Antepartum Risk Score Predicts Adverse Birth Outcomes

ObjectiveStandardized risk assessment plays an important role in providing medical care of uniform quality to pregnant women, even though it is not a substitute for clinical judgement. This study was designed to determine whether the antepartum risk score currently used across Alberta is associated with neonatal morbidity and adverse pregnancy outcomes for singleton live births and to examine whether the current classification of “lower risk” pregnancies (score < 3) is justified.MethodsA retrospective study was conducted of the delivery records for a cohort of all live singleton births in Alberta from 2001 to 2005 that contained a completed antenatal risk assessment. Adverse neonatal condition or pregnancy outcome was assessed by Apgar score, transfer of the infant to a neonatal intensive care unit, “serious” resuscitation measures, preterm birth, and low birth weight. The population-attributable fraction of any of the adverse outcomes was calculated.ResultsAll outcome measures except for NICU admissions were available for the entire 2001 to 2005 period (n = 191 686); NICU admissions were consistently recorded only from 2002 to 2005 (n = 154 924). The incidence of complications increased steadily as the risk score increased and increased more steeply above a score of 4. Approximately one third of the complications were associated with risk scores of between 2 and 6.ConclusionThe antepartum risk score currently used in Alberta is a useful tool for identifying women at higher risk of an adverse pregnancy outcome. Current categorization of pregnancies with an antepartum risk score of 2 as lower risk should be reconsidered in light of these findings.     

Adverse Pregnancy Outcomes Among Foreign-Born Canadians

ObjectiveNumerous non-Canadian studies have shown that immigrant women experience higher rates of adverse maternal and perinatal events than the general non-immigrant population. Limited information about the pregnancy outcomes of immigrant Canadian women is available.MethodsWe conducted a retrospective cohort study at St. Michael's Hospital between October 2002 and June 2006 to estimate the risk of adverse obstetrical and perinatal outcomes among foreign-born women residing in Toronto. The main study outcomes were the incidences of preterm delivery between 32 and 36 completed weeks’ gestation, low infant birth weight, and delivery by Caesarean section.ResultsCompared with Canadian-born women, those who were foreign-born had an associated adjusted odds ratio of 0.85 (95% CI 0.64 to 1.14) for preterm delivery, 1.92 (95% CI 1.29 to 2.85) for low infant birth weight, and 1.16 (95% CI 1.01 to 1.34) for delivery by Caesarean section.ConclusionIn this study, foreign-born women had a non-significantly lower risk of preterm birth, but a significantly higher risk of low birth weight infants and Caesarean section than Canadian-born women. In this urban setting, recent immigrant women have worse pregnancy outcomes, warranting increased attention to this group during antenatal and intrapartum care.     

Birth Outcomes Associated with Receipt of Group Prenatal Care Among Low‐Income Hispanic Women

Introduction: Although Hispanic women in the United States have preterm birth and low‐birth‐weight rates comparable to non‐Hispanic white women, their rates fall short of 2010 Healthy People goals, with variability found across states. This study examined the effectiveness of the CenteringPregnancy group prenatal care model in reducing preterm birth and low‐birth‐weight rates for Hispanic women. Methods: Pregnant Hispanic women at less than or equal to 20 weeks, gestation initiating prenatal care between January 2008 to July 2009 at 2 Palm Beach County, Florida, public health clinics selected either group or traditional prenatal care. Data on neonatal birth weight and gestational age were obtained through abstraction of Palm Beach County Health Department medical records. Records were abstracted for 97% of CenteringPregnancy (n = 150) and 94% of traditional care (n = 66) participants. Results: A statistically significant difference was found in the percentage of women giving birth to preterm neonates (5% group prenatal care vs 13% traditional care; P= .04). There were no statistically significant differences in the percentage of women having a low‐birth‐weight neonate when group and traditional care participants were compared. Discussion: The CenteringPregnancy model holds promise for improving the birth outcomes of Hispanic women. Future research should be conducted with larger sample sizes to replicate study findings using experimental designs and incorporating formal cost‐effectiveness analyses.     

High Parity and Adverse Birth Outcomes: Exploring the Maze

Abstract: Background : Despite extensive literature on the topic, it is uncertain if grand (para ≥ 5) and great grand (para ≥ 10) multiparity are associated with adverse birth outcomes. We critically evaluate the evidence for and against the existence of adverse maternal and/or fetal outcomes in high parity women. Methods : An electronic search of MEDLINE and other bibliographic databases (Current Contents, EMBASE, and CAB) was conducted, and all relevant articles in English language were retrieved. Results : Findings on the association between high parity and maternal‐fetal birth outcomes are not consistent. Although the older literature tends to suggest that multiparity is a risk factor for negative birth outcomes, more recent reports are not supportive. Comparison across studies was further complicated by confounding factors like maternal age, socioeconomic status, and levels of prenatal care, as well as by variations in study designs and in the definition of parity itself. Furthermore, most studies that examined women of extreme parity (para ≥ 10) were handicapped by inadequate power. Conclusions : After accounting for quality, culture, and degrees of associations, the preponderance of evidence seems to point to possible existence of heightened risk for certain medical complications and placental pathologies among women of extreme parity. The literature also provides reasonable evidence for a higher‐than‐expected likelihood for occurrence of fetal macrosomia with advanced parity.     

重度子痫前期单双胎妊娠不良结局的高危因素分析

目的:探讨重度子痫前期单双胎妊娠发生不良结局的高危因素,为围生保健提供重要临床资料。方法:纳入2005年至2014年四川大学华西第二医院的重度子痫前期住院患者1856例,采用多因素Logistic回归分析单双胎妊娠孕妇发生不良结局的高危因素。结果:双胎妊娠发生不良结局的比例(62.1%)高于单胎妊娠(50.7%),差异有统计学意义(OR1.592,95%CI 1.228~2.062,P0.001)。Logistic回归分析显示,单胎妊娠有统计学意义的高危因素包括:发病孕周34周和34~37周、高龄(≥35岁)、孕前BMI 25~30kg/m2、未产检、IVF、合并ICP、合并GDM、合并肾脏疾病(P0.05);双胎妊娠中有统计学意义的高危因素包括:发病孕周34周、IVF、合并ICP(P0.05)。结论:重度子痫前期双胎妊娠发生不良结局的风险高于单胎妊娠。在单胎妊娠中,发病孕周在37周前、高龄(≥35岁)、孕前BMI 25~30kg/m2、未产检、IVF、合并症(ICP、GDM、肾脏疾病)的患者发生不良结局的风险更高;在双胎妊娠中,发病孕周34周、IVF、合并ICP的患者发生不良结局的风险更高。     

Neighbourhood Income and Risk of Having an Infant With Concomitant Preterm Birth and Severe Small for Gestational Age Birth Weight

ObjectiveSocioeconomic position gradients have been individually demonstrated for preterm birth (PTB) at <37 weeks gestation and severe small for gestational age birth weight at <5th percentile (SGA). It is not known how neighbourhood income is related to the combination of PTB and severe SGA, a state reflective of greater placental dysfunction and higher risk of neonatal morbidity and mortality than PTB or severe SGA alone.MethodsThis population-based study comprised all 1 367 656 singleton live births in Ontario from 2002 to 2011. Multinomial logistic regression was used to estimate the odds of PTB with severe SGA, PTB without severe SGA, and severe SGA without PTB, compared with neither PTB nor severe SGA, in relation to neighbourhood income quintile (Q). The highest income quintile, Q5, served as the exposure referent. Adjusted odds ratios (aORs) were adjusted for maternal age at delivery, parity, marital status, and world region of birth (Canadian Task Force Classification II-2).ResultsRelative to women residing in Q5 (2.3 per 1000), the rate of PTB with severe SGA was highest among those in Q1 (3.6 per 1000), with an aOR of 1.34 (95% confidence interval [CI] 1.20–1.50). The corresponding aORs were 1.23 (95% CI 1.09–1.37) for Q2, 1.14 (95% CI 1.02–1.28) for Q3, and 1.06 (95% CI 0.95–1.20) for Q4. Less pronounced aORs were seen for each individual outcome of PTB and severe SGA.ConclusionWomen residing in the lowest-income areas are at highest risk of having a fetus born too small and too soon. Future research should focus on identifying those women most predisposed to combined PTB and severe SGA.     

Elevated Risk Factors for Adverse Pregnancy Outcomes Among Filipina-Canadian Women

ObjectivesFilipina immigrant women have higher than expected rates of preeclampsia and perinatal morbidity. Since obesity, diabetes mellitus (DM), and chronic hypertension are established risk factors for adverse pregnancy outcomes, we sought to determine whether they are more prevalent among Filipina women than other East Asian and Caucasian women.MethodsWe pooled data from the 2000-01, 2003, 2005, and 2007 cycles of the nationally administered Canadian Community Health Survey. We generated data representative of 115 842 Filipina, 394 357 other East Asian, and 5 812 851 Caucasian women aged 18 to 49 years and living in Canada. Crude and adjusted odds ratios and 95% confidence intervals expressed the association between ethnicity and the risk of overweight (BMI > 25.0 kg/m²), obesity (BMI > 30.0 kg/m²), DM, and chronic hypertension.ResultsThe respective rates of obesity were approximately 5% for Filipinas, 2% for other East Asian women, and 14% for Caucasian women. The adjusted OR of obesity was 0.28 (95% CI 0.16 to 0.47) among Filipina women and 0.14 (95% CI 0.10 to 0.20) among other East Asians. The risk of DM was not significantly lower in Filipina women or other East Asian women than in Caucasians. Relative to a rate of 4.8% among Caucasians, chronic hypertension was significantly more prevalent among Filipinas (7.1%; adjusted OR 2.14, 95% CI 1.51 to 3.03), but not other East Asians (3.9%; adjusted OR 1.27, 95% CI 0.96 to 1.70). Post-hoc analyses showed that Filipina women were more likely to be hypertensive (adjusted OR 1.79, 95% CI 1.12 to 2.85) than other East Asian women; for obesity the adjusted OR was 1.88 (95% CI 0.97 to 3.66), and for DM it was 1.62 (95% CI 0.65 to 4.02).ConclusionFilipina women have higher than expected rates of excess weight and chronic hypertension, underlining the need to consider Filipina and other East Asian women separately.     

Quitting Smoking During Early Versus Late Pregnancy: The Risk of Preeclampsia and Adverse Birth Outcomes

ObjectiveTo examine the impact of women’s quitting smoking during early and late pregnancy on their risk of preeclampsia and on birth outcomes.MethodsWe analyzed data from a case–control study of 86 preeclamptic women and 239 controls at three hospitals in Quebec between January 2003 and March 2006.ResultsCompared with never having smoked, early smoking cessation, i.e., quitting before 20 weeks’ gestation, was not associated with a reduced risk of preeclampsia (adjusted OR 1.03; 95% CI 0.42–2.60). Both late smoking cessation (quitting after 20 weeks of gestation) and persistent smoking (smoking before and during pregnancy) were associated with a non-significant reduction in the risk of preeclampsia (aOR 0.78; 95% CI 0.12–5.02 for late quitting and aOR 0.62; 95% CI 0.16–2.37 for persistent smoking). However, persistent smoking was associated with an increased risk of other adverse pregnancy outcomes, such as low birth weight (aOR 10.2; 95% CI 2.49–41.8) and preterm birth (aOR 3.59; 95% CI 1.06–12.1).ConclusionAlthough late quitting and persistent smoking may be associated with a decreased risk of preeclampsia, the benefit of early smoking cessation on pregnancy outcome is evident.     

Differences in the Valuation of Birth Outcomes Among Pregnant Women,Mothers, and Obstetricians

Background: Decisions are usually based on the perceived merits of alternative approaches. This process can be quantified by combining the probabilities of expected outcomes with their desirability. We studied differences in the valuation of birth outcomes among pregnant women, mothers, and obstetricians, and assessed how these would affect a particular obstetric decision. Methods: In a study conducted at Leiden Hospital, Leiden, The Netherlands, 12 obstetricians, 15 pregnant women, and 15 mothers participated in a standard reference gamble to determine the value of 12 different outcomes: 3 types of birth combined with 4 states of infant outcome. These were then applied to an obstetric decision tree based on the Dublin trial of intermittent auscultation versus electronic intrapartum fetal heart rate monitoring. Results: Contrary to obstetricians, women valued permanent neurologic handicap significantly higher than neonatal death ( p < 0.01). Women expressed no overriding preferences for the type of birth, whereas obstetricians were clearly antipathetic to cesarean section. Within-group consistency was significantly higher for pregnant women and mothers than for obstetricians ( p < 0.0001). However, application of the measured values to the obstetric decision tree merely led to marginal changes in overall expected value of the decision alternatives. Conclusions: Values attached to birth processes and outcomes differ significantly between (expectant) mothers and doctors. These differences should be recognized and respected in obstetric decision making.     

The Principal Pregnancy Complications Resulting in Preterm Birth in Singleton and Twin Gestations

Preterm birth is the major cause of perinatal mortality for both singleton and twin gestations in the United States; most preterm birth prevention programs are primarily structured to detect and treat preterm labor. Most of these programs have had limited success, and the preterm birth rate for twins has remained well above that for singletons. Little attention has been paid to the question of whether the frequency of conditions that result in preterm twin delivery differs from those that result in the delivery of preterm singletons. Delivery records were reviewed for all 1,976 preterm (24–36 completed gestational weeks) singleton pregnancies and 221 preterm twin pregnancies delivered at the University of Connecticut Health Center, 1980–1989, to determine the primary complication that resulted in preterm delivery. Premature rupture of membranes was responsible for 46% of these singleton preterm deliveries, while the other causes were preterm labor with intact membranes (20%), pregnancy-induced hypertension (15%), antepartum hemorrhage (9%), and other maternal-fetal indications (10%). The five groups differed significantly in maternal and neonatal characteristics. The principal pregnancy complications resulting in preterm delivery of twins were preterm rupture of membranes (42%), preterm labor (31%), antepartum hemorrhage (4%), pregnancy-induced hypertension (11%), and other maternal-fetal indications (12%). Compared to preterm singletons, the preterm twins were significantly more likely to deliver because of preterm labor and less likely to deliver because of hemorrhage. Substantial reduction in the preterm birth rate requires programs tailored to the specific population and etiologies involved and should not solely address preterm labor.     

Maternal Area of Residence,Socioeconomic Status,and Risk of Adverse Maternal and Birth Outcomes in Adolescent Mothers

ObjectiveAdolescent pregnancy is a significant public health issue in Canada. Current evidence highlights the individual role of social determinants of health such as maternal residence and socioeconomic status (SES) on teen pregnancy outcomes. This study evaluated the joint association between residence/SES and adverse adolescent pregnancy outcomes.MethodsThis was a population-based retrospective cohort study of all singleton, live deliveries (2010-2015) from women aged 15 to 19 who were registered in the Alberta Perinatal Health Program. Information on maternal residence and SES was extracted from the Pampalon Material Deprivation Index data set. The study categorized mothers into four risk dyads: rural/high SES, rural/low SES, urban/high SES, and urban/low SES. Adjusted odds ratios (ORs) of adverse pregnancy outcomes were calculated in logistic regression models (Canadian Task Force Classification II-2).ResultsA total of 9606 births from adolescent mothers were evaluated. Thirty percent of adolescent mothers were classified as urban/high SES; 27% were urban/low SES; 7% were rural/high SES; and 36% were placed in the rural/low SES category. Compared with urban/high SES mothers, rural/low SES mothers had increased odds of postpartum hemorrhage (OR 1.57; 95% confidence interval [CI] 1.41–1.74), operative vaginal delivery (OR 1.37; 95% CI 1.18–1.60), Caesarean section (OR 1.39; 95% CI 1.19–1.62), large for gestational age infants (OR 1.39; 95% CI 1.16–1.66), low birth weight (OR 1.11; 95% CI 1.07–1.65), and preterm birth (OR 1.48; 95% CI 1.17–1.87).ConclusionRural pregnant adolescents of low SES have the highest odds for adverse pregnancy outcomes. Social determinants of health that affect adolescent pregnancies need further examination to identify high-risk subgroups and understand pathways to health disparities in this vulnerable population.     

Adolescent Deliveries in a Secondary-Level Care Hospital of Cameroon: A Retrospective Analysis of the Prevalence, 6-Year Trend,and Adverse Outcomes

Study ObjectiveAdolescents are generally ill-equipped to deal with the burden of a pregnancy. A high prevalence of adolescent pregnancies is among the indicators of limitations toward the achievement of the Millennium Development Goals in most developing countries. We sought to determine the prevalence, 6-year trend, and adverse outcomes of adolescent deliveries. We also tested whether being married decreased the risk of adverse fetal outcomes in these adolescents.DesignA 6-year retrospective register analysis.SettingBuea Regional Hospital.ParticipantsBirth records from 2007 to 2012.InterventionsNone.Main Outcome MeasuresPrevalence and 6-year trend in the rate of adolescent deliveries; adverse fetal outcomes.ResultsThe overall prevalence of adolescent deliveries was 9.9% (491 of 4941). There was no significant change in the annual prevalence of adolescent deliveries over 6 years (P trend = .8). Adolescent pregnancies were at higher risk of preterm deliveries (deliveries at gestational age <37 completed weeks; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3-2.2; P < .01), low birth weight (defined as birth weight <2600 g; OR, 1.8; 95% CI, 1.4-2.3; P < .01), and neonatal asphyxia (OR, 1.4; 95% CI, 1.1-1.7; P < .01). There was no significant difference in the frequency of adverse outcomes between married and single adolescents.ConclusionOne of every 10 babies is born from adolescent mothers in the Buea Regional Hospital. Whether these mothers are married or not, their neonates are exposed to higher morbidity. This emphasizes the need for more adolescent-friendly public health policies geared toward reducing the prevalence of this condition to improve the chances of attaining the Millennium Development Goals in Cameroon.     

水中分娩及分娩并发症的探讨

目的:时水中分娩产妇的产程、产道裂伤、产时和产后并发症、产时和产后镇痛药使用及新生儿结局进行分析,以评价水中分娩的安全性.方法:2003年3月1日至2007年6月30日在我院选择水中分娩的1227例产妇作为水中分娩组,将同期的单胎(无妊娠合并症及并发症)顺产的1227例产妇作为对照组.比较两组产程、产道裂伤、产时和产后并发症、产时和产后镇痛药使用及新生儿结局.结果:水中分娩组第一及第二产程时间、产褥病率、产后出血、会阴阴道血肿、产后尿潴留、新生儿轻度及重度窒息与对照组比较,两组差异无统计学意义(P>0.05);水中分娩组均未行会阴切开,对照组会阴切开率66.67%,两组比较,差异有高度统计学意义(P<0.01);水中分娩组下水后用镇痛药及产后用镇痛药与对照组比较明显减少,两组差异有高度统计学意义(P<0.01).结论:水中分娩能减轻分娩疼痛,减少产时、产后镇痛药的使用.减少产道损伤,且未发现对母儿有其他不良结局.     

Outcomes of Father Involvement in Pregnancy and Birth

: To test the assumption that father involvement in pregnancy and childbirth results in more positive birth and fathering experiences, 40 primiparous couples recruited from childbirth education classes and obstetricians were studied. About two weeks before their due dates each mother was asked to rate her marital closeness and her husband's interest in children. These couples were observed for one hour in mid-labor. Then mothers and fathers were interviewed about one week after the birth. Fathers who were more involved in terms of their wives’ reports of prenatal marital closeness gave generally more positive reports of the delivery and the new baby. Fathers who were involved in terms of their wives’ estimates of their interest in children were rated by observers as interacting with their wives less during labor. (BIRTH 10:1, Spring 1983)     

Depressive Symptoms and Birth Outcomes among Pregnant Teenagers

Study ObjectiveFew studies have examined the effects of maternal depressive symptoms among adolescent women. The purpose of this study was to investigate the impact of depressive symptoms on birth outcomes of infants born to adolescent mothers.DesignThe medical records of pregnant adolescent patients were examined. Information about maternal depressive symptoms and birth outcomes was collected.SettingData were collected at Washington Hospital Center, a nonprofit, community-based hospital that serves residents throughout the Washington, DC area.ParticipantsParticipants were 294 African-American and Latina adolescent mothers. Mean age was 16.2 years (standard deviation [SD] 1.4). Based on self-reports of depressive symptoms, adolescents were categorized by the following: no reported symptoms, depressive symptoms without SI/SA (suicidal ideation or attempt), and depressive symptoms with SI/SA.Main Outcome MeasuresInfant birth weight and gestational age at delivery.ResultsOver one-quarter of pregnant adolescents in this study reported symptoms of depression. Adolescents reporting depressive symptoms with SI/SA delivered babies that weighed 239.5 grams (98.3% confidence interval [CI] 3.9 to 475.1) less than babies born to mothers reporting depressive symptoms without SI/SA. There was no association between reported symptoms and gestational age.ConclusionsResults suggest that compared to nonpregnant teens and adults, pregnant teens may have an increased risk for depression. Additionally, pregnant adolescents with suicidal ideation are at greater risk for delivering infants of lower birth weight compared with teens reporting depressive symptoms without SI/SA and teens reporting no symptoms. This study supports the need for early screening and treatment of depression for young pregnant women.     

Risk-Appropriate Care to Improve Practice and Birth Outcomes

Identification and referral of women with high-risk pregnancies to hospitals better equipped and staffed to provide care for them have been important steps to improve birth outcomes. Based on recent recommendations from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine to provide regionalized maternal care for pregnant women at high risk and reduce rates of maternal morbidity and mortality, health care organizations and providers have refocused their attention to women’s well-being rather than solely on the well-being of the fetus or newborn. Opportunities to improve practice and birth outcomes exist through the implementation of a more standardized and integrated system of risk-appropriate care.     

维生素B12缺乏与不良妊娠结局

维生素B12是人体必需的水溶性维生素,作为甲硫氨酸合酶和甲基丙二酰辅酶A变位酶的辅酶,参与叶酸循环、甲硫氨酸循环以及DNA合成,还可降低血清同型半胱氨酸水平,在妊娠期发挥重要生理作用。由于妊娠期母体对维生素B12的需求增加,如果同时伴有摄入不足、吸收障碍或利用不良,易引起妊娠期维生素B12缺乏,可以导致妊娠期糖尿病、早产、流产、低出生体质量儿和神经管畸形等妊娠期并发症,但其致病机制尚未完全明确。综述维生素B12缺乏与不良妊娠结局的研究进展,为临床诊疗提供思路。     

Adverse Maternal and Neonatal Outcomes in Adolescent Pregnancy

Study ObjectiveTo investigate the outcomes of adolescent pregnancy.DesignRetrospective cohort study from the Consortium on Safe Labor between 2002 and 2008.SettingTwelve clinical centers with 19 hospitals in the United States.ParticipantsNulliparous women (n = 43,537) younger than 25 years of age, including 1189 younger adolescents (age ≤ 15.9 years), 14,703 older adolescents (age 16-19.9 years), and 27,645 young adults (age 20-24.9 years).InterventionsAdjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated, controlling for maternal characteristics and pregnancy complications (young adults as a reference group).Main Outcome MeasuresMaternal, neonatal outcomes, cesarean indications, and length of labor.ResultsYounger adolescents had an increased risk of maternal anemia (aOR = 1.25; 95% CI, 1.07-1.45), preterm delivery at less than 37 weeks of gestation (aOR = 1.36; 95% CI, 1.14-1.62), postpartum hemorrhage (aOR = 1.46; 95% CI, 1.10-1.95), preeclampsia or hemolysis, increased liver enzyme levels, and low platelet syndrome (aOR = 1.44; 95% CI, 1.17-1.77) but had a decreased risk of cesarean delivery (aOR = 0.49; 95% CI, 0.42-0.59), chorioamnionitis (aOR = 0.63; 95% CI, 0.47-0.84), and neonatal intensive care unit admission (aOR = 0.80; 95% CI, 0.65-0.98). Older adolescents had an increased risk of maternal anemia (aOR = 1.15; 95% CI, 1.09-1.22), preterm delivery at less than 37 weeks of gestation (aOR = 1.16; 95% CI, 1.08-1.25), and blood transfusion (aOR = 1.21; 95% CI, 1.02-1.43), but had a decreased risk of cesarean delivery (aOR = 0.75; 95% CI, 0.71-0.79), chorioamnionitis (aOR = 0.83; 95% CI, 0.75-0.91), major perineal laceration (aOR = 0.82; 95% CI, 0.71-0.95), and neonatal intensive care unit admission (aOR = 0.89; 95% CI, 0.83-0.96). Older adolescents were less likely to have a cesarean delivery for failure to progress or cephalopelvic disproportion (aOR = 0.89; 95% CI, 0.81-0.98). For adolescents who entered spontaneous labor, the second stage of labor was shorter (P < .01).ConclusionAdolescents were less likely to have a cesarean delivery. Failure to progress or cephalopelvic disproportion occurred less frequently in older adolescents. Adolescents who entered spontaneous labor had a shorter second stage of labor.