Postpartum dyspareunia and sexual functioning: a prospective cohort study

Objectives: Sexual functioning is an important concern for women in the postpartum period. The aim of this research was to investigate the prevalence and determinants of dyspareunia and sexual dysfunction before and after childbirth.

Methods: Between November 2013 and April 2014, 109 women in their third trimester of pregnancy were enrolled in a prospective cohort study at Ghent University Hospital. Dyspareunia, sexual functioning and quality of life (QOL) were evaluated at enrolment and again 6 weeks and 6 months postpartum. Sexual functioning and QOL were assessed using validated self-report questionnaires: the Female Sexual Function Index and the Short Form-36 health survey. Dyspareunia was evaluated by a specific self-developed questionnaire.

Results: One hundred and nine women were enrolled; respectively, 71 (65.1%), 66 (60.6%) and 64 (58.7%) women returned the questionnaires prepartum, and 6 weeks and 6 months postpartum. Sexual functioning at 6 weeks was predictive of sexual functioning at 6 months postpartum (r_s?=?0.345, p?=?.015). The prevalence of dyspareunia in the third trimester of pregnancy, and 6 weeks and 6 months postpartum was, respectively, 32.8%, 51.0% and 40.7%. The severity of pain decreased significantly between 6 weeks and 6 months postpartum (p?=?.003). In the first 6 weeks postpartum, the degree of dyspareunia was significantly associated with breastfeeding (p?=?.045) and primiparity (p?=?.020). At 6 months, only the association with primiparity remained significant (p?=?.022).

Conclusions: The impaired postpartum sexual functioning, the high prevalence of dyspareunia postpartum and their impact on QOL indicate the need for further investigation and extensive counselling of pregnant women, especially primiparous women, about sexuality after childbirth.     

Retrievable inferior vena cava filter utilization in obstetric patients

Objectives: The objective of this study is to evaluate patterns of use and outcomes of retrievable inferior vena cava filters (rIVCF) in obstetric patients.

Methods: A single center review of consecutive patients who underwent rIVCF placement during pregnancy/postpartum in 2005–2016. A pooled analysis of the relevant cases in the English literature was conducted.

Results: The current cohort comprised 24 women, median age 27 [interquartile range 24–30] years. Among 10 filters placed during pregnancy, the most common indication (n?=?4) was the need to withhold anticoagulation therapy before delivery, in the presence of acute thrombosis. In the postpartum period, most filters (64%, 9/14) were an adjunct to catheter-directed thrombolytic therapy. Inferior vena cava filters (IVCF)-related complications occurred in seven (29.2%). Retrieval was attempted in 21 patients (87.5%), and was technically successful in 19 (90.5%), for an overall removal rate of 79.1%. Pooled analysis of the literature (n?=?98) showed comparable rates for filter removal and complications (81.6%, p?=?.78 and 24.2%, p?=?.60, respectively). Suprarenal placement (p?=?.12) and elective cesarean section (p?=?.19) did not reduce overall complication and retrieval rates. The estimated radiation dose among pregnant patients who underwent rIVCF placement without adjunct catheter directed thrombolysis (CDT) (mean 695?Gy cm²) was significantly lower than the radiation dose used in postpartum patients (1863?Gy cm²) or in pregnant patients in whom adjunct CDT was utilized (4059?Gy cm²) (p?=?.001 for both comparisons).

Conclusions: Frequent rIVCF-related complications, radiation exposure, and removal failure call for their cautious utilization in obstetric patients. The role of suprarenal placement and elective cesarean section to improve outcomes has yet to be established.     

Maternal and neonatal outcomes among scheduled versus unscheduled deliveries in women with prenatally diagnosed,pathologically proven placenta accreta

Objective: To evaluate maternal and neonatal outcomes among scheduled versus unscheduled deliveries in cases of prenatally diagnosed, pathologically proven placenta accreta.

Study design: Retrospective cohort of placenta accreta cases delivered in five University of California hospitals.

Results: Of 151 cases of histopathologically proven placenta accreta, 82% were prenatally diagnosed. Sixty-seven percent of women underwent scheduled deliveries and 33% were unscheduled. There were no differences in demographics between groups except a higher rate of antepartum bleeding in the unscheduled delivery group (81 versus 53%; p?=?.003). Scheduled deliveries were associated with a later gestational age at delivery (34.6 versus 32.6 weeks; p?=?.001), lower blood loss (2.0 versus 2.5?l; p?=?.04), higher birth weight (2488 versus 2010?g; p?p?=?.03) and neonatal length of stay (12 versus 20 d; p?=?.005).

Conclusion: Despite a prenatal diagnosis of placenta accreta, 1/3 of these cases require unscheduled delivery, portending poorer maternal and neonatal outcomes.     

Manual removal versus spontaneous delivery of the placenta at cesarean section in developing countries: a randomized controlled trial and review of literature

Purpose: Cesarean section (CS) rates have increased; this is especially concerning in developing countries. The mode of placental delivery contributes to morbidity associated with CS and determines blood loss during CS. We aimed to compare manual removal versus spontaneous delivery of the placenta at CS.

Methods: In a randomized controlled trial, 574 women admitted for primary or repeat elective CS were randomized into two groups. In group A, the placenta was manually removed, whereas in group B, the placenta was left for spontaneous delivery. Blood loss, operative and postoperative data were recorded.

Results: Blood loss was 875.2?±?524.2?ml in group A versus 731.8?±?426.7?ml in group B (p?=?.001), with a significant drop in postoperative HB (p?=?.015) and HCT (p?=?.031). In group A, odds ratios for blood loss (>1000?ml), HB drop (>?4g/dl), postpartum hemorrhage and blood transfusion were 2.581, 2.850, 2.614 and 1.665, respectively. However, the total operative time (p?=?.326), duration of hospital stay (p?=?.916) and intensive care unit (ICU) admission (p?=?.453) were not statistically different between the two groups.

Conclusions: Manual removal of the placenta at CS is associated with a higher risk of blood loss, postpartum hemorrhage and blood transfusion, with no decrease in operative time.     

Patient satisfaction and cosmetic outcome in a randomized study of cesarean skin closure

Objective: To evaluate patient satisfaction and patient and physician assessment of scar appearance after cesarean skin closure with suture versus staples.

Methods: Women undergoing cesarean delivery (CD) at ≥23 weeks’ gestation via low-transverse skin incisions at three hospitals in the CROSS Consortium were randomized to receive skin closure using subcuticular absorbable suture or nonabsorbable metal staples. The primary outcome of this substudy, patient satisfaction, was assessed by surveys at the postpartum visit using a 10-point Likert scale. Scar outcomes according to patients and trained observers were assessed at the primary research site using the Patient and Observer Scar Assessment Scale (POSAS). The POSAS is comprised of a patient-completed assessment including subjective data such as pain and itchiness, and an observer-completed assessment about cosmetic criteria.

Results: Between June 2010 and August 2012, 746 women were randomized; 370 received suture and 376 received staples. Satisfaction data were available for 606 (81%). Complete patient scar assessment data were available for 577 (77%) and complete observer scar assessment data were available for 275 (57% of the 480 planned for evaluation at the primary research site). Demographic data for women in the two groups were similar. Satisfaction with the closure method was higher (superior) among women who received suture closure: median 10 (interquartile range 9, 10) versus 9 (interquartile ranges (IQR) 6, 10); p?p?=?.02. Receiving one’s preferred closure method was associated with higher patient satisfaction, and wound complications were associated with lower satisfaction. POSAS scores were superior (lower) in the suture group. Patient Scar Assessment Scale scores were median 15 (IQR 10, 25) for sutures versus 20 (IQR 11, 28) for staples; p?p?=?.01.

Conclusions: Satisfaction with the closure method, satisfaction with the scar’s appearance, and patient and physician assessments of scar cosmesis were all superior in those closed with suture. These results further support the use of sutures for cesarean skin closure.

Trial registration: ClinicalTrials.gov identifier: NCT01211600.     

Birth setting,labour experience,and postpartum psychological distress

Objectivealthough psychosocial risk factors have been identified for postpartum depression (PPD) and perinatal posttraumatic stress disorder (PTSD), the role of labour- and birth-related factors remains unclear. The present investigation explored the impact of birth setting, subjective childbirth experience, and their interplay, on PPD and postpartum PTSD.Methodin this prospective longitudinal cohort study, three groups of women who had vaginal births at a tertiary care hospital, a birthing center, and those transferred from the birthing centre to the tertiary care hospital were compared. Participants were followed twice during pregnancy (12–14 and 32–34 weeks gestation) and twice after childbirth (1–3 and 7–9 weeks postpartum).Resultssymptoms of PPD and PTSD did not significantly differ between birth groups; however, measures of subjective childbirth experience and obstetric factors did. Moderation analyses indicated a significant interaction between pain and birth group, such that higher ratings of pain among women who were transferred was associated with greater symptoms of postpartum PTSD.Conclusion and implications for practicewomen who are transferred appear to have a unique experience that may put them at greater risk for postpartum psychological distress. It may be beneficial for care providers to help prepare women for pain management and potential unexpected complications, particularly if it is their first childbirth.     

Maternal mental health in the first 3-week postpartum: the impact of caregiver support and the subjective experience of childbirth – a longitudinal path model

Objective: Acute stress reactions (ASR) and postpartum depressive symptoms (PDS) are frequent after childbirth. The present study addresses the change and overlap of ASR and PDS from the 1- to 3-week postpartum and examines the interplay of caregiver support and subjective birth experience with regard to the development of ASR/PDS within a longitudinal path model. Method: A total of 219 mothers completed questionnaires about caregiver support and subjective birth experience (Salmon’s Item List) at 48–6-h postpartum. ASR and PDS were measured for 1- and 3-week postpartum. The Impact of Event Scale (IES) was used to assess ASR, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PDS. Results: ASR was frequent 1-week postpartum (44.7%) and declined till week 3 (24.8%, p <.001), while the prevalence of PDS was continuous (14.2% week 1; 12.6% week 3; p = .380). Favorable reports of caregiver support were related to better subjective childbirth experience, which was related to lower ASR and PDS (controlled for age, mode of delivery, parity, EDA and duration of childbirth). Conclusion: High quality of intrapartum care and positive birth experiences facilitate psychological adjustment in the first 3-week postpartum.     

The association of second trimester biomarkers in amniotic fluid and fetal outcome

Objective: To identify the level of amniotic fluid lactate (AFL), placental growth factor (PLGF), and vascular endothelial growth factor (VEGF) at second trimester amniocentesis, and to compare levels in normal pregnancies with pregnancies ending in a miscarriage, an intrauterine growth restricted fetus (IUGR) or decreased fetal movements.

Study design: A prospective cohort study. Amniotic fluid was consecutively collected at amniocentesis in 106 pregnancies. Fetal wellbeing at delivery was evaluated from medical files and compared with the levels of AFL, VEGF, and PLGF at the time of amniocentesis.

Results: The median level of AFL was 6.9?mmol/l, VEGF 0.088?pg/ml, and PLGF 0.208?pg/ml. The median levels of AFL in pregnancies ended in miscarriage were significantly higher (10.7?mmol/l) compared to those with a live new-born (6.9?mmol/L, p?=?.02). The levels of VEGF (p?=?.2) and PLGF (p?=?.7) were not affected. In pregnancies with an IUGR, the median level of AFL was higher compared to those with normal fetal growth (p?=?.003). No differences VEGF (p?=?.5), but significant lower PLGF were found in IUGR pregnancies (p?=?.03).

Conclusions: Pregnancies ending in a miscarriage or with IUGR had significantly higher median values of AFL but lower values of PLGF in the amniotic fluid at the time of second trimester amniocentesis compared to normal pregnancies.     

Targeted delivery at 34 versus 35 weeks in women with preterm prelabor rupture of membranes

Objective: To compare planned delivery at 34 versus 35 weeks for women with preterm prelabor rupture of membranes (PPROM).

Materials and methods: We performed a retrospective cohort study of singleton pregnancies with PPROM after 24 weeks delivered from 2006 to 2014. In 2009, an institutional practice change established 35 weeks as the target gestational age before induction of labor was initiated after PPROM. Demographic and outcome measures were compared for two cohorts: women delivered 2006–2008 – target 34 weeks (T34) and women delivered 2009–2014 – target 35 weeks (T35). The primary outcome was neonatal intensive care unit (NICU) admission.

Results: Of the 382 women with PPROM, 153 (40%) comprized the T34 cohort and 229 (60%) comprized the T35 cohort. Demographic characteristics were similar between groups. There were no differences between groups in gestational age at PPROM (31.0?±?3.3 weeks versus 31.2?±?3.1 weeks; p?=?.50) or maternal complications. The mean gestational age at delivery was earlier in the T34 group (31.8?±?3.2 weeks versus 32.4?±?2.7 weeks; p?=?.04). The median predelivery maternal length of stay (LOS) was 1?day longer in the T35 group (p?=?.03); the total and postpartum LOS were similar between groups (p?>?.05). There were no differences in the rate of NICU admission (T34 89.5% versus T35 92.1%; p?=?.38) or median neonatal LOS (T34 14 days versus T35 17 days; p?=?.15). In those patients who reached their target gestational age, both maternal predelivery LOS and total LOS were longer in the T35 group (p?>?.05). The frequency of NICU admission in those reaching their target gestational age was similar between groups (T34 83.37% versus T35 76.19%; p?=?.46).

Conclusions: A 35-week target for delivery timing for women with PPROM does not decrease NICU admissions or neonatal LOS. This institutional change increased maternal predelivery LOS, but did not increase maternal or neonatal complications.     

Investigation of possible maternal and fetal factors which affect umbilical coiling index

Aim: The aim of this study was to investigate the possible maternal and fetal factors, which affect the Umbilical Coiling Index (UCI).

Methods: This prospective, observational, analytic study was conducted using the data of 380 women with term pregnancy and newborns who presented at a University Hospital. Hemoglobin (Hb), ferritin, iron, and the total iron binding capacity (TIBC) of the maternal blood were measured, and transferrin saturation was estimated based on the ratio between serum iron and TIBC. Blood gases, ferritin, iron, and TIBC of the umbilical cord were also measured, and the transferrin saturation was calculated. The length and thickness of the umbilical cord, numbers of coilings, weight of placenta, neonatal weight were registered. The UCI was calculated dividing the total number of coils by the length of the umbilical cord (in cm).

Results: A positive, linear, and statistically significant relationship was found between the UCI scores and the umbilical cord blood transferrin saturation, umbilical cord thickness, and the first- and fifth-min APGAR scores (p?=?.044, p?p?=?.008, p?=?.022, respectively). No statistically significant relationship was found between the maternal Hb values and the UCI scores (p?=?.472). In addition, there was no statistically significant relationship between the UCI scores and maternal ferritin, maternal transferrin saturation and umbilical cordon ferritin levels (p?=?.940, p?=?.681, and p?=?.975, respectively).

Conclusions: A positive correlation was found between the UCI and umbilical cord transferrin saturation and between the newborn APGAR scores. However, this finding is not sufficient to explain the relationship of the umbilical cord dynamics with the newborn wellbeing and coiling.     

Endomyometritis after cesarean delivery in the era of antibiotic prophylaxis: incidence and risk factors

Purpose: To identify the rate of postpartum endomyometritis (PPE) after cesarean delivery (CD) in the era of antibiotic prophylaxis and determine risk factors.

Methods: A single institution retrospective study was performed in women undergoing CD. Data regarding obstetrical and surgical variables were collected. Diagnosis of PPE was made clinically.

Results: Among 2419 patients, the rate of PPE was 1.6% (n?=?38) and was associated with lower age (27.0 versus 31.0; p?p?p?=?.0081). There was no difference in PPE for cefazolin 2?g versus 1?g (OR: 1.91; p?=?.17) or 3?g versus 1?g (OR: 3.69; p?=?.29), gentamicin/clindamycin versus cefazolin (OR: 5.60; p?p?=?.001), sexually transmitted infection during the pregnancy (OR: 4.197; p?=?.02) or blood transfusion (OR: 9.50; p?Conclusions: While the overall rate of PPE was low, several risk factors were identified. Preoperative diagnosis of chorioamnionitits is associated with a higher rate of PPE. Further studies are needed to identify optimal regimens for antimicrobial prophylaxis in women undergoing CD.     

Psychological factors influencing choice of prenatal diagnosis in Chinese multiparous women with advanced maternal age

Objectives: To investigate the psychological predictors in Chinese multiparous pregnant women of advanced maternal age (AMA) for choosing aneuploidy screening or diagnostic testing.

Methods: A total of 84 pregnant women of AMA were consecutively enrolled from Renming Hospital, Wuhan University. All participants completed three questionnaires: Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), and Pregnancy Stress Rating Scale (PSRS). Demographic information and the choice of noninvasive prenatal testing (NIPT) versus invasive prenatal diagnosis (PND) were also collected.

Results: Thirty-seven chose to have invasive PND, and 47 chose NIPT. Choosing invasive PND, as opposed to NIPT, was associated with lower educational background (χ²?=??2.269, p?=?.023), higher SAS scores (47.62?±?7.96 versus 44.21?±?6.10, p?=?.029), and higher SDS scores (50.41?±?9.80 versus 45.96?±?11.05, p?=?.058). Logistic regression analysis further showed that the decisive predictors for invasive PND are SAS (OR =1.106, p?=?.008) scores, scores of factor 3 in PSRS and the stress from changes of shape and motility (OR =0.471, p?=?.038). Subgroup analysis showed that women with previous negative pregnancy experience had higher scores in factor 2-stress (guarantee of maternal-fetal safety: 1.96?±?0.63 versus 2.49?±?0.65, p?=?.004) and total PSRS scores (1.60?±?0.4 versus 1.83?±?0.31, p?=?.044) than those without. Additionally, unemployment post pregnancy was associated with marginally significant higher PSRS scores (p?=?.083).

Conclusions: The decision for invasive PND might be swayed by anxiety and attenuated by pregnancy stress originating from worry about changes in fetal shape and motility (measured by SAS and factor 3 score of PSRS, respectively).     

Meconium aspiration syndrome: risk factors and predictors of severity

Purpose: To identify risk factors and predictors of severity associated with meconium aspiration syndrome (MAS) in the patients admitted to the neonatal intensive care unit (NICU).

Materials and methods: Retrospective study including newborns admitted, between 2005 and 2015, with a diagnosis of MAS.

Results: Of the newborns admitted to the NICU, 0.66% were diagnosed with MAS. These had higher prevalence of caesarean delivery (p?p?p?=?.002), Apgar scores at the first minute <7 (p?p?p?=?.001) and 73.3% had pulmonary hypertension (p?=?.027). They required significantly more days of oxygen therapy, mechanical ventilation, nitric oxide, inotropic, and surfactant therapy, as well as longer hospital stay.

Conclusions: Nonreassuring or abnormal CTG and low Apgar score at the first minute were established as risk factors for MAS and need of surfactant therapy as a predictor of severity.     

Embryo transfer is a risk factor for severe postpartum hemorrhage and blood transfusion requirement

Purpose: This study aimed to investigate the risk factors for severe postpartum hemorrhage (PPH) and blood transfusion requirement that are recognizable during any period of pregnancy.

Materials and methods: We retrospectively reviewed the medical data of 4829 pregnant women who received care and delivered at our institution between July 2010 and March 2015. The cohort was divided into patients with and without severe PPH. Multivariate logistic regression analysis was performed to assess risk factors associated with severe PPH. The same analysis was repeated for blood transfusion requirement.

Results: A total of 127 (2.7%) patients had severe PPH and 43 (0.87%) required blood transfusion. The multivariate logistic regression analysis demonstrated that embryo transfer (odds ratio [OR] 2.6; p?p?p?=?.03), prior cesarean section (OR 1.8; p?=?.01), and maternal age (OR 1.5; p?=?.03) were independent risk factors for severe PPH. Embryo transfer was an independent risk factor for blood transfusion requirement (OR 3.1, p?Conclusions: Embryo transfer is a risk factor for both severe postpartum hemorrhage and blood transfusion requirement.     

Recent status of pregnant women with mental disorders at a Japanese perinatal center

Introduction: Recently, we have been providing comprehensive treatment for pregnant women with mental disorders involving specialists from multiple fields in cooperation with local administrative agencies. In this study, we examined the outcomes of treatment for women with perinatal mental disorders in our institute to evaluate the effect of our recent approach to improve perinatal mental health.

Methods: We retrospectively compared the outcomes between pregnant women with mental disorders who delivered from April 2015 to March 2017 with those from April 2009 to March 2011. We examined the following: presence or absence of necessity of medication, self-interruption of medication, deterioration/relapse of mental disorders, and administrative support.

Results: There was no significant difference in the rate of pregnant women with mental disorders between the two periods (3.2 versus 3.2%, respectively, p?=?.94). The rates of patients requiring medication and those with self-interruption of medication did not reach significance (p?=?.90 and .19, respectively) between the two periods; however, the rate of patients with deterioration/relapse of mental disorders decreased significantly during pregnancy and postpartum (20.3 versus 10.7 and 7.3 versus 1.7%, p?=?.04 and .03, respectively). On the other hand, the patients receiving administrative supports increased significantly over the total study period (p?Conclusions: It was suggested that our recent active management of pregnant women with mental disorders might have contributed to prevent the deterioration/relapse of mental disorders during pregnancy and postpartum.     

The impact of maternal epilepsy on perinatal outcome in singleton gestations

Objective: We sought to evaluate perinatal outcomes in women with epilepsy.

Methods: We performed a retrospective cohort study between 2007 and 2014, at a tertiary, university-affiliated medical center. All women with singleton gestation who delivered during the study period were included, except for pregnancies in which fetuses with chromosomal or structural anomalies were diagnosed. Perinatal outcome was compared between two groups: women diagnosed with epilepsy and women without epilepsy.

Results: Out of 62,102 deliveries during the study period, 61,455 met the inclusion criteria, of whom 206 (0.3%) had epilepsy. The only difference found in maternal demographics was higher rate of nulliparity in the epilepsy group (p?=?.02). As for maternal adverse outcome, higher rates of placental abruption and longer postpartum admission were found in women with epilepsy (p?=?.02 and p?p?p?=?.02), neonatal intensive care unit (NICU) admissions (OR 1.84, 95%CI 1.25–2.70, p?=?.002), seizures (OR 4.33, 95%CI 1.60–11.77, p?=?.004), transient tachypnea of the newborn (OR 2.47, 95%CI 1.005–6.05, p?=?.049) and respiratory distress syndrome (OR 7.16, 95%CI 2.47–20.76, p?Conclusions: Epilepsy in pregnant women is associated with adverse perinatal outcomes, including neonatal seizures, placental abruption and respiratory problems.     

A qualitative analysis of the process,mediating variables and impact of traumatic childbirth

Abstract

The processes occurring during traumatic childbirth experiences, factors mediating development of PTSD symptoms and the impact on post-partum adaptation were explored in a cohort of 20 women 10 months post childbirth. Pain, past experiences and beliefs that their baby would be harmed led to feeling out of control which was maintained by failed attempts to elicit practical and emotional support from staff and partners. Following childbirth, coping strategies relating to successfully accessing more than one source of social support, positive reinterpretation of traumatic events and making time for own interests were associated with reduced distress. Avoidance of thinking about events and a belief that one should not admit to not coping maintained distress. Consequences of continued distress related to an impact on self, relationships with others and fear of future childbirth. The Revised Impact of Event Scale (Horowitz et al., 1979) was used as a measure of PTSD symptoms. Six women reported scores above the cut-off point indicating clinically significant scores and two women had borderline scores. The present findings therefore support the evidence from the PTSD and childbirth literature that some women do report clinically significant levels of PTSD symptoms following childbirth.     

Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy: magnetic resonance imaging findings and neurological outcomes in a Brazilian cohort

Objective: To determine the neurodevelopment outcomes after therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (HIE) and identify the neonatal magnetic resonance imaging (MRI) findings associated with neurological outcome in a middle-income country.

Study design: All infants born after 35 completed weeks’ gestation with signs of moderate to severe encephalopathy and evidence of perinatal asphyxia before 6?hours of life were submitted to whole-body hypothermia and were imaged at 18?±?8.4 days of life (range 7–33 days) after birth. Surviving infants had the neurodevelopment outcome assessed at 12 to 18 months of age by trained professional masked to MRI findings.

Results: Forty-eight infants included, MRI scans were obtained from 34 infants; 14 (29.1%) patients died during hospitalization before MRI was performed. Nine (64.3%) of 14 patients were classified as severe encephalopathy presented Posterior Limb Internal Capsule (PLIC) sign at the MRI, 10 (71.4%) thalamus and basal ganglia (TBG) lesion, 9 (64.3%) white matter (WM) lesion, and 7 (50.0%) cortical lesion. Severe encephalopathy was associated with the motor delay at 12–18 months by Bayley III, Alberta Infant Motor Scale (AIMS), and Gross Motor Function Classification System (GMFCS) scores (p?=?.020, p?=?.048, p?=?.033, respectively), but not for the cognitive (p?=?.167) or language skills (p?=?.309). Lower BSID-III motor, cognitive, and language composite scores were associated with PLIC sign (p?=?.047; p?=?.006 and p?=?.003, respectively). TBG lesion (p?=?.051) and cortical lesion (p?=?.030) were associated with lower language composite score. Motor delay by AIMS and the presence of PLIC sign, TBG lesion, WM lesion, and Cortical lesion on MRI were observed (p?p?=?.002; p?=?.001 and p?=?.027, respectively); as well as higher GMFCS score were associated with the presence of PLIC sign, TBG lesion, WM lesion, and Cortical lesion on MRI (p?p?=?.001; p?=?.001, and p?=?.011, respectively).

Conclusions: Brain MRI in neonates with HIE after therapeutic hypothermia is a valuable tool for diagnosis of encephalopathy cerebral abnormalities and is an early predictor of outcome in infants treated with whole body hypothermia for HIE in the Brazilian experience.     

High transverse skin incisions may reduce wound complications in obese women having cesarean sections: a pilot study

Objective: Women having cesarean section have a high risk of wound complications. Our objective was to determine whether high transverse skin incisions are associated with a reduced risk of cesarean wound complications in women with BMI greater than 40.

Methods: A retrospective cohort study was undertaken of parturients ages 18–45 with BMI greater than 40 having high transverse skin incisions from January 2010 to April 2015 at a tertiary maternity hospital. Temporally matched controls had low transverse skin incisions along with a BMI greater than 40. The primary outcome, wound complication, was defined as any seroma, hematoma, dehiscence, or infection requiring opening and evacuating/debriding the wound. Secondary outcomes included rates of endometritis, number of hospital days, NICU admission, Apgar scores, birth weight, and gestational age at delivery. Analysis of outcomes was performed using two-sample t-test or Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables.

Results: Thirty-two women had high transverse incisions and were temporally matched with 96 controls (low transverse incisions). The mean BMI was 49 for both groups. There was a trend toward reduced wound complications in those having high transverse skin incisions, but this did not reach statistical significance (15.63% versus 27.08%, p?=?.2379). Those having high transverse skin incisions had lower five minute median Apgar scores (8.0 versus 9.0, p?=?.0021), but no difference in umbilical artery pH values. The high transverse group also had increased NICU admissions (28.13% versus 5.21%, p?=?.0011), and early gestational age at delivery (36.8 versus 38.0, p?=?.0272).

Conclusion: High transverse skin incisions may reduce the risk of wound complications in parturients with obesity. A study with more power should be considered.     

The influence of massage on neonatal hyperbilirubinemia: a meta-analysis of randomized controlled trials

Introduction: The efficacy of massage to treat neonatal hyperbilirubinemia remains controversial. We conducted a systematic review and meta-analysis to explore the influence of massage on the neonatal hyperbilirubinemia.

Methods: We search PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through November 2017 for randomized controlled trials (RCTs) assessing the effect of massage on neonatal hyperbilirubinemia. This meta-analysis is performed using the random-effect model.

Results: Six RCTs involving 357 patients are included in the meta-analysis. Overall, compared with the control group in neonatal hyperbilirubinemia, massage therapy is associated with substantially reduced serum bilirubin level within 4?d (mean difference (MD)?=??2.31; 95% CI?=??2.92 to ?1.70; p?p?p?=?.23), transcutaneous bilirubin level on 2?d (MD?=??0.17; 95% CI?=??1.34 to 1.00; p?=?.77), frequency of defecation daily on 2?d (MD?=?0.57; 95% CI?=??0.03 to 1.16; p?=?.06), and frequency of defecation daily within 4?d (MD?=?0.83; 95% CI?=??0.11 to 1.76; p?=?.08).

Conclusions: Massage therapy can significantly reduce serum bilirubin level and transcutaneous bilirubin level within 4?d, but demonstrates no influence on serum bilirubin level and transcutaneous bilirubin level on 2?d, frequency of defecation daily on 2 and 4?d for neonatal hyperbilirubinemia.