The effect of gestational age on trial of labor after Cesarean section.

OBJECTIVES: To evaluate the effect of gestational age on the rate of successful vaginal delivery and the rate of uterine rupture in patients undergoing a trial of labor (TOL) after a prior Cesarean delivery. STUDY DESIGN: This was a cohort study including patients with a live singleton fetus undergoing a TOL after a previous low transverse Cesarean delivery between 1988 and 2002. Patients were divided into three groups according to gestational age: 24-36 weeks 6 days, 37-40 weeks 6 days and > or = 41 weeks. Obstetric outcomes, including the rates of successful vaginal delivery and symptomatic uterine rupture, were compared between the groups. Multivariate logistic regression analysis was performed to adjust for potential confounding factors. RESULTS: There were 253, 1911 and 329 patients in each group, respectively. In patients with advanced gestational age (> or = 41 weeks) the rate of uterine rupture was significantly higher (0% vs. 1.0% vs. 2.7%, p = 0.006) and the rate of successful vaginal deliveries was significantly lower (83% vs. 76.9% vs. 62.6%, p < 0.001). After adjusting for confounding variables, advanced gestational age was associated with a lower rate of successful vaginal delivery (odds ratio 0.68, 95% CI 0.51-0.89), and a higher rate of uterine rupture (odds ratio 2.85, 95% CI 1.27-6.42) when compared to 37-40 weeks 6 days. CONCLUSION: Advanced gestational age is associated with higher rates of failed TOL and uterine rupture.     

The cost of prematurity: quantification by gestational age and birth weight

OBJECTIVE: To determine gestational age- and birth weight-related pregnancy outcomes and resource use associated with prematurity in surviving neonates. METHODS: A data set linking birth certificates with maternal and newborn hospital discharge records from hospitals in California (from January 1, 1996, to December 31, 1996) was examined for all singleton deliveries by gestational age (weekly, from 25 to 38 weeks) and birth weight (by 250-g increments from 500 to 3000 or more g). Records were examined for respiratory distress syndrome (RDS), use of mechanical ventilation, length of hospital stay in days, and hospital costs. RESULTS: As expected, RDS, ventilation, length of hospital stay, and costs per case decreased exponentially with increasing gestational age and birth weight. Specifically, neonatal hospital costs averaged 202,700 dollars for a delivery at 25 weeks, decreasing to 2600 dollars for a 36-week newborn and 1100 dollars for a 38-week newborn. Neonatal costs were 224,400 dollars for a newborn at 500-700 g, decreasing to 4300 dollars for a newborn at 2250-2500 g and 1000 dollars for a birth weight greater than 3000 g. For each gestational age group from 25 to 36 weeks, total neonatal costs were similar, despite increasing case numbers with advancing gestational age. Neonatal RDS and need for ventilation were significant at 7.4% and 6.3%, respectively, at 34 weeks' gestation. Significant "excess" costs were found for births between 34 and 37 weeks' gestational age when compared with births at 38 weeks. CONCLUSION: Prematurity, whether examined by gestational age or birth weight, is associated with significant neonatal hospital costs, all of which decrease exponentially with advancing gestational age. Because total costs for each gestational age group from 25 to 36 weeks were roughly the same (38,000,000 dollars), opportunity for intervention to prevent preterm delivery and decrease costs is potentially available at all preterm gestational ages.     

Impact of labor induction,gestational age,and maternal age on cesarean delivery rates

OBJECTIVE: To quantify the impact of labor induction and maternal age on cesarean delivery rates in nulliparous and multiparous women between 36 and 42 weeks' gestation. METHODS: We performed a retrospective cohort study on 14,409 women delivering at two teaching hospitals in metropolitan Boston during 1998 and 1999. Women who had contraindications to labor, including a prior cesarean delivery, were excluded. The risks for cesarean delivery by induction status, gestational age by completed week between 36 and 42 weeks, maternal age <35, 35-39, and >/=40 years, and stratified by parity, were calculated by logistic regression. RESULTS: In nulliparas, labor induction was associated with an increase in cesarean delivery from 13.7% to 24.7% (adjusted odds ratio [OR] 1.70; 95% confidence interval [CI] 1.48, 1.95]). In multiparas, induction was associated with an increase from 2.4% to 4.5% (OR 1.49; 95% CI 1.10, 2.00). Other variables that placed a nulliparous woman at increased risk for cesarean delivery included maternal age of at least 35 years and gestational ages over 40 weeks. For multiparas, only maternal age 40 years or older and gestational age of 41 weeks were associated with an increase in cesarean deliveries. CONCLUSION: Induction of labor, older maternal age, and gestational age over 40 weeks each independently increase the risk for cesarean delivery in both nulliparous and multiparous women. Although the relative risk from induction is similar in nulliparas and multiparas, the absolute magnitude of the increase is much greater in nulliparas (11% versus 2.1%).     

The influence of maternal age on pregnancy outcome in nulliparous women with twin gestation

We sought to determine if outcomes of nulliparous twin pregnancies differ based on maternal age. Nulliparous women with current twin pregnancies were identified from a database of women enrolled for outpatient nursing surveillance. Data were stratified into four groups by maternal age: less than 20, 20 to 34, 35 to 39, and greater than or equal to 40 years. Maternal and neonatal outcomes for women less than 20, 35 to 39, and 40 or more were compared with 20- to 34-year-old controls using Kruskal-Wallis, Mann-Whitney, and Pearson chi-square analyses. We analyzed 2144 nulliparous twin pregnancies. Patients ≥35 years (34 to 39, 78.5% or ≥40, 85.9%) were more likely to have cesarean deliveries compared with controls 20 to 34 years old (71.2%). Women aged 35 to 39 were less likely to deliver at <37 weeks, and women in the ≥40 group were less likely to deliver at <35 weeks due to spontaneous preterm labor compared with the controls. Neonates born to women aged 35 to 39 had a greater gestational age at delivery and larger average birth weight than controls. Maternal and neonatal outcomes were not adversely influenced by advanced maternal age in nulliparous women carrying twin gestations.     

Heterogeneity of perinatal outcomes in the preterm delivery syndrome

OBJECTIVE: Our aim was to document the differential neonatal morbidity and intrapartum and neonatal mortality of subgroups of preterm delivery. METHODS: This analysis included 38,319 singleton pregnancies, of which 3,304 (8.6%) were preterm deliveries (less than 37 completed weeks) enrolled in the World Health Organization randomized trial of a new antenatal care model. We classified them as preterm deliveries after spontaneous initiation of labor, either with or without maternal obstetric and medical complications; preterm deliveries after prelabor spontaneous rupture of amniotic membranes (PROM), either with or without obstetric and medical complications; and medically indicated preterm deliveries with maternal obstetric and medical complications. Severe neonatal morbidity and neonatal mortality were the primary outcomes. RESULTS: Fifty-six percent of all preterm deliveries were spontaneous, without maternal complications. Small for gestational age was increased only among the medically indicated preterm delivery group (22.3%). Very early preterm delivery (less than 32 weeks of gestation) was highest among PROM with complications (37%). For intrapartum fetal death and neonatal death, after adjusting by gestational age and other confounding variables, we found that the obstetric and medical complications preceding preterm delivery predicted the different risk levels. Conversely, for severe neonatal morbidity the clinical presentation, ie, PROM or medically indicated, predicted the increased risk. CONCLUSION: There are differential neonatal outcomes among preterm deliveries according to clinical presentation, pregnancy complications, gestational age at delivery, and its association with small for gestational age. This syndromic nature of the condition should be considered if preterm delivery is to be fully understood and thus reduced.     

Outcomes of term vaginal breech delivery

In December 2001, the American College of Obstetricians and Gynecologists revised their recommendations for breech delivery. These recommendations acknowledge that although a planned vaginal delivery may no longer be appropriate, there are instances in which vaginal breech delivery is inevitable. Moreover, there continues to be patients who for any number of reasons will choose vaginal over cesarean delivery when faced with a fetus in the breech presentation. We sought to review maternal and fetal outcomes in such circumstances when vaginal breech delivery occurs, and compare these outcomes to elective cesarean deliveries for breech presentation. We performed a retrospective review of all singleton breech deliveries at our county hospital from January 2002 through June 2003. We reviewed maternal age, ethnicity, gestational age, gravity, parity, birthweight, mode of delivery, Apgar scores, umbilical arterial blood gases, and maternal and infant complications of both cesarean deliveries and vaginal breech deliveries. Univariate and logistic regression statistical analyses were performed with NCSS software. We had a total of 150 term breech deliveries with gestational ages between 37 and 42 weeks. Of these, 41 were vaginal breech and 109 were cesarean deliveries. Greater than 95% of patients are of Hispanic origin. There were no statistically significant differences in maternal age, ethnicity, gravity, or gestational age. Mean birthweight was significantly lower and parity was significantly higher in the vaginal delivery group. There was also a higher proportion of patients who underwent labor induction/augmentation in the vaginal group. We found no differences in the outcomes of 5-minute Apgar scores, umbilical arterial blood gas values, neonatal intensive care unit admissions, deaths or maternal/fetal complications reported between the two groups. Mean umbilical arterial blood gas values were greater than 7.18 in both groups. Vaginal breech delivery cannot always be avoided. Moreover, at our county hospital several patients continue to choose vaginal breech delivery. Our data would suggest that vaginal breech delivery remains a viable option in selected patients.     

Perinatal outcomes of spontaneous twins compared with twins conceived through intracytoplasmic sperm injection

OBJECTIVE: To compare perinatal outcomes in spontaneous twins compared with those conceived by intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective case-control study. PATIENTS: Cases consisted of 274 intracytoplasmic sperm injection twins, controls were 348 naturally conceived twins delivered between 1999 and 2003 in a tertiary hospital. MAIN OUTCOME MEASURES: Birth weight, gestational age at birth, cesarean delivery rate, perinatal mortality and morbidity, congenital anomalies, gestational diabetes and pregnancy induced hypertension. RESULTS: Preterm deliveries (76.6% vs. 64.1% <37 weeks and 19.7% vs. 13.2% <32 weeks) and low birth weight (73% vs. 60.3% <2500 g and 19.7% vs. 12.6% <1500 g) were significantly higher in the ICSI group compared with controls. Gestational diabetes mellitus (8% vs. 2.9%) and cesarean deliveries (95.2% vs. 77.6%) were more common in cases compared with the control group. There was a significantly higher rate of perinatal morbidity (16.4% vs. 7.8%) and mortality (8% vs. 2.6%) in ICSI twins. The incidence of congenital malformations diagnosed at birth was higher in cases (4.4%) compared with controls (0.9%) but the difference was not significant when adjusted for maternal age. CONCLUSION: Perinatal outcomes of twins after ICSI treatment are less optimal than naturally conceived twins.     

Schwangerschaft am Termin

In Germany 75% of the total perinatal mortality is caused by antenatal fetal deaths and 40% of stillbirths occur at or later than 38 weeks of gestation. The rate of stillbirths increases 3 to 4-fold between 37 and 42 weeks of gestation relative to ongoing pregnancies. Mothers with advanced maternal age and primiparae are at higher risk of stillbirth. Neonatal complications show a continuous increase between 37 and 42 weeks of gestation. Pregnancy beyond 40 weeks is associated with significant risks to the pregnant women such as increased rate of cesarean delivery, operative vaginal delivery, postpartum hemorrhage, endomyometritis and birth injuries. At a gestational age of 41 weeks and accurate pregnancy dating, induction of labor is recommended without causing an increase in the frequency of cesarean deliveries. If additional risks for placental insufficiency are present, delivery from 37 weeks onwards might improve maternal and fetal outcome.     

Perinatal outcome of teenage pregnancies in a selected group of patients

STUDY OBJECTIVE: To explore the effect of young age on the outcome of teenage pregnancies by studying teenage deliveries in our unique population. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review of teenage gravidas (age 19 and younger), who had delivered in our hospital. OUTCOME MEASURES: Mode of delivery, gestational age at delivery, newborn's weight and Apgar scores and maternal and neonatal complications. RESULTS: We recruited 565 teenage delivery cases from the hospital's computerized database. Mean maternal age was 18 (14-19). Most (96%) were married. Fifty-one percent were Jewish and 44% were Muslim. Most of the girls were nulligravidas. Mean gestational age at delivery was 39 weeks (33-44 weeks). A normal vaginal delivery ensued in 72.7%, while 9% had a cesarean section and 17.4% instrumental deliveries (compared to 85.75%, 10% and 4.25% in our adult population, respectively) and 1% underwent vaginal breech delivery. Mean birth weight was 3108 g (1450-4980 g). Apgar score of 9 at 5 minutes was recorded in 97.8% of the newborns. Prenatal care included a mean of 6 prenatal visits with a range of 1-18. The main complication was anemia; 41% had hemoglobin levels of less than 11 g/dL. The rate of other complications was low. CONCLUSIONS: In our homogenous group of teenagers, there was a similar complication rate as in the adult population. The only significant complication was anemia (less than 11 g/dL). There was a higher rate of instrumental deliveries and the cesarean delivery rate was slightly lower than in our adult population. Teenage pregnancy should not be considered as a high-risk situation as long as it is planned and followed with the normal routines of prenatal care.     

辅助生殖技术单胎妊娠结局分析

目的:研究辅助生殖技术(ART)与自然受孕两种不同受孕方式单胎妊娠的妊娠结局。方法:回顾分析2009年1月1日至2017年12月31日在广州医科大学附属第三医院住院分娩的妊娠≥20周的单胎妊娠病例资料。按受孕方法分为ART组及自然妊娠组,分析两组母儿结局,再按是否为高龄妊娠,比较ART组及自然妊娠组的母儿结局。结果:ART组孕妇的平均年龄、初产妇、定期产检、非足月胎膜早破(PPROM)、羊水量异常、子痫前期、妊娠期高血压、妊娠合并血小板减少症、妊娠期糖尿病、糖尿病合并妊娠、前置胎盘、胎盘植入/粘连、产后出血、剖宫产分娩、产钳/吸引产助产、人工剥离胎盘、药物/机械性引产、流产、胎儿窘迫及胎儿为男性发生率均高于自然妊娠组,ART组的住院天数更长,分娩孕周更低,转诊重症监护病房(ICU)、急性器官衰竭发生风险较低,ART组围产儿平均体重高于自然受孕组。高龄妊娠孕妇中,ART组的妊娠期糖尿病、剖宫产分娩发生风险增加。非高龄妊娠孕妇中,ART组子痫前期、妊娠期高血压、妊娠期糖尿病、糖尿病合并妊娠、流产、PROM、羊水量异常、前置胎盘、胎盘植入/粘连、产后出血、胎儿窘迫、人工剥离胎盘、药物/机械性引产发生风险增加。ART组较自然妊娠组钳产/吸引产风险均增加,产妇转诊ICU及非规律产检发生风险均降低,差异均有统计学意义(均P<0.05)。结论:ART受孕单胎妊娠并发症及新生儿不良结局发生率高于自然妊娠组孕妇,但其更注重孕期产检;在非高龄妊娠孕妇中,ART组母儿不良结局风险增加,而高龄妊娠孕妇中,ART组母儿不良结局风险增加不明显。     

Maternal and neonatal outcomes associated with infertility

Objective: To investigate perinatal outcomes in a cohort of fertile and infertile nulliparous women.

Design: Retrospective cohort study.

Setting: Academic medical center.

Patients: All nulliparous women delivering singletons ≥24-week gestation at our center from 1 January 2012 to 31 December 2012 were included. Women were classified into two groups – fertile and infertile – based on a chart review at the time of delivery.

Outcome measure: Perinatal outcomes of interest included mode of delivery, gestational age at delivery, and birth weight.

Results: A total of 3293 mother/infant dyads fulfilled the inclusion criteria. Of these, 277 women (8.4%) were classified as infertile. Infertile women were significantly older than fertile women. In bivariate analyses, infertile women were more likely to undergo cesarean delivery (51.8 versus 36.1%, p?p?β coefficient ?0.42, 95%CI ?0.64, ?0.2). There was no difference in infant birth weight. Late preterm deliveries (34–36 completed gestational weeks) accounted for 8.3% of deliveries for infertile women compared to 4.3% for fertile women (p?=?.032).

Conclusions: We conclude that the increased risk of cesarean section associated with infertility is driven by maternal age. Late preterm infants represent a key cohort for further evaluation in the perinatal outcomes of infertile women.     

Cervical length and the risk of spontaneous labor at term.

OBJECTIVE: To investigate the relationship between cervical length (CL) at 37 to 40 weeks and delivery within 7 days and delivery by 41 weeks. STUDY DESIGN: We performed transvaginal ultrasound to measure CL in women with singleton gestations at 37 to 40 weeks. We then used a receiver operating characteristic curve (ROC) to assess the relationship between CL and delivery within 7 days and delivery by 41 weeks. RESULT: For the 120 women included in the analysis, the mean CL (+/-s.d.) was 25.3+/-9.8 mm. The logistic regression model to predict each of the outcomes includes gestational age at ultrasound (GA-US) and CL. Neither birthweight, nor parity seems to affect the probability of delivery within 7 days. The ROC curve was used to assess the probability of spontaneous labor within 7 days at each CL measurement. The likelihood ratio of delivery within 7 days when CL is < or = 10 mm is 12. CONCLUSION: CL measurement at 37-40 weeks is an independent predictor of delivery within 7 days and delivery by 41 weeks regardless of GA-US. This information can be utilized when counseling patients regarding the management of term pregnancies.     

A comparison of risk factors for breech presentation in preterm and term labor: a nationwide,population-based case–control study

To determine if the common risks for breech presentation at term labor are also eligible in preterm labor. A Finnish cross-sectional study included 737,788 singleton births (24–42 gestational weeks) during 2004–2014. A multivariable logistic regression analysis was used to calculate the risks of breech presentation. The incidence of breech presentation at delivery decreased from 23.5% in pregnancy weeks 24–27 to 2.5% in term pregnancies. In gestational weeks 24–27, preterm premature rupture of membranes was associated with breech presentation. In 28–31 gestational weeks, breech presentation was associated with maternal pre-eclampsia/hypertension, preterm premature rupture of membranes, and fetal birth weight below the tenth percentile. In gestational weeks 32–36, the risks were advanced maternal age, nulliparity, previous cesarean section, preterm premature rupture of membranes, oligohydramnios, birth weight below the tenth percentile, female sex, and congenital anomaly. In term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, premature rupture of membranes, oligohydramnios, congenital anomaly, female sex, and birth weight below the tenth percentile. Breech presentation in preterm labor is associated with obstetric risk factors compared to cephalic presentation. These risks decrease linearly with the gestational age. In moderate to late preterm delivery, breech presentation is a high-risk state and some obstetric risk factors are yet visible in early preterm delivery. Breech presentation in extremely preterm deliveries has, with the exception of preterm premature rupture of membranes, similar clinical risk profiles as in cephalic presentation.     

Male gender predisposes to prolongation of pregnancy

OBJECTIVE: The purpose of this study was to evaluate the association between fetal gender and prolonged pregnancy. STUDY DESIGN: All deliveries in Sweden between 1987 and 1996 were evaluated for participation in this study. Inclusion criteria included (1) singleton pregnancy, (2) the absence of apparent congenital or chromosomal anomalies, (3) accurate dating established by early second trimester ultrasound examination, and (4) gestational age at delivery of > or =37 weeks (ie, > or =259 days). Initially, we calculated the mean gestational age at delivery and the percentage of prolonged pregnancies by fetal gender. Subsequently, the Mantel-Haenszel chi-square analysis was used to calculate the weekly odds ratios and their corresponding 95% confidence intervals for the delivery of a male fetus beyond 37 weeks of gestation. RESULTS: The study population comprised 656,423 deliveries; 333,192 were male deliveries, and 323,231 were female deliveries (male/female ratio, 1.03). The mean gestational age at delivery was significantly higher in male fetuses (280.6 +/- 8.9 days vs 279.8 +/- 8.6 days, respectively; P <.0001). The percentage of pregnancies that delivered beyond term was significantly higher for male relative to female fetuses (26.5% vs 22.5% [P <.000001] at > or =41 weeks of gestation and 7.6% vs 5.5% [P <.000001] at > or =42 weeks of gestation, respectively). The weekly odds ratios for a delivery of a male fetus beyond term were 1.14, 1.39, and 1.50 at 41, 42, and 43 weeks, respectively. CONCLUSION: Male gender significantly predisposes to the prolongation of pregnancy to the extent that, by 43 weeks of gestation, there are 3 male deliveries for every 2 female deliveries.     

Outcomes of multiple gestations with advanced maternal age

Objective.?To investigate outcomes of twin gestations with advanced maternal age (AMA).

Study design.?Historical cohort of twin gestations cared for by a maternal–fetal medicine faculty practice. Outcomes of patients with AMA (70) and non-AMA (75) were compared. AMA was defined as age ≥35. Analysis including mode of delivery, gestational age at delivery and overall complications was performed. Significance was determined using the chi-square test or the Student's t-test.

Results.?The Cesarean rate for AMA was significantly greater compared to non-AMA (80.0% vs. 54.7%; p = 0.001). The main reason for the increased rate was uterine dysfunction. The mean gestational age at delivery for AMA was significantly greater than for non-AMA (36.7 weeks vs. 35.4 weeks; p = 0.02). There were no differences in rates of other adverse outcomes including gestational hypertension, pre-eclampsia, gestational diabetes, suspected fetal growth restriction, preterm birth, low birth weight or low birth weight percentiles. This remained true when we compared the 32 women ages ≥40 years to 118 women ages <40 years.

Conclusion.?Among twin pregnancies, AMA women are not at an increased risk of adverse pregnancy outcomes, aside from an increased rate of cesarean delivery.     

Obstetric outcome of twin gestations in a tertiary hospital South-western Nigeria

Background: Twin pregnancy is considered a high risk pregnancy due to associated adverse obstetric outcomes. The objective was to determine the prevalence, complications and the obstetric outcomes of twin deliveries in EKSUTH.

Material and methods: A retrospective analysis of twin gestations managed at the Ekiti State University Teaching Hospital, Ado-Ekiti between January 2009 and December 2012 was done.

Results: The prevalence of twin deliveries was 1 in 23 deliveries (4.3%). Increasing age and parity and Yoruba ethnicity were associated with higher twinning rate. The mean gestational age at delivery was 36.6?±?2.9 weeks and the mean birth weight was 2.47?±?0.49?kg with first twins having higher birth weight. Spontaneous vaginal delivery was the most common mode of delivery accounting for 52.6% and 49.3% in twin 1 and twin 2, respectively, and majority (39.5%) of the twins were in cephalic–cephalic presentation. The most common indication for caesarean delivery was breech presentation in the first twin. Preterm labour was the commonest maternal complications occurring in 25.7% of cases. The perinatal mortality rate was 105 per 1000 deliveries and this was significantly associated with unbooked patients, p?=?0.001. There were no maternal deaths.

Conclusion: Preterm labour remains the commonest complication with associated high perinatal mortality.     

Indicated and non-indicated preterm delivery in twin gestations: impact on neonatal outcome and cost.

OBJECTIVE: To identify the etiology and impact of preterm delivery in twin gestations. STUDY DESIGN: Twin gestations delivered at 33.0 to 36.9 weeks were identified in a perinatal database, and categorized by indication for delivery. Deliveries were identified as indicated, or non-indicated (discretionary). Neonatal outcomes were measured by birth weight, length of stay, NICU admission, and ventilator utilization. Data were divided and analyzed by indicated or discretionary delivery, and gestational age at delivery. RESULTS: Analyzed were 3252 twin gestations (6504 infants), with 78% having indicated delivery. Of the 22% with discretionary delivery, nearly 40% required NICU admission. With each advancing week of gestation, there was a significant decrease in incidence of NICU admission and nursery days. CONCLUSION: The majority of preterm deliveries were indicated, though 22% were discretionary. It is vital to consider neonatal morbidity and costs related to gestational age when choosing discretionary delivery.     

An analysis of the maternal and infant outcomes in the delayed interval delivery of twins

ObjectiveTo investigate the treatment methods used for the delayed interval delivery of twins and to evaluate the maternal and infant outcomes.Materials and methodsThe clinical data of 5 patients that underwent delayed interval delivery of twins at Fujian Maternal and Child Health Hospital from 2014 to 2018 were analyzed. The gestational ages at delivery, obstetrical management, the interval between deliveries, and the maternal and child outcomes were analyzed.ResultsThe average gestational age at delivery of the first child was 23⁺³ weeks (range: 20⁺¹–30⁺² weeks). All 5 mothers underwent high ligation of the umbilical cord and received prophylactic antibiotic treatment. Tocolytics were administered to 3 patients, 1 of which had previously undergone cervical cerclage placement. No tocolytics were administered to the remaining 2 patients. The average delayed delivery time was 15 days (range: 3–31 days). The second child was delivered at an average gestational age of 25⁺⁵ weeks (range: 20⁺⁴–31⁺³ weeks). The average birth weight of the second twin was 957 g (range: 360–1930 g). Three of the patients delivered vaginally, 1 delivered via a cesarean section, and 1 required a breech extraction. Of these deliveries, there were 3 neonatal survivals. Pathogens were detected in the cervical secretion cultures in all cases. Two patients had grade 2 placental abruption, 5 had an intrauterine infection, 1 developed sepsis, 1 developed postpartum hemorrhage, and 5 showed a placenta adherence.ConclusionThe delayed interval delivery of twins is a unique treatment for patients experiencing a twin pregnancy. Successful performance of this method can improve the survival rates for the second twin and improve prognosis. However, careful attention is required when performing this treatment to prevent and treat possible complications that may arise during the procedure.     

Associated factors and outcomes of persistent occiput posterior position: A retrospective cohort study from 1976 to 2001.

OBJECTIVE: To identify maternal and fetal risk factors associated with persistent occiput posterior position at delivery, and to examine the association of occiput posterior position with subsequent obstetric outcomes. METHODS: This is a retrospective cohort study of 30 839 term, cephalic, singleton births. Women with persistent occiput posterior (OP) position at delivery were compared to those with occiput anterior (OA) position. Demographics, obstetric history, and labor management were evaluated and subsequent obstetric outcomes examined. Potential confounding variables were controlled for using multivariate logistic regression analysis. RESULTS: The overall frequency of OP position was 8.3% in the study population. When compared to Caucasians, a higher rate of OP was observed among African-Americans (OR = 1.4, 95% CI 1.25-1.64) while no other racial/ethnic differences were noted. Other associated factors included nulliparity, maternal age > or =35, gestational age > or =41 weeks, and birth weight >4000 g, as well as artificial rupture of the membranes (AROM) and epidural anesthesia (p < 0.001 for all). Persistent OP was associated with increased rates of operative vaginal (OR = 4.14, 95% CI 3.57-4.81) and cesarean deliveries (OR = 13.45, 95% CI 11.94-15.15) and other peripartum complications including third or fourth degree perineal lacerations (OR = 2.38, 95% CI 2.03-2.79), and chorioamnionitis (OR = 2.10, 95% CI 1.81-2.44). CONCLUSION: Epidural use, AROM, African-American ethnicity, nulliparity, and birth weight >4000 g are associated with persistent OP position at delivery, with higher rates of operative deliveries and obstetric complications. This information can be useful in counseling patients regarding risks and associated outcomes of persistent OP position.     

Short interpregnancy interval and risk of spontaneous preterm delivery

OBJECTIVES: Short interpregnancy intervals are related to increased prevalence of adverse perinatal outcomes. However, the reported association with preterm birth might be due to confounding by factors such as previous pregnancy outcomes, socioeconomic level or lifestyles. The objective of this study was to evaluate the effect of short interpregnancy interval on the occurrence of spontaneous preterm delivery. STUDY DESIGN: The prevalence of a short interpregnancy interval, defined as six or less months between a preceding delivery or abortion and the last menstrual period before index pregnancy, was compared between 263 spontaneous preterm (<37 weeks) and 299 term (37-42 weeks) consecutive births. Separate analyses were performed for early (<34 weeks) and late (34-36 weeks) preterm deliveries. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated using unconditional logistic regression. RESULTS: There was a significant association between short interpregnancy interval and spontaneous early preterm delivery, both crude (OR=3.9; 95% CI: 1.91-8.10) and adjusted for maternal age, school education, previous birth outcomes, antenatal care, smoking habits, body mass index and gestational weight gain (adj(OR)=3.6; 95% CI: 1.41-8.98). No significant effect on spontaneous late preterm delivery was found (crude(OR)=0.8; 95% CI: 0.32-1.83). CONCLUSIONS: This study showed that short interpregnancy intervals significantly increased the risk of early spontaneous preterm birth but no such effect was evident for late preterm deliveries.