Perinatal outcomes after therapeutic rest in the latent phase of labor: A cohort study.

INTRODUCTION: Therapeutic rest refers to the usage of medication to relieve pain in women in the latent phase of labor. Very few data are available to evaluate the safety and effect of its use. The objectives of this study were to compare perinatal and labor outcomes in women who were seeking hospital care during the latent phase of labor and who were treated either with or without therapeutic rest. MATERIAL AND METHODS: Retrospective cohort study with inclusion of nulliparous singleton pregnant women in the latent phase of labor presenting at the labor ward at Aarhus University Hospital, Denmark from May 13, 2018 to June 1, 2021. We identified two groups: women who were treated with therapeutic rest and women who were not. The primary outcomes were neonatal admission and neonatal resuscitation. Secondary outcomes included use of cardiotocography during labor, nonreactive fetal heart rate, meconium-stained amniotic fluid, pediatric delivery room assistance, umbilical cord arterial pH and standard base excess, Apgar score at 5 minutes, interventions during labor and mode of delivery. RESULTS: In our sample of 800 women in the latent phase of labor, 414 women (52%) were treated with therapeutic rest and 386 women (48%) were not. The most frequently used (n = 206) medication for therapeutic rest was a combination of paracetamol, triazolam and codeine. We found no significant difference in neonatal admission (9.2% vs 6.5%, adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.4-3.1) or neonatal resuscitation (2.4% vs 3.1%, aOR 0.7, 95% CI 0.1-4.0) between women treated with or without therapeutic rest. There were no differences between the two groups in other perinatal adverse outcomes, interventions during labor or mode of delivery. CONCLUSIONS: This study found no significant association between therapeutic rest and neonatal admission or resuscitation. Our findings indicate that therapeutic rest is a safe method for managing the latent phase of labor concerning neonatal health and does not increase the risk of labor complications.

Medically assisted reproduction and the risk of being born small and very small for gestational age: Assessing prematurity status as an effect modifier.

Over the last decade, the use of medically assisted reproduction (MAR) has steadily increased but controversy remains with regards to its risks. We aimed to quantify the risk of being born small for gestational age (SGA) and very SGA (VSGA) associated with MARs overall and by type, namely ovarian stimulators (OS) and assisted reproductive technology (ART). We conducted a cohort study within the Quebec Pregnancy Cohort. Pregnancies coinciding with Quebec's MAR reimbursement PROGRAM period (2010-2014) with a singleton liveborn were considered. MAR was first defined dichotomously, using spontaneous conception as the reference, and categorized into three subgroups: OS alone (categorized as clomiphene and non-clomiphene OS), ART, OS/ART combined. SGA was defined as being born with a birth weight below the 10th percentile based on sex and gestational age (GA), estimated using populational curves in Canada, while VSGA was defined as being born with a birth weight below the 3rd percentile. We then estimated odds ratios (OR) for the association between MAR and SGA as well as VSGA using generalized estimated equation (GEE) models, adjusted for potential confounders (aOR). Two independent models were conducted considering MAR exposure overall, and MAR subgroup categories, using spontaneous conceptions as the reference. The impact of prematurity status (less than 37 weeks gestation) as an effect modifier in these associations was assessed by evaluating them among term and preterm pregnancies separately. A total of 57,631 pregnancies met inclusion criteria and were considered. During the study period, 2,062 women were exposed to MARs: 420 to OS alone, 557 to ART, and 1,085 to OS/ART combined. While no association was observed between MAR and SGA nor VSGA in the study population, MAR was associated with an increased risk for SGA (aOR 1.69, 95% CI 1.08-2.66; 25 exposed cases) among preterm pregnancies; no increased risk of SGA was observed in term pregnancies. MARs are known to increase the risk of preterm birth and our results further confirm that they also increase the risk of SGA among preterm pregnancies.

Colestasis intrahepática del embarazo Un reto más para la obstetricia / Intrahepatic Cholestasis of Pregnancy. One More Challenge for Obstetrics

Resumen: La colestasis intrahepática del embarazo es el trastorno hepático específico más común durante la gestación; es una condición multifactorial que aparece en mujeres genéticamente susceptibles. Se caracteriza principalmente por prurito palmo-plantar de predominio nocturno, su importancia radica en su considerable morbimortalidad fetal y aunque su tratamiento es sencillo, se debe diagnosticar. Objetivo: Realizar una revisión actualizada y a detalle de la bibliografía nacional e internacional de la etiología, las pruebas diagnósticas, tratamiento, resultados perinatales y su asociación con otras patologías del embarazo. Metodología: Se realizó una búsqueda de la literatura publicada en inglés y en español en bases de datos como PubMed / MEDLINE, Ovid, MD Consult, entre otras, utilizando las palabras clave: colestasis intrahepática del embarazo, etiología, diagnóstico, tratamiento, efectos adversos perinatales, preeclampsia, embarazo múltiple. De la información obtenida se seleccionaron 64 artículos, los cuales fueron clasificados y utilizados como soporte para realizar esta revisión. Resultados: Se aporta una actualización en cuanto al diagnóstico y tratamiento de esta enfermedad para actuar como guía clínica a los profesionales de la salud. Conclusión: Esta enfermedad es una entidad importante de diagnosticar para evitar los efectos adversos fetales que implica, la principal limitación es la carencia de determinación de niveles de ácidos biliares séricos en nuestro país, por lo tanto, la sospecha clínica se convierte en la herramienta más factible para su diagnóstico e inicio oportuno de tratamiento.

Abstract: Intrahepatic cholestasis of pregnancy is the most common specific liver disorder during pregnancy, it is a multifactorial condition that appears in genetically susceptible women and it is mainly characterized by palmoplantar itching predominantly at night. Its importance lies in the considerable fetal morbidity and mortality. Although the treatment is simple, we must know how to make the diagnosis. Objective: To carry out an updated and detailed review of the national and international bibliography of etiology, diagnostic tests, treatment, perinatal results, and their association with other pregnancy pathologies. Methodology: A search of the literature published in English and Spanish was conducted in databases such as PubMed / MEDLINE, Ovid, MD Consult, and others, using the keywords: intrahepatic cholestasis of pregnancy, etiology, diagnosis, treatment, perinatal adverse effects, preeclampsia, tween pregnancy. 64 articles were selected from the obtained, which were classified and used as support to carry out this review. Results: An update regarding the diagnosis and treatment of this disease is provided, to act as a clinical guide for healthcare professionals. Conclusion: This disease is an important entity to diagnose in order to avoid the fetal adverse effects that implies. The main limitation is the lack of determination of serum bile acid levels in our country, therefore, clinical suspicion becomes the most useful tool for diagnosis and early treatment.

Associations of Vitamin D Deficiency, Parathyroid hormone, Calcium, and Phosphorus with Perinatal Adverse Outcomes. A Prospective Cohort Study.

Vitamin D deficiency during pregnancy has been linked to perinatal adverse outcomes. Studies conducted to date have recommended assessing interactions with other vitamin D-related metabolites to clarify this subject. We aimed to evaluate the association of vitamin D deficiency during early pregnancy with preterm birth. Secondary outcomes included low birth weight and small for gestational age. Additionally, we explored the role that parathyroid hormone, calcium and phosphorus could play in the associations. We conducted a prospective cohort study comprising 289 pregnant women in a hospital in Granada, Spain. Participants were followed-up from weeks 10-12 of gestation to postpartum. Serum 25-hydroxyvitamin D, parathyroid hormone, calcium, and phosphorus were measured within the first week after recruitment. Pearson's χ2 test, Mann-Whitney U test, binary and multivariable logistic regression models were used to explore associations between variables and outcomes. 36.3% of the participants were vitamin D deficient (<20 ng/mL). 25-hydroxyvitamin D concentration was inversely correlated with parathyroid hormone (ρ = -0.146, p = 0.013). Preterm birth was associated with vitamin D deficiency in the multivariable model, being this association stronger amongst women with parathyroid hormone serum levels above the 80th percentile (adjusted odds ratio (aOR) = 6.587, 95% CI (2.049, 21.176), p = 0.002). Calcium and phosphorus were not associated with any studied outcome. Combined measurement of 25-hydroxyvitamin D and parathyroid hormone could be a better estimator of preterm birth than vitamin D in isolation.