% vs 11.6%, P < 0.001). They were also more likely to have an anterior placenta (56.2% vs 51.8%, P < 0.001) and poly/oligohydramnios (0.7% vs 0.4%, P = 0.015 and 3.6% vs 2.1%, P < 0.001, respectively). Induction of labor was more common in the RFM group (33.9% vs 19.7%, P < 0.001), as well as meconium (16.8% vs 15.0%, P = 0.026) and vacuum extractions (10.1% vs 8.0%, P < 0.001). Higher rates of stillbirth and the severe composite neonatal outcome were observed in the RFM group (1.5% vs 0.2%, P < 0.001 and 0.6% vs 0.3%, P = 0.010, respectively). The RFM group was characterized by higher rates of triple nuchal cord (P = 0.015), UC around body or neck (32.2% vs 29.6%, P = 0.010), and true knot (2.3% vs 1.4%, P = 0.002). Multivariable logistic regression found RFMs to be independently associated with triple nuchal cord and with a true cord knot. A sub-analysis including only cases of stillbirth (n = 127) revealed even higher rates of UC complications: 7% of all stillbirths presented with a true cord knot (20% true knots were found in stillbirths preceded by RFMs vs 6.1% in stillbirth cases without RFMs). Additionally, 33.8% of all stillbirths presented with nuchal cord (40% preceded by RFMs vs 33.3% without RFMs). CONCLUSIONS: RFMs are associated with increased risk of UC complications observed at delivery, as well as increased risk of stillbirth and neonatal adverse outcomes.

The impact of childbirth education classes on delivery outcome.

OBJECTIVE: To determine whether participating in childbirth classes is associated with pregnancy outcomes. METHODS: A retrospective study was conducted to review the medical records of all nulliparous women who participated in childbirth classes during their pregnancy and delivered in the authors' institute, between January 2014 and December 2017 (CB class group). The control group comprised nulliparous women who delivered in the same time period, but who did not participate in any education classes (Not attended CB class group). The controls were matched in a ratio of 1:1 for gestational age at delivery and neonatal birth weight. RESULTS: Overall, 159 patients were included in each group. The class group was characterized with above average income (28 [23.9%] vs 19 [16.7%]; P=0.001) and higher education level (80 [64.0%] vs 60 [45.1%]; P=0.002), higher rate of normal vaginal delivery (128 [80.5%] vs 93 [58.5%]; P<0.001), and lower rate of vacuum extraction (12 [7.5%] vs 36 [22.6%]; P<0.001) compared to the Not attended CB class group. By logistic regression analysis, after controlling for obstetrics and socioeconomic variables, participation in childbirth classes was found to be independently associated with successful normal vaginal delivery (odds ratio 2.90; 95% confidence interval 1.13-7.38; P=0.024). CONCLUSION: Participation in childbirth classes has a positive impact on pregnancy outcome.