Fetal growth retardation in rats exposed to cigarette smoke during pregnancy

The relationship was examined in healthy young primigravidas between the length of gestation and several factors measured during pregnancy, including the physical and chemical state of the cervix, uterine contractility, smoking, and sexual intercourse. Cervical dilatation and effacement during pregnancy relate to the time in gestation at which labor starts. For example, at the thirty-second week the internal cervical os was one fingerbreadth dilated in all patients who subsequently were delivered before the thirty-eighth week, but in only 10 per cent of those delivered after the forty-first week. The concentration of cervical hydroxyproline did not relate to gestation at labor nor to the physical state of the cervix. There was a highly significant negative correlation between the activity of the uterus at the thirty-sixth week of pregnancy and gestation at the onset of labor. The proportion of patients delivered before the end of the thirty-ninth week was significantly greater for smokers that for nonsmokers. However, the relationship between the length of gestation and cervical dilatation and uterine contractility in pregnancy remained significant in nonsmokers. The frequency of sexual intercourse during pregnancy did not influence the time in gestation when labor began.     

Treatment and Outcomes of Psychotic Patients During Pregnancy and Childbirth

ABSTRACT: This study examined whether particular groups of psychotic women are likely to present management problems during pregnancy and childbirth. The pregnancy courses and outcomes of 22 psychiatric inpatients were reviewed. Schizophrenic women with delusions or psychotic denial about the pregnancy were significantly less likely to detect labor than were nondelusional women. Ability to detect signs of labor and cooperate with labor instructions was significantly more likely in women with bipolar affective disorders than in those with schizophrenic disorders, and was also more likely in those women with severe personality disorders and substance abuse histories. The total patient cohort underwent significantly more cesarean sections than their nonpsychiatric counterparts who delivered at the same hospital. These findings suggest that psychotic women are at high risk for the development of pregnancy and birth complications.     

Factors associated with delivery complications in rural Bangladesh.

OBJECTIVES: There are only a few studies on maternal morbidity, delivery complications and maternal mortality in Bangladesh. This study analyzes data from a follow-up study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993. METHODS: A total of 1020 pregnant women were interviewed in the follow-up component of the study. The survey collected information on socioeconomic and demographic characteristics, pregnancy-related care and practice, morbidity during the period of follow-up as well as in the past, information concerning complications at the time of delivery and during the postpartum period. For the purpose of this study, we selected 993 pregnant women with at least one antenatal follow-up. Both bivariate and multivariate analyses were conducted to identify the potential risk factors for complication during delivery and duration of labor. RESULTS AND CONCLUSIONS: It appears that complications during the antenatal period can result in various complications at the time of delivery. Some of the important findings are: hemorrhage during the antenatal period increases the risk of excessive hemorrhage during delivery, the risk of obstructed labor increases significantly if abdominal pain is observed during the antenatal period, prolonged labor appears to be significantly higher for the first pregnancy, and pregnancies suffering from abdominal pain during pregnancy tend to have a higher risk of prolonged labor during delivery. The duration of labor appears to be negatively associated with the number of previous pregnancies, being longest for the first pregnancies. The duration of labor pain is significantly higher for the respondents who reported the index pregnancy as undesired, and, similarly, the respondents who were reported to be involved with gainful employment would have a shorter duration of labor pain than those having no involvement with gainful employment.     

Factors associated with delivery complications in rural Bangladesh

Objectives There are only a few studies on maternal morbidity, delivery complications and maternal mortality in Bangladesh. This study analyzes data from a follow-up study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993. Methods A total of 1020 pregnant women were interviewed in the follow-up component of the study. The survey collected information on socioeconomic and demographic characteristics, pregnancy-related care and practice, morbidity during the period of follow-up as well as in the past, information concerning complications at the time of delivery and during the postpartum period. For the purpose of this study, we selected 993 pregnant women with at least one antenatal follow-up. Both bivariate and multivariate analyses were conducted to identify the potential risk factors for complication during delivery and duration of labor. Results and conclusions It appears that complications during the antenatal period can result in various complications at the time of delivery. Some of the important findings are: hemorrhage during the antenatal period increases the risk of excessive hemorrhage during delivery, the risk of obstructed labor increases significantly if abdominal pain is observed during the antenatal period, prolonged labor appears to be significantly higher for the first pregnancy, and pregnancies suffering from abdominal pain during pregnancy tend to have a higher risk of prolonged labor during delivery. The duration of labor appears to be negatively associated with the number of previous pregnancies, being longest for the first pregnancies. The duration of labor pain is significantly higher for the respondents who reported the index pregnancy as undesired, and, similarly, the respondents who were reported to be involved with gainful employment would have a shorter duration of labor pain than those having no involvement with gainful employment.     

Pregnancy course and outcome following blunt trauma

Objective: To investigate short- and long-term outcome following blunt trauma in pregnancy, and to identify risk factors for adverse pregnancy outcome in these cases. Methods: A retrospective cohort study of all pregnant women who were admitted following blunt trauma (N?=?411). Women who experienced immediate complications (N?=?13) were compared with those who did not (N?=?398). Pregnancy outcome of women who experienced trauma during pregnancy and did not deliver during the trauma admission (N?=?303) were compared with a control group of women matched to by maternal age and parity in a 3:1 ratio (N?=?909). Results: The overall rate of immediate complications was 3.2%, with the most common complications being preterm labor (2.0%) and placental abruption (1.7%). Independent risk factors for immediate complications were higher severity of trauma, multiple gestation, vaginal bleeding and uterine contractions at admission. Patients who experienced trauma were at increased risk for long-term adverse outcome including preterm labor, placental abruption, and perinatal morbidity. Increased trauma severity (ISS ≥ 5) and the need for laparotomy during the trauma hospitalization were independently associated with long-term adverse pregnancy outcome. Conclusion: Trauma during pregnancy is associated with both immediate and long-term adverse pregnancy outcome. Women who experience trauma should be followed more closely throughout pregnancy.     

Delivery outcomes following loop electrosurgical excision procedure for microinvasive (FIGO stage IA1) cervical cancer

OBJECTIVE: The goal of this study was to report the delivery outcomes in women who had loop electrosurgical excision procedure (LEEP) for microinvasive cervical cancer (stage IA1 without lymphovascular invasion) and became pregnant and progressed beyond 24 weeks. METHODS: A case-control study was performed. Twenty-eight women who were managed exclusively with LEEP for microinvasive cervical carcinoma had at least one pregnancy beyond 24 weeks and were the cases. Each case was matched with one woman who delivered at the same department without prior treatment of her cervix (controls) and their delivery outcomes were compared with those of the cases. Known risk factors for preterm delivery were used as matching factors. RESULTS: There was no statistically significant difference (P > 0.05) between cases and controls in the duration of pregnancy (37.6-38.4 weeks respectively), birth weight (3212-3315 g), cesarean section rate (17.8-32.1%), neonatal unit admission rate (21.4-10.7%), and precipitate labor rate (13-10.5%). The duration of labor was significantly shorter in cases (5.5-7.1 h, P = 0.032). After LEEP the relative risk for preterm delivery is 3.67 (95% confidence interval, 0.97-20.27), for low birth weight infant 0.67 (0.06-5.8), for precipitate labor 1 (0.05-3.88), and for delivery by cesarean section 0.5 (0.17-4.46). CONCLUSIONS: Women treated for microinvasive cancer with LEEP did not have significantly more delivery complications compared with controls apart from shorter duration of labor. There was a possible non-statistically significant trend toward shorter duration of pregnancy in cases. While caution should be advised when selecting and treating women with microinvasive carcinoma by LEEP, the apparent safety of the management and the satisfactory delivery outcome seem to justify this approach in many cases.     

前次剖宫产术对再次妊娠影响的临床评价

目的:探讨剖宫产术后再次妊娠时妊娠期并发症的发生及不良分娩结局的情况。方法:选择2012年3月至2015年10月在成都市妇女儿童中心医院诊治的剖宫产术后再次妊娠孕妇5960例为观察组,选择同期非瘢痕子宫再次妊娠分娩经产妇6656例为对照组,回顾性分析比较两组妊娠期并发症的发生情况及分娩后母儿情况。结果:观察组前置胎盘、胎盘植入、妊娠期高血压疾病、早产、胎膜早破、胎儿生长受限的发生率均高于对照组(P0.05),观察组重型胎盘植入(穿透型、植入型)的发生率高于对照组(P0.05)。观察组产后输血、子宫切除、产褥感染的发生率均明显高于对照组(P0.05),两组产后出血率及新生儿窒息率差异无统计学意义(P0.05)。结论:剖宫产术增加了再次妊娠时妊娠期并发症及不良分娩情况的发生率,并且可能是导致重型胎盘植入的主要原因之一。严格控制首次剖宫产有助于改善母婴结局。     

Pregnancy Outcome in Patients Requiring Parenteral Nutrition

Objective: The purpose of this retrospective study was to evaluate maternal and perinatal outcomes and complications of parenteral nutrition during pregnancy in our institution.

Methods: This study was a review of medical records of all women who required parenteral nutrition during pregnancy at our institution from 1990–1997. The frequency of maternal and perinatal complications was calculated.

Results: Twenty-six pregnancies required parenteral nutrition for the following indications: hyperemesis gravidarum (n = 16), cholecystitis/pancreatitis (n = 3), small bowel obstruction (n = 2), intracranial bleed (n = 2), ulcerative colitis (n = 1), and other (n = 2). The mean gestational age at initiation of therapy was 16.2 weeks and the mean duration of therapy was 30.6 days. Five pregnancies were terminated prior to fetal viability. Of the remaining pregnancies, obstetric complications occurred in 11, including two cases of idiopathic preterm labor resulting in preterm deliveries. Maternal complications resulting from the central venous catheters included four infections, two thromboses, one occlusion, one pneumothorax, and one catheter dislodgment. The complication rate for centrally inserted central catheters (50%) was significantly greater than the rate for peripherally inserted central catheters (9%).

Conclusions: Successful outcomes can be achieved in obstetric patients requiring parenteral nutrition. In this group of patients, the frequency of maternal complications secondary to centrally inserted central venous catheters was greater than that reported in nonpregnant patients. Peripherally inserted central catheters may be preferable when parenteral nutrition is required during pregnancy.     

Epilepsy and pregnancy: an obstetric perspective

OBJECTIVE: The purpose of this study was to determine the obstetric and neonatal outcomes of women with prepregnancy diagnoses of epilepsy. STUDY DESIGN: This was a cohort study of women with epilepsy (n=414 women) who were delivered in a tertiary referral center (1978-2000). Outcomes were compared with women who did not have epilepsy (n=81,759 women) who were delivered during the same period, with the use of t tests or contingency table analyses. RESULTS: Comparison showed increased rates of nonproteinuric hypertension (P<.05), induction of labor (P<.001), and fetal cardiovascular malformations (P<.001) among women with epilepsy. Rates of other antenatal, intrapartum, and neonatal complications and congenital malformations were similar to those of control subjects. There were fewer instrumental vaginal deliveries. There were no live births with neural tube defects. The occurrence of major antepartum seizures did not increase the rate of adverse outcomes significantly. Major congenital malformations increased in proportion to the number of anticonvulsants that were prescribed. CONCLUSION: Women with epilepsy are not at increased risk for obstetric complications, provided that appropriate care is available during preconception, pregnancy, labor, delivery, and after delivery.     

The safety of low molecular weight heparin therapy during labor.

OBJECTIVE: Current recommendations are to discontinue low molecular weight heparin (LMWH) at least 24 hours prior to labor induction or administering epidural anesthesia. We assessed the safety of discontinuing LMWH 12-24 hours before delivery. METHODS: We evaluated the prevalence of hemorrhagic complications during labor, cesarean or epidural catheter placement in 284 women treated with enoxaparin during pregnancy as compared with 16132 untreated women. Treated participants were divided into subgroups by the various intervals between last LMWH dose hemorrhage-prone events (vaginal delivery,epidural, cesarean etc.). The rate of hemorrhagic complications and hemoglobin values were compared between the study and control groups. RESULTS: Postpartum hemorrhage was uncommon and occurred in 2.1% and 1.9% in study and control groups, respectively (p=0.13). Antenatal as well as postnatal hemoglobin values were very similar for treated and untreated women. No differences were noted between women who discontinued enoxaprin 12-24 hours before labor and those who discontinued treatment later with regard to maternal hemorrhagic complications. No spinal hematomas were report among 12792 treated and un-treated women who had epidural or spinal block. No hemorrhagic neonatal complications were encountered. CONCLUSION: Discontinuing LMWH more than 12 hours before delivery is safe in relation to maternal hemorrhagic complications.     

Do patients who deliver at term after being hospitalized for preterm contractions have an increased risk for obstetrical complications?

Objectives

To determine the obstetrical complications and perinatal outcomes of patients with recurrent episodes of preterm contractions (PTC) that eventually delivered at term compared to those who delivered preterm.

Methods

A retrospective study evaluating pregnancy complications and adverse perinatal outcomes of patients with recurrent episodes of PTC (three or more) was conducted. A comparison was made between those who delivered preterm to those who eventually delivered at term.

Results

Deliveries occurred between the years 1989 and 2009. During the study period, there were 1,897 singleton deliveries at term and 393 preterm singleton deliveries of patients who were previously hospitalized with PTCs. Patients who delivered at term were significantly more likely to be in their first pregnancy and to be primiparous. Patients in the study group were less likely to have had fertility treatments, a history of miscarriage, a higher incidence of one previous hospitalization but lower rates of multiple hospitalizations for PTC. Patients who delivered at term had a significantly lower rate of severe preeclampsia as well as cesarean delivery and a shorter hospital stay than those who delivered preterm. At term, an increased incidence of small for gestational age (SGA) neonates was noted compared to patients who delivered prematurely (10.07 vs. 5.6 %; P = 0.005).

Conclusion

Patients with symptoms of preterm labor may require further surveillance, not only because of their risk to progress to preterm delivery, but also because they are at an increased risk for delivering an SGA neonate at term.     

Prostaglandin E2 induction of labor for isolated oligohydramnios in women with unfavorable cervix at term

OBJECTIVE: To evaluate the maternal and neonatal outcomes of pregnancies complicated with isolated oligohydramnios at term, managed by induction of labor. METHODS: We conducted a retrospective case-control study. 138 women with uncomplicated oligohydramnios at term [amniotic fluid index (AFI) < or =5 cm] and a low Bishop score (< or =6) underwent induction of labor with prostaglandin E2. These women were compared to 67 women who underwent induction of labor at 42 weeks' gestation and 276 women at low-risk pregnancy and spontaneous onset of labor, matched for parity and race. RESULTS: Cesarean section (CS) rate was similar in the study and the post-date group (17.4 and 17.9%, respectively), but significantly higher than the spontaneous labor group (5.8%, OR 3.42, 95% CI 1.75-6.68). No differences were found with other outcomes. CONCLUSION: Pregnancies with isolated oligohydramnios at term apparently are not at higher risk of perinatal complications, but induction of labor is associated with increased rate of CS.     

Elective induction: When? Ever?

The frequency of labor induction has increased significantly in recent years. Although medically indicated inductions comprise a portion of this increase, elective inductions have increased in frequency as well. Given that elective inductions, by definition, provide no benefit from a strictly medical standpoint, it is particularly important to evaluate whether women who undergo these inductions incur greater risks than those who labor spontaneously. This article will assess whether elective inductions are associated with changes in pregnancy outcomes, and evaluate how these associations are influenced by parity and cervical ripeness.     

Antepartum hemorrhage of unknown origin--what is its clinical significance?

BACKGROUND: Antepartum hemorrhage of unknown origin is a common antenatal complication, accounting for more than half of the cases of antepartum hemorrhage. Few investigators had reported the importance of this condition and the proper management. METHOD: The present study reviewed retrospectively 718 cases with singleton pregnancies diagnosed as having antepartum hemorrhage of unknown origin after 24 weeks from 1991 to 1996 and compared their pregnancy outcomes with controls who delivered during the same period of time as the study cases. Clinical and ultrasound examinations were performed in all recruited cases to exclude accidental hemorrhage, placenta previa or lower genital tract bleeding. RESULTS: Patients with antepartum hemorrhage of unknown origin ran a higher risk of spontaneous preterm labor (p<0.001). The birthweight, when adjusted for gestation, did not differ between the two groups. Labor induction rate and cesarean section rates were significantly higher in the antepartum hemorrhage group. The incidences of major antepartum complications and neonatal complications did not differ between the two groups. There were more babies with congenital abnormalities in the antepartum hemorrhage group (p<0.001) and perinatal mortality rate was also higher, though this difference was not statistically significant. CONCLUSION: The main fetal risks associated with antepartum hemorrhage of unknown origin is preterm labor and its subsequent fetal complications. A small but significant proportion of these pregnancies might be associated with fetal congenital abnormalities. Routine induction at term for this group of patients is of questionable value as adverse fetal outcomes are mostly associated with those that delivered prematurely, or with babies with congenital malformations. When gross fetal abnormalities could be reasonably excluded, labor induction at term should only be contemplated in the presence of other obstetric indications.     

Effect of epidural analgesia on the primary cesarean section and forceps delivery rates

OBJECTIVE: To determine the impact of introducing epidural analgesia for labor pain relief on the primary cesarean and forceps delivery rates. STUDY DESIGN: The control group consisted of 1,720 women who delivered on a charity hospital service between September 1, 1992, and August 31, 1993; epidural analgesia was not available for this cohort of patients. The study group consisted of 1,442 patients who delivered on the same service between September 1, 1993, and August 31, 1994; elective epidural analgesia for labor pain relief was available for this cohort of patients. A computerized obstetric database was analyzed to compare the two groups regarding demographics, parity, pregnancy complications, labor characteristics, type of delivery, low birth weight incidence and five-minute Apgar scores. RESULTS: The two groups were similar with respect to demographics and pregnancy complications. No control group patient received epidural analgesia for labor pain relief; 734 of 1,285 (57%) laboring patients in the study group elected epidural analgesia for pain relief. The primary cesarean delivery rate for the control group was 9.6% and for the study group 11.0% (not statistically significant). The control group had 34 (2.0%) forceps deliveries and the study group, 88 (6.1%), for a statistically significant difference. There were significantly more vaginal births after cesarean in the study group (42 vs. 26). CONCLUSION: Epidural analgesia was not associated with an increase in the primary cesarean delivery rate but was associated with an increase in the operative vaginal delivery rate.     

依沙吖啶及其联合方案在中期妊娠引产中的应用

目的探讨依沙吖啶及其联合方案在中期妊娠引产过程中的影响因素、疗效和并发症的发生情况。 方法回顾性分析2015年1月1日至2019年12月31日自愿于我院妇产科进行中期妊娠引产的388例患者临床资料，根据不同的引产方式分为单一方案(依沙吖啶)组(252例)和联合方案(依沙吖啶+米非司酮或米索前列醇)组(136例)，比较两种方案患者的基本情况、临床疗效、产程合并症和并发症等。 结果联合方案与单一方案比较，有剖宫产史者(26.47% vs 17.01%)、体外受精-胚胎移植(7.35% vs 1.98%)、多胎妊娠(8.82% vs 3.57%)、因胎儿异常引产(75.74% vs 62.70%)及胎盘异常(16.9% vs 9.1%)，两组差异均具有统计学意义(P均<0.05)。用药至规律宫缩的时间和引产时间单一方案组均较联合方案组长，分别为(33.59±11.11)h vs(31.17±9.81)h，(11.57±10.91)h vs(8.18±7.86)h，差异均有统计学意义(P<0.05)，引产成功率、清宫率、产后出血量、产后发热及子宫破裂等两组间差异没有统计学意义(P>0.05)。 结论孕产妇有剖宫产史、体外受精-胚胎移植、多胎妊娠和胎盘异常等情况，推荐选择联合方案引产。联合方案可有效缩短引产时间，降低产后并发症，有利患者身心健康。     

Simplified and standardized intrapartum management can yield high rates of successful VBAC in spontaneous labor

Objective: To examine the outcomes of vaginal birth after cesarean (VBAC) in women, in spontaneous labor, delivering after 37 weeks’ gestation at an institution where trial of labor after a previous cesarean delivery (TOLAC) is encouraged and management of labor is standardized.

Methods: This retrospective cohort study included 3071 women with one previous cesarean only and no vaginal delivery who underwent a trial of labor from 2001 to 2011. Women were managed using the standardized “active management of labor” intrapartum protocol. Outcomes and characteristics of women who delivered vaginally were compared with those who required cesarean delivery.

Results: In spontaneous labor in their second pregnancy, those who attempted TOLAC had a 72.5% (1611/2222) rate of successful VBAC. Women who had a successful VBAC had smaller babies (3584?±?452?g versus 3799?±?489?g; p?p?p?Conclusion: This study shows that serious complications associated with TOLAC are rare providing intrapartum care and decision-making is made simple for the benefit of staff and patients alike. This is achieved through a standardized labor management protocol.     

Maternal complications of pregnancy increase beyond 40 weeks of gestation in low-risk women.

OBJECTIVE: We sought to determine when rates of maternal pregnancy complications increase for low-risk nulliparous and multiparous women at term. METHODS: We designed a retrospective cohort study of low-risk women delivered beyond 37 weeks gestational age from 1976 to 2001. Rates of mode of delivery and maternal complications of labor and delivery were examined by gestational age with both bivariate and multivariate analyses. Statistical significance was designated by P<0.05. RESULTS: We found that among the 32,828 low-risk women who delivered at 37 completed weeks and beyond, the rates of primary cesarean delivery, operative vaginal delivery, third- or fourth-degree perineal lacerations, and chorioamnionitis all increased at 40 weeks of gestation (P<0.001), and the rate of postpartum hemorrhage increased at 41 weeks of gestation (P<0.001). These increases of rates of complications were larger and increased at an earlier gestational age among nulliparous women. CONCLUSION: We found that the risk of maternal complications for otherwise low risk nulliparous and multiparous women increased as pregnancy progressed beyond 40 weeks of gestation. Counseling of women who progress past their EDC should include comparing the risks of induction of labor to that of expectant management.     

Amnioinfusion in the evaluation of fetal obstructive uropathy: the effect of antibiotic prophylaxis on complication rates.

OBJECTIVE: Amnioinfusion plays an important role in the intrauterine evaluation and treatment of fetal obstructive uropathy. However, it may significantly increase the risk for chorioamnionitis, premature rupture of membranes and premature labor. We evaluated the impact of prophylactic antibiotics on postamnioinfusion complications. METHODS: Thirty pregnancies complicated by fetal obstructive uropathy, treated by amnioinfusion and with documentation of pregnancy outcome were identified from our database. Pregnancy outcomes were compared between patients who were treated with prophylactic antibiotics and those with no prophylaxis. RESULTS: Chorioamnionitis was diagnosed in 3 out of 15 (20%) patients who did not receive prophylactic antibiotics as compared to 2 (13%) in the treated group. The overall rate of serious obstetrical complication was significantly higher in the untreated group (66 vs. 20%; p = 0. 021). Patients receiving prophylactic antibiotics delivered at a significantly greater gestational age than those who did not receive antibiotics (34.0 +/- 3.7 vs. 31.3 +/- 1.9 weeks, respectively; p = 0.018). CONCLUSIONS: Our study supports the use of oral prophylactic antibiotics as being effective in reducing the previously observed significant risks associated with amnioinfusion in fetal obstructive uropathy.     

The influence of prepregnancy body mass index on labor complications.

BACKGROUND: To investigate the influence of Body Mass Index on the incidence of labor complications in a population of women with a normal pregnancy. MATERIAL AND METHODS: From a local database, information on maternal weight and height was extracted concerning 4258 women who had an uncomplicated pregnancy. After calculation and stratification with respect to Body Mass Index, this was retrospectively related to labor interventions and complications. RESULTS: High Body Mass Index was related to more oxytocin infusion and early amniotomy, but not to vacuum extraction or cesarean section. Primary inertia and, to a minor degree, cephalopelvic disproportion and secondary inertia were seen more often in women with high Body Mass Index. CONCLUSIONS: Overweight (25.0<=BMI<30.0) and obesity (BMI>=30.0) are only weak predictors of labor complications, given a normal pregnancy. However, the heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home.