Sonographic examination at the beginning of the second stage of labor predicts birth outcome in vaginally intended breech deliveries: a blinded prospective study.

PURPOSE: In order to spread competence in vaginal breech deliveries, it is necessary to develop new and easily applicable tools for birth progression and safety evaluation. Ultrasound is a useful and ubiquitously available tool with already documented value for birth progression observation. In deliveries out of breech presentation, an established ultrasound examination is missing. We determined the descent of the fetal buttocks in relation to the maternal pelvic inlet using intrapartum ultrasound. We evaluated these results in comparison to the clinical vaginal examination with the aim to establish an easily applicable method for birth outcome prediction. Therefore, we analyzed the predictive value of our examinations on birth outcome parameters, such as cesarean section rate, as well as fetal and maternal outcome parameters. METHODS: We performed a prospective blinded study on 106 mothers with vaginally intended breech delivery. At beginning of stage two in labor, the descent of the fetal buttocks into the mother's pelvic inlet was detected with transabdominal ultrasound and vaginal examination by different observers. PRIMARY OUTCOME VARIABLE: Cesarean section rate. Secondary outcome variables: rate of manual assistance in vaginal deliveries, birth duration, 5' APGAR score, umbilical arterial pH, maternal blood loss, and perineal injury. For non-parametric values, Wilcoxon's χ2 test was performed. In order to analyze the predictive value of our examination, lack-of-fit analysis was conducted. Reliability evaluation of the sonographic examination was done with a matched-pair analysis. RESULTS: Women with positive intrapartum ultrasound breech engagement sign (+ IPUBES) had a significantly lower rate of cesarean section in comparison with those with negative IPUBES (5/67; 7.5% vs. 18/39; 46.2%; p < 0.0001). The area under the ROC curve for the prediction of CS for negative IPUBES was 0.765 with a sensitivity of 78.3% and a specificity of 74.7%. Sonographic examination showed an excellent reliability in a matched-pair analysis comparing vaginal and sonographic examinations with a mean difference of 0.012 (SD ± 0.027, 95% CI - 0.014 to 0.065). Mean birth duration was significantly longer in deliveries with negative IPUBES (533 min vs. 440 min; p = 0.0011). Fetal and maternal outcome parameters were not significantly different between deliveries with positive and negative IPUBES. CONCLUSIONS: Sonographic evaluation of the fetal descent in relation to the mother's pelvic inlet screens reliably for emergency cesarean section. This newly presented method for birth progression observation might be a powerful tool for distribution of expertise in vaginal breech delivery and is able to give reference for clinical vaginal examination by obstetricians in training. TRAIL REGISTRY: Clinical trial. Date of registration: 13.03.2019; Date of initial participant enrollment: 20.03.2019; DRKS00016885; https://www.drks.de ; German clinical trials register.

Effectiveness of antenatal yoga in reducing intensity of labour pain: A systematic review and meta-analysis.

Background: Yoga during pregnancy was found to be beneficial in various aspects of pregnancy including pain management during the time of labour. The current systematic review and meta-analysis aims to assess the effectiveness of antenatal yoga practices in reducing pain during the time of labour. Methods: We searched electronic databases such as PubMed, Embase, Cochrane Library, and Web of Science, till January 2023. Randomized controlled trials (RCTs) which measured the effects of antenatal yoga practices on pain management during labour were included. The main outcome was the pain intensity measured with any validated questionnaire. The methodological quality of included studies was evaluated by using a risk-of-bias assessment tool developed by the Cochrane Collaboration. For the effect size, standardized mean differences (SMDs) with a 95% confidence interval (CI) were generated with a random effect model using R software (version 4.2.2). Results: Eight studies including 576 antenatal women between the age of 14 and 40 years were included. Results of this meta-analysis showed that yoga is effective in reducing labour pain (SMD: -1.34 95% of CI: -1.86, -0.81) with significant heterogeneity among the studies (I2 73%, p < 0.0008). Conclusion: Antenatal yoga can be a promising intervention in the field of obstetrics to reduce the intensity of labour pain. However, we are still in need of RCT with a large sample size to confirm the reliability of the present meta-analysis.

Proportion and factors influencing client satisfaction with delivery services in health facilities in the Sissala East Municipality, Ghana: A cross-sectional study.

Background and Aims: Client satisfaction is the difference between the healthcare services delivered and the needs of the client. Anecdotal evidence suggests the quality of maternal health and delivery services in Ghana especially in the Upper West Region is appalling. Moreover, there is a paucity of data on clients' satisfaction with maternal and delivery services rendered by healthcare. This study, therefore, assessed clients' satisfaction with delivery services and their associated factors. Methods: This analytical cross-sectional study included 431 women who had delivered in the last 7 days from four health facilities within Sissala East Municipality using a multistage and simple random sampling technique. A well-structured questionnaire was used to collect sociodemographic and client satisfaction data. All statistical analyses were done using Statistical Package for Social Sciences Version 26.0 and GraphPad Prism Version 8.0. A p < 0.05 was considered statistically significant. Results: Clients' satisfaction with general delivery services was rated as 80.3% and was significantly associated with process-related factors (p < 0.0001) and structural-related factors (p < 0.0001) of the health facilities. This study found that health facilities' delivery services differed significantly and were associated with clients' satisfaction (p < 0.0001). Moreover, age group (p = 0.0200), occupation (p = 0.0090), kind of delivery (p = 0.0050), and delivery outcome (p < 0.0001) were significantly associated with client satisfaction with delivery services. Conclusion: More than two-thirds of women are satisfied with delivery services within selected health facilities in the Sissala East municipality, although satisfaction within health facilities differs. Furthermore, age group, occupation, kind of delivery, delivery outcome, process, and structural-related factors significantly contribute to client satisfaction with delivery services. To provide more comprehensive coverage of customers' satisfaction with delivery services in the municipality, strategies such as free maternal health initiatives and health education on the significance of facility delivery should be reinforced.

Advanced Maternal Age Among Nulliparous at Term and Risk of Unscheduled Cesarean Delivery.

BACKGROUND: With the rise in the number of women giving birth at an advanced age, the association between advanced maternal age and adverse obstetrical outcomes is a growing concern in developed countries. Despite the well-established link between advanced maternal age and pregnancy-related complications, there has been limited research examining the specific risks related to unscheduled cesarean delivery in nulliparas at term. OBJECTIVE: This study aimed to evaluate the risks associated with unscheduled cesarean delivery in nulliparas at ≥37 weeks of gestation, comparing the outcomes of younger patients with those aged ≥40 years. STUDY DESIGN: This retrospective cohort study was conducted in a tertiary maternity hospital in Switzerland (high-income country). The study included nulliparas who delivered a live-born infant at ≥37 weeks between January 2015 and December 2019. We excluded pregnant women who had a planned cesarean delivery, were aged <18 years, multiparous, delivered before 37 weeks of gestation, or had pregnancies that ended in stillbirth. Participants were divided into 2 age groups: (1) ≥40 years and (2) <40 years. The primary outcome was the incidence of unscheduled cesarean delivery. Its association with advanced maternal age was evaluated after adjusting for confounding factors by multivariate logistic regression, expressed as an adjusted odds ratio. Secondary outcomes included pregnancy outcomes and neonatal outcomes. RESULTS: A total of 5211 patients were included: 173 in the ≥40-years (advanced maternal age) group and 5038 in the <40-years (non-advanced maternal age) group; 26.01% (95% confidence interval, 19.65-33.22; n=45) of women in the advanced maternal age group had an unscheduled cesarean delivery, whereas 15.26% (95% confidence interval, 14.28-16.29; n=769) of women in the non-advanced maternal age group underwent the procedure. Advanced maternal age was associated with unscheduled cesarean delivery, with an adjusted odds ratio of 1.51 (95% confidence interval, 1.06-2.17; P=.024). Among vaginal deliveries, assisted procedures were performed on 29.7% (95% confidence interval, 21.9-38.4; n=38) of advanced maternal age patients vs 20.1% (95% confidence interval, 18.9-21.3; n=856) of non-advanced maternal age patients. Postpartum blood loss >1000 mL occurred in 5.8% (95% confidence interval, 2.8-10.4; n=10) of advanced maternal age patients and 3.1% (95% confidence interval, 2.6-3.6; n=156) of non-advanced maternal age patients. CONCLUSION: Advanced maternal age is associated with increased risk of unscheduled cesarean delivery among nulliparas. This provides healthcare professionals with confirmation that advanced age may represent an individual risk factor, suggesting that nulliparous patients aged over 40 years may benefit from improved information regarding the factors contributing to this pregnancy outcome.

Construction and application of a prediction model for the delivery outcome of women with scarred uterus based on ultrasonic parameters.

OBJECTIVE: To explore the application value of the prediction model for delivery outcome of women with scarred uterus based on ultrasonic parameters. METHODS: In this retrospective study, a total of 100 pregnant women with scarred uterus who delivered in Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine were selected as the research subjects. Adverse pregnancy outcomes included premature delivery, low birth weight, neonatal asphyxia, postpartum hemorrhage, and uterine rupture. In line with delivery outcome, the pregnant women were segmented into good outcome group (n = 78) and poor outcome group (n = 22). We collected and compared the clinical data and the ultrasonic parameters of pregnant women of the two groups. Multivariate logistic regression analysis was conducted to explore the risk factors affecting the delivery outcome of women with scarred uterus and to establish a prediction model. RESULTS: Multivariate logistic regression analysis showed that low hemoglobin (Hb) before delivery, high grade of uterine scar, low muscle thickness of lower uterine segment, and low blood flow index were the risk factors for poor delivery outcome of women with scarred uterus. According to the risk factors, the prediction model was obtained: Prob = 1/[1 + e^ (-5.110-2.568 * Pre-delivery Hb - 1.697 * uterine scar grade -2.895 * lower uterine muscle thickness + 19.584 * blood flow index)]. The sensitivity, specificity and area under the curve were 90.0, 91.0 and 0.959, respectively. After validation, the sensitivity and specificity were 85.71 and 87.04, respectively. CONCLUSION: Low Hb before delivery, low grade of uterine scar, low musculature thickness of lower uterine segment, and low blood flow index were the risk factors for poor delivery outcome of women with scarred uterus. The establishment of prediction model based on risk factors could effectively evaluate the risk of poor delivery outcome of women with scarred uterus.

Management of pregnant female with Haemophilia-A: A case report.

Haemophilia-A is a rare, X-linked recessive inherited disease affects males and females are carrier results in prolonged bleeding after minor injuries, procedures or surgery. Spontaneous or recurrent bleeding may occur in deep muscles, joints but intracranial haemorrhage can be dangerous. Women with a family history of bleeding disorder, personal history of bleeding (menorrhagia, mucous membrane, postoperative bleeding and PPH) or a prolonged activated partial thromboplastin time (aPTT) should be screened for haemophilia by measuring coagulation factor VIII level during hospital visits for these reason or antenatal care (ANC). Female heterozygote carriers may have variable presentation of bleeding due to reduced levels of clotting FVIII and may experience excessive bleeding due to gynaecologic issues, during spontaneous abortion, medical termination of pregnancy or invasive prenatal diagnostic techniques in first trimester of pregnancy, antepartum and postpartum haemorrhage in later part of gestation and after delivery.

Sonographic knowledge of occiput position to decrease failed operative vaginal delivery: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: This study aimed to assess the efficacy of sonographic assessment of fetal occiput position before operative vaginal delivery to decrease the number of failed operative vaginal deliveries. DATA SOURCES: The search was conducted in MEDLINE, Embase, Web of Science, Scopus, ClinicalTrial.gov, Ovid, and Cochrane Library as electronic databases from the inception of each database to April 2021. No restrictions for language or geographic location were applied. STUDY ELIGIBILITY CRITERIA: Selection criteria included randomized controlled trails of pregnant women randomized to either sonographic or clinical digital diagnosis of fetal occiput position during the second stage of labor before operative vaginal delivery. METHODS: The primary outcome was failed operative vaginal delivery, defined as a failed fetal operative vaginal delivery (vacuum or forceps) extraction requiring a cesarean delivery or forceps after failed vacuum. The summary measures were reported as relative risks or as mean differences with 95% confidence intervals using the random effects model of DerSimonian and Laird. An I2 (Higgins I2) >0% was used to identify heterogeneity. RESULTS: A total of 4 randomized controlled trials including 1007 women with singleton, term, cephalic fetuses randomized to either the sonographic (n=484) or clinical digital (n=523) diagnosis of occiput position during the second stage of labor before operative vaginal delivery were included. Before operative vaginal delivery, fetal occiput position was diagnosed as anterior in 63.5% of the sonographic diagnosis group vs 69.5% in the clinical digital diagnosis group (P=.04). There was no significant difference in the rate of failed operative vaginal deliveries between the sonographic and clinical diagnosis of occiput position groups (9.9% vs 8.2%; relative risk, 1.14; 95% confidence interval, 0.77-1.68). Women randomized to sonographic diagnosis of occiput position had a significantly lower rate of occiput position discordance between the evaluation before operative vaginal delivery and the at birth evaluation when compared with those randomized to the clinical diagnosis group (2.3% vs 17.7%; relative risk, 0.16; 95% confidence interval, 0.04-0.74; P=.02). There were no significant differences in any of the other secondary obstetrical and perinatal outcomes assessed. CONCLUSION: Sonographic knowledge of occiput position before operative vaginal delivery does not seem to have an effect on the incidence of failed operative vaginal deliveries despite better sonographic accuracy in the occiput position diagnosis when compared with clinical assessment. Future studies should evaluate how a more accurate sonographic diagnosis of occiput position or other parameters can lead to a safer and more effective operative vaginal delivery technique.

Development of prediction models for successful external cephalic version and delivery outcome.

OBJECTIVE: To develop prediction models for the chance of successful external cephalic version (ECV) and delivery outcome. STUDY DESIGN: This is a single-center retrospective study including 350 pregnant women with a singleton non-cephalic pregnancy at or after 36 weeks of gestational age. We selected 22 factors for ECV prediction and 21 for delivery outcome after successful ECV prediction as candidate predictors. Multivariable logistic regression with a stepwise backward selection procedure was used to construct a prediction model for the chance of successful ECV and the other for the delivery outcome. The discrimination and calibration of the models were assessed and internal validation was done with bootstrapping. RESULTS: ECV was successfully performed in 232 cases (66.3%) among 343 women. Eight predictive factors were identified to be associated with a successful ECV: Gestational week at ECV < 39 weeks, multiparous, BMI before pregnancy < 22 kg/m3, palpable fetal head, breech engagement, larger AFI, larger BPD and posterior placenta. This model showed good calibration and good discrimination (c-statistic = 0.82, 95% CI 0.76-0.88). Six predictive factors were identified to be associated with vaginal delivery after successful ECV: age < 35, multiparous, BMI before pregnancy < 22 kg/m3, anterior placenta, lateral placenta and none-front fetal spine position. This model showed fair discrimination (c-statistic = 0.79, 95% CI 0.72-0.85). However, its calibration was not so satisfactory especially when the predicted probability was low. CONCLUSION: We validated a prediction model for ECV and delivery outcome, showing that the model's overall performance is good. This can be used in clinical practice after external validation.

Effect of birth ball abdominal core training on pregnancy fatigue, waist pain and delivery outcomes.

OBJECTIVE: To evaluate the effect of birth ball abdominal core training on fatigue, waist pain, and delivery outcomes in middle and late pregnancy. METHODS: A prospective study of 209 primipara in total with 24-27 weeks of gestation were recruited and divided into the training group (109 cases) and the control group (100 cases). The control group received routine prenatal exercise. On the basis of routine prenatal exercise, pregnant women in the training group were given birth ball exercises based on abdominal core training. The difference in pregnancy fatigue, waist discomfort, and delivery outcomes between the two groups were compared. RESULTS: The waist pain and fatigue ratings of women were significantly lower and the vaginal delivery rate (74.3%) was significantly higher (62%) (P < 0.001) in the training group. There were no significant differences in the total stage of labor, postpartum hemorrhage, neonatal weight and 1-min neonatal Apgar score between the two groups. The rate of episiotomy in the training group (14.7%) was significantly lower than that in the control group (25.0%) (P < 0.05). CONCLUSION: Birth ball exercises can relieve fatigue and waist pain in middle and late 2021 pregnancy, reduce the rate of episiotomy, and promote spontaneous vaginal delivery.

The effectiveness of a Pilates exercise program during pregnancy on childbirth outcomes: a randomised controlled clinical trial.

BACKGROUND: Performing exercise with medium intensity has positive effects on the maternal health. The aim of this study was to investigate the effectiveness of Pilates exercise program during pregnancy on childbirth outcomes: METHODS: This clinical trial study was performed on 110 primiparous women who were randomly divided into two groups of intervention (n = 55) and control (n = 55). The intervention group performed Pilates exercises from 26 to 28 weeks of gestation for 8 weeks while the control group did not do any exercise. Data collection tools included Visual Analog Scale (VAS), Mackey Childbirth Satisfaction Rating Scale, and a checklist including demographic and obstetrics information. RESULTS: The results of the study showed that Pilates exercise during pregnancy significantly reduces the labor pain intensity, length of the active phase and second stage of labor and increases maternal satisfaction of the labor process (p < 0.05). Based on the Kaplan Meyer analysis, the mean whole length of labor was shorter in Pilates exercise group than in the control group (P = .004). There was no statistically significant difference between the two groups in terms of Episiotomy, type of delivery, first and fifth Apgar score of neonates (p > 0.05). CONCLUSION: According to the results of this study, Pilates exercise during pregnancy improved the labor process and increased maternal satisfaction of chidbirthprocess, without causing complications for the mother and baby. However, studies with larger sample sizes are recommended to prove the efficacy and safty of this practiceduring labor. TRIAL REGISTRATION: IRCT registration number: IRCT20200126046266N1 . Registration date: 2020-05-02 (retrospectively registered).

Effect of an evidence-based activity management program on delivery outcomes in pregnant women after intraspinal labor analgesia.

OBJECTIVE: To investigate the effect of an evidence-based activity management program for pregnant women after intraspinal labor analgesia based on their delivery outcomes. METHODS: A prospective study was conducted in 96 pregnant women who received intraspinal labor analgesia in our hospital. The control group (48 cases) received routine nursing care after analgesia, and the intervention group (48 cases) received evidence-based activity management program after analgesia. The labor time, sense of birth control, physiological and psychological stress reactions, analgesic effect, delivery outcome and early postpartum pelvic floor function were compared between the two groups. RESULTS: Compared with the control group, the first, second and third stages of labor time and the total labor time of the intervention group were significantly shorter, while the Labor Agentry Scale (LAS) score was significantly higher (P<0.05). Compared with the control group, the diastolic blood pressure, systolic blood pressure, heart rate, Visual Analogue Scale (VAS) score, Self-Rating Anxiety Scale (SAS) score and Self-Rating Depression Scale (SDS) score of the intervention group were significantly lower (P<0.05). The total analgesic rate of the intervention group was significantly higher than that of the control group (95.83% vs. 79.17%, P<0.05). The overall incidence of postpartum hemorrhage, perineal laceration, lateral episiotomy, fetal distress and neonatal asphyxia in the intervention group was significantly lower than that of the control group (16.67% vs. 35.42%, P<0.05). The incidence of pelvic organ prolapse (POP) and pelvic floor dysfunction in the intervention group were significantly lower than those in the control group (P<0.05). CONCLUSION: An evidence-based activity management program for pregnant women after intraspinal labor analgesia can effectively shorten the labor time, strengthen the analgesic effect, reduce the physiological and psychological stress reactions, increase the sense of control during birth and improve the delivery outcome as well as early pelvic floor function.

Effect of incentive spouse cooperative psychological intervention on the delivery outcome of primipara / 上海预防医学

ObjectiveTo explore the effect of incentive spouse collaborative psychological intervention on delivery outcomes of primipara. MethodsFrom July 2019 to July 2020， 300 primiparas with an uneventful pregnancy were recruited and divided into the control group and the intervention group， with 150 cases in each group. The control group was managed by routine nursing care， and the intervention group was managed by incentive spouse collaborative psychological intervention. The delivery outcomes in two groups， including delivery route， postpartum blood loss， and perineal laceration were compared. ResultsAfter intervention， the cesarean section rate， the 2-hour postpartum blood loss and perineal laceration in the intervention group were less common than those in the control group and the difference was statistically significant （P<0.05）. The first， second and total stages of labor duration in the intervention group were shorter than those in the control group and the difference was statistically significant （P<0.05）. There was no significant difference in the incidence of neonatal asphyxia between these two groups （P>0.05）. In terms of vaginal delivery experience scores of the two groups， the intervention group was better than the control group and the difference was statistically significant （P<0.05）. ConclusionThe mode of incentive spouse collaborative psychological intervention can reduce the rate of cesarean section， the amount of bleeding 2 hours after delivery， and perineum injury. It can shorten the labor process， and effectively improve the delivery outcome of primiparas.

Effect of incentive spouse cooperative psychological intervention on the delivery outcome of primipara / 上海预防医学

ObjectiveTo explore the effect of incentive spouse collaborative psychological intervention on delivery outcomes of primipara. MethodsFrom July 2019 to July 2020， 300 primiparas with an uneventful pregnancy were recruited and divided into the control group and the intervention group， with 150 cases in each group. The control group was managed by routine nursing care， and the intervention group was managed by incentive spouse collaborative psychological intervention. The delivery outcomes in two groups， including delivery route， postpartum blood loss， and perineal laceration were compared. ResultsAfter intervention， the cesarean section rate， the 2-hour postpartum blood loss and perineal laceration in the intervention group were less common than those in the control group and the difference was statistically significant （P<0.05）. The first， second and total stages of labor duration in the intervention group were shorter than those in the control group and the difference was statistically significant （P<0.05）. There was no significant difference in the incidence of neonatal asphyxia between these two groups （P>0.05）. In terms of vaginal delivery experience scores of the two groups， the intervention group was better than the control group and the difference was statistically significant （P<0.05）. ConclusionThe mode of incentive spouse collaborative psychological intervention can reduce the rate of cesarean section， the amount of bleeding 2 hours after delivery， and perineum injury. It can shorten the labor process， and effectively improve the delivery outcome of primiparas.

[Multiple sclerosis and childbirth: Relapse frequency and pregnancy outcome. A hospital-based retrospective study].

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system which affects young people, especially women. The aim of the study was to examine the disease profile of MS during pregnancy and postpartum as well as pregnancy outcomes in women with MS compared to a control group. Such a study has not been conducted in Iceland before. MATERIAL AND METHODS: A hospital based retrospective study with data from the Icelandic Medical Birth Register and medical records from Landspitali University Hospital including women with MS diagnosis during 2009-2018 and their deliveries through 1999-2018, a total of 91 women and 137 births. RESULTS: Relapse frequency decreased during pregnancy compared to the preceding year. Over half of the women received disease modifying drugs before pregnancy, all stopped treatment before or shortly after conception. Women in the study group underwent cesarean sections before labor more frequently than the control group. The gestational length was comparable between the groups when labor was spontaneous. The numbers of heavy- and lightweight newborns as well as Apgar scores were alike in both groups. CONCLUSION: We believe that our study reflects actual pregnancy outcome among Icelandic women with MS and our results show that their pregnancies and deliveries do not differ in any major aspect from the general population. Our findings agree with previous studies in that pregnancy protects against MS relapses although in our study this is confined to the first and second trimester.

Reduced fetal movements at term, low-risk pregnancies: is it associated with adverse pregnancy outcomes? Ten years of experience from a single tertiary center.

OBJECTIVE: We aimed to assess the outcomes of low-risk pregnancies complicated by isolated reduced fetal movements (RFM) at term. STUDY DESIGN: The study population were patients at term, with singleton, low-risk, pregnancies who presented to our obstetric-triage and delivered during the subsequent 2 weeks. The study group included patients with an isolated complaint of RFM (RFM group). The control group included patients without history of RFM (control group). The pregnancy, delivery, and neonatal outcomes were compared between the groups. Severe and mild composites of adverse neonatal outcomes were defined. Multivariate regression analyses were performed to identify independent association with adverse neonatal outcomes. RESULTS: Among the 13,338 pregnant women, 2762 (20.7%) were included in the RFM group and 10,576 (79.3%) in the control group. The RFM group had higher rates of nulliparity (p < 0.001), and smoking (p < 0.001). At admission, the RFM group had higher rates of IUFD (p < 0.001). The RFM group had higher rates of Cesarean delivery due to non-reassuring fetal monitor (p < 0.001), and mild adverse neonatal outcomes (p = 0.001). RFM was associated with mild adverse outcome independent of background confounders (aOR = 1.4, 95% CI 1.2-2.6, p < 0.001). CONCLUSION: Patients presented with isolated RFM at term had higher rates of IUFD at presentation and significant adverse outcomes at delivery.

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.

Choice of scheduled cesarean delivery versus trial of labor for advanced maternal age primiparous women.

OBJECTIVE: We aimed to evaluate perinatal outcomes of advanced maternal age (AMA) primiparous women seeking scheduled cesarean delivery (CD) versus a trial of labor (TOL). MATERIALS AND METHODS: This was a retrospective cohort study of primiparous women ≥40 years of age carrying a single fetus, who delivered at a tertiary, university-affiliated medical center (2007-2014). We compared perinatal outcomes of women who chose a scheduled CD with those who chose TOL. Subsequently, we compared women who had successful TOL (sTOL) with those who had a failed TOL (fTOL). RESULTS: Out of 62 102 deliveries during the study period, inclusion criteria were met by 374 women. Of them, 83 (22.2%) women had a scheduled CD, and 291 (77.8%) had TOL. Of the TOL group, 118 women (40.5%) had fTOL and 173 (59.5%) had sTOL. Women in the fTOL had higher rates of 1-min Apgar score <7, neonatal asphyxia and adverse neonatal composite outcome compared with women in the sTOL group (p < .05). After adjusting for potential confounders, compared with sTOL, fTOL was not associated with adverse neonatal composite outcome. Compared with scheduled CD, fTOL was associated with an increased risk for adverse neonatal composite outcome (aOR 2.65, 95% CI 1.13-6.19, p = .03). CONCLUSION: AMA primiparous women attempting TOL have comparable outcome to those seeking scheduled CD, however, women with fTOL have higher rates of adverse neonatal outcome.

Pregnancy outcomes following nonobstetric surgery during gestation: a nationwide population-based case-control study in Taiwan.

BACKGROUND: Whether nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion or adverse delivery outcomes is still unclear. METHODS: We performed a retrospective case-control study using a Longitudinal Health Insurance Database (LHID 2000) containing claim-data of 1 million randomly selected beneficiaries. We compared the incidences and estimated the adjusted odds ratios (aOR) with 95% confidence interval (95% CI) for spontaneous abortion, adverse delivery outcomes, cesarean delivery, and prolonged hospital stay to determine the risk of adverse outcomes in women who had nonobstetric surgery during gestation as compared to those who did not have any surgery during gestation. RESULTS: After exclusion, we were left with 114,852 delivery and 3999 abortion cases in our study; and 462 (0.39%) of them had nonobstetric surgery under general or regional anesthesia during pregnancy. The leading surgeries were repair of cervical os (33.12%), appendectomy (17.32%), ovarian surgeries (13.64%), and fixation of fractured bone (8.01%).The risk of spontaneous abortion (4.23% vs. 2.43%, aOR:1.53; 95% CI: 1.01-2.31), antepartum hemorrhage (7.14% vs. 2.83%, aOR: 2.51; 95% CI: 1.74-3.61), pre-eclampsia/eclampsia (2.60% vs. 1.01%, aOR: 2.35; 95% CI: 1.30-4.23), gestational diabetes (2.38% vs. 0.69%, aOR: 3.12; 95% CI: 1.69-5.78), prematurity (9.06 vs. 4.90%, aOR: 3.31; 95% CI: 2.54-4.31), cesarean section (43.55% vs. 33.76%, aOR: 1.41; 95% CI: 1.17-1.71), and prolonged hospital stay (1.82% vs. 5.91%, aOR: 3.23; 95% CI: 2.16-4.83) were higher in those women who had nonobstetric surgery after adjusting for age and comorbidities. CONCLUSIONS: Nonobstetric surgery during gestation were associated with a higher risk of spontaneous abortion, adverse delivery outcomes, cesarean section, and prolonged hospital stay.

The Effects of Enriched Environmental Intervention on the Parturition Outcome and Filial Health of Pregnant Mice With Chronic Pain.

Chronic pain (CP) adversely impacts people's health. However, the influence of CP on pregnant women and their fetuses remains unclear. Few reasonable interventions have been offered to these women. This study aimed to examine the effects of enriched environmental intervention (EEI) on the delivery outcome and offspring health of pregnant mice with CP. Forty pregnant mice were equally and randomly divided into four groups (control, sham, CP, and CP + EEI). Monoarthritis was induced by subcutaneous injection of the complete Freund's adjuvant (100 µg/100 µl) into the left hind paw of mice on Day 0 of gestation. Sham mice received 100 µl of sterile phosphate-buffered saline subcutaneously. General health status and delivery outcomes of pregnant mice and general physical status, growth, and development of offspring were observed and compared between groups. CP mice exhibited less weight gain, higher rate of premature delivery, smaller litter size, lower live birth rate, lower filial birth weight, shorter filial tail length, and lower filial rates of achieving righting reflex and crawling compared to mice in the control/sham/CP + EEI groups. There were no significant differences between mice in the CP + EEI group and those in the control and sham groups. CP during pregnancy led to serious adverse impacts on both the mother and fetus mice in this study, and EEI was an effective treatment for these effects.

Second-trimester cervical length and outcomes of induction of labor at term.

OBJECTIVE: To evaluate whether second-trimester cervical length (CL) is associated with induction of labor (IOL) outcomes. METHODS: Retrospective cohort study of nulliparous singletons undergoing CL screening at 18 0/7-23 6/7 weeks from 1/1/2012 to 12/31/2013. Women induced at term (≥37 weeks) were included. Primary outcome was vaginal delivery (VD) within 24 h. The effect of CL on outcomes was assessed by incidence across CL quartiles and a receiver operating characteristics (ROC) curve. Odds ratios (OR) were adjusted (aOR) for confounders. RESULTS: Two-hundred-and-sixty-eight women were included. Aside from a difference in incidence of prior cervical surgery between CL quartiles (p <. 02), other characteristics were similar. Ninety-two women (35%) had a VD within 24 h (versus a CD or VD >24 h). A longer a CL was associated with a decreased likelihood of a VD within 24 h with aORs of the third and fourth quartiles of 0.35 (0.16-0.75) and 0.43 (0.21-0.90), respectively, compared to the first quartile. A CL >40 mm was predictive of not having a VD within 24 h with a sensitivity of 56%, specificity of 58% and a positive predictive value of 72%. CONCLUSION: A second-trimester CL >40 mm is associated with a decreased likelihood of VD within 24 h in an IOL.