Antenatal Corticosteroid Prophylaxis at Late Preterm Gestation: Clinical Guidelines Versus Clinical Practice

ObjectiveWe investigated how the Antenatal Late Preterm Steroids (ALPS) trial findings have been translated into clinical practice in Canada and the United States (U.S.).MethodsThe study included all live births in Nova Scotia, Canada, and the U.S. from 2007 to 2020. Antenatal corticosteroids (ACS) administration within specific categories of gestational age was assessed by calculating rates per 100 live births, and temporal changes were quantified using odds ratio (OR) and 95% confidence intervals (CI). Temporal trends in optimal and suboptimal ACS use were also assessed.ResultsIn Nova Scotia, the rate of any ACS administration increased significantly among women delivering at 35⁰ to 36⁶ weeks, from 15.2% in 2007–2016 to 19.6% in 2017–2020 (OR 1.36, 95% CI 1.14–1.62). Overall, the U.S. rates were lower than the rates in Nova Scotia. In the U.S., rates of any ACS administration increased significantly across all gestational age categories: among live births at 35⁰ to 36⁶ weeks gestation, any ACS use increased from 4.1% in 2007–2016 to 18.5% in 2017–2020 (OR 5.33, 95% CI 5.28–5.38). Among infants between 24⁰ and 34⁶ weeks gestation in Nova Scotia, 32% received optimally timed ACS, while 47% received ACS with suboptimal timing. Of the women who received ACS in 2020, 34% in Canada and 20% in the U.S. delivered at ≥37 weeks.ConclusionPublication of the ALPS trial resulted in increased ACS administration at late preterm gestation in Nova Scotia, Canada, and the U.S. However, a significant fraction of women receiving ACS prophylaxis delivered at term gestation.     

Cannabis Use in Pregnancy in British Columbia and Selected Birth Outcomes

ObjectiveThis study sought to determine the association between cannabis use in pregnancy and stillbirth, small for gestational age (SGA) (<10th percentile), and spontaneous preterm birth (<37 weeks).MethodsThe study used abstracted obstetrical and neonatal medical records for deliveries in British Columbia from April 1, 2008 to March 31, 2016 that were contained in the Perinatal Data Registry of Perinatal Services British Columbia. Chi-square tests were conducted to compare maternal sociodemographic characteristics by cannabis use. Logistic regression was conducted to determine the association between cannabis use and SGA and spontaneous preterm births. Cox proportional hazards regression modelling was used to identify the association between cannabis use and stillbirth. Secondary analyses were conducted to ascertain differences by timing of stillbirth (Canadian Task Force Classification II-2).ResultsMaternal cannabis use has increased in British Columbia over the past decade. Pregnant women who use cannabis are younger and more likely to use alcohol, tobacco, and illicit substances and to have a history of mental illness. Using cannabis in pregnancy was associated with a 47% increased risk of SGA (adjusted OR 1.47; 95% CI 1.33–1.61), a 27% increased risk of spontaneous preterm birth (adjusted OR 1.27; 95% CI 1.14–1.42), and a 184% increased risk of intrapartum stillbirth (adjusted HR [aHR] 2.84; 95% CI 1.18–6.82). The association between cannabis use in pregnancy and overall stillbirth and antepartum stillbirth did not reach statistical significance, but it had comparable point estimates to other outcomes (aHR 1.38; 95% CI 0.95–1.99 and aHR 1.34; 95% CI 0.88–2.06, respectively).ConclusionCannabis use in pregnancy is associated with SGA, spontaneous preterm birth, and intrapartum stillbirth.     

Temporal Trends in Preterm Birth,Neonatal Mortality,and Neonatal Morbidity Following Spontaneous and Clinician-Initiated Delivery in Canada, 2009-2016

ObjectiveClinician-initiated deliveries at 34 to 36 weeks gestation have increased in Canada since 2006, but the impacts of clinician-initiated deliveries on the overall preterm birth (PTB) rate and concomitant changes in neonatal outcomes are unknown. This study examined gestational age–specific trends in spontaneous and clinician-initiated PTB and associated neonatal mortality and morbidity.MethodsThis population-based study included 1 880 444 singleton live births in Canada (excluding Québec) in 2009-2016, using hospitalization data from the Canadian Institute for Health Information. The primary outcomes were neonatal mortality and a composite outcome mortality and/or severe neonatal morbidity identified by International Statistical Classification of Diseases and Related Health Problems, 10th revision, Canada codes. Outcomes were stratified by spontaneous and clinician-initiated deliveries and gestational age categories. Logistic regression yielded adjusted odds ratios (aORs) per 1-year change and 95% confidence intervals (CIs) (Canadian Task Force Classification II-2).ResultsThe PTB rate remained stable (6.2%) and the proportion of clinician-initiated PTBs increased from 31.0% to 37.9% (P < 0.001). Although overall neonatal mortality remained stable (1.1%), mortality declined among infants born spontaneously at 28 to 33 weeks gestation (aOR 0.92; 95% CI 0.87–0.97). The composite mortality and/or severe morbidity declined from 12.7% to 12.2% (aOR 0.98; 95% CI 0.97–0.99). Declines were observed in the rates of sepsis (aOR 0.96; 95% CI 0.95–0.98) and respiratory distress syndrome requiring ventilation (aOR 0.97; 95% CI 0.96–0.98), whereas rates of intraventricular hemorrhage increased (aOR 1.03; 95% CI 1.01–1.05).ConclusionWith the increase in clinician-initiated deliveries, the stable rates of PTB and neonatal mortality and the decline in composite mortality and/or severe morbidity are encouraging findings. This study adds to clinical understanding of carefully timed and medically justified early interventions.     

In utero nicotine exposure and fetal growth inhibition among twins

We examined the impact of cigarette smoking on fetal growth among twins by analyzing matched twin live births in the United States from 1995 through 1998. The outcomes of interest were low and very low birthweight, preterm and very preterm birth, and small for gestational age. Out of a total of 163,901 mothers, 19,234 reported active smoking during pregnancy (11.7%). Twins born to smokers weighed an average of 182 g less than their counterparts born to nonsmokers (p<0.001). The risk for fetal growth inhibition was greater among twins of smokers: low birthweight (adjusted odds ratio [OR], 1.84; 95% confidence Interval [CI], 1.79 to 1.89), very low birthweight (OR, 1.27; 95% CI, 1.21 to 1.32), preterm (OR, 1.3; 95% CI, 1.09 to 1.16), very preterm (OR, 1.18; 95% CI, 1.13 to 1.23), and small for gestational age (OR, 1.91; 95% CI, 1.84 to 1.98). In conclusion, prenatal smoking significantly inhibits fetal growth among twins, and small for gestational age appeared more affected than shortened gestation.     

Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study

OBJECTIVES: To evaluate the risk of very preterm birth (22-32 weeks of gestation) associated with previous induced abortion according to the complications leading to very preterm delivery in singletons. DESIGN: Multicentre, case-control study (the French EPIPAGE study). SETTING: Regionally defined population of births in France. SAMPLE: The sample consisted of 1943 very preterm live-born singletons (< 33 weeks of gestation), 276 moderate preterm live-born singletons (33-34 weeks) and 618 unmatched full-term controls (39-40 weeks). METHODS: Data from the EPIPAGE study were analysed using polytomous logistic regression models to control for social and demographic characteristics, lifestyle habits during pregnancy and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, fetal growth restriction, premature rupture of membranes, idiopathic preterm labor and other causes. MAIN OUTCOME MEASURES: Odds ratios for very preterm birth by gestational age and by pregnancy complications leading to preterm delivery associated with a history of induced abortion. RESULTS: Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1-2.0); the risk was even higher for extremely preterm deliveries (< 28 weeks). The association between previous induced abortion and very preterm delivery varied according to the main complications leading to very preterm delivery. A history of induced abortion was associated with an increased risk of premature rupture of the membranes, antepartum haemorrhage (not in association with hypertension) and idiopathic spontaneous preterm labour that occur at very small gestational ages (< 28 weeks). Conversely, no association was found between induced abortion and very preterm delivery due to hypertension. CONCLUSION: Previous induced abortion was associated with an increased risk of very preterm delivery. The strength of the association increased with decreasing gestational age.     

Risk factors associated with preterm deliveries among racial groups in a national sample of married mothers.

Seven sociodemographic and behavioral factors that may explain the increased risk of preterm deliveries among black women were examined using data from a national sample of 5823 married mothers who responded to the 1980 National Natality Survey (NNS) Questionnaire. There was a twofold increase in the rate of preterm deliveries among black women. Additionally, there was a significant decrease (by 1 week) in the mean gestational age in black mothers (p less than 0.0001) compared with white mothers. The two groups were similar with respect to smoking and age; however, there were significant differences between the two groups with respect to other risk factors. Black women had a higher rate of heavy alcohol use, significantly fewer prenatal visits, prenatal care was started later during pregnancy (p less than 0.0001) and were less educated compared with white women. The odds ratio (OR) for race adjusted for the risk factors was 1.56 (95% confidence interval (CI) equals 1.21, 2.01). All other risk factors except education had adjusted ORs greater than 1. Those risk factors that were more strongly associated with the risk of preterm births included weight gain (OR, 2.10; 95%, 1.79, 2.47), number of prenatal visits (OR, 3.37; 95% CI, 2.87, 3.95) and smoking (OR, 1.34; 95% CI, 1.13, 1.59). We conclude that race is an independent risk factor for preterm deliveries. Additionally, it is shown here that the risk of preterm deliveries is attributable to health behaviors that are amendable to change.     

Clinical significance of first-trimester intrauterine haematomas detected in pregnancies achieved by IVF-embryo transfer

In this study, the clinical significance of first-trimester intrauterine haematomas (IUH) detected in pregnancies achieved by IVF-embryo transfer (IVF-ET) was evaluated. A retrospective case-control study was designed to compare obstetric and perinatal outcomes of 350 pregnancies with IUH and 350 matched controls without IUH. The incidence of first-trimester IUH detected in the IVF-ET pregnancies was 13.5%. In women who delivered after 28 weeks' gestation, the incidence of gestational hypertension (OR 2.6; 95% CI 1.5 to 4.6), preeclampsia (OR 2.8; 95% CI 1.5 to 5.0) and postpartum haemorrhage (OR 3.1; 95% CI 1.8 to 5.3) was significantly higher in the IUH group. Compared with controls, placenta previa (OR, 8.7 95%; CI 3.4 to 22.2) and oligohydramninos (OR 5.8; 95% CI 2.4 to 14.0) were more common in the IUH group. The incidence of preterm delivery (<37 weeks' gestation) was significantly higher in the IUH group (OR 2.1; 95% CI 1.4 to 3.0), although the incidence of preterm delivery before 34 weeks' gestation was not. No differences were observed in the incidence of gestational diabetes mellitus, premature rupture of membranes and low birth weight. The presence of first-trimester IUH in IVF-ET pregnancies was associated with a higher risk of several pregnancy complications.     

Prevention of preterm birth by cervical cerclage compared with expectant management: a systematic review

Our objective was to review the evidence on the use of cervical cerclage to prevent preterm births compared with expectant management. An OVID, MEDLINE, Cochrane Database, and Science Citation Index search using the medical subject headings and terms "cervical cerclage," "cervical incompetence" and "preterm delivery" was conducted for the period 1966 to 2002. We included all randomized trials that evaluated the effectiveness of cervical cerclage in preventing preterm birth. Using a standardized data collection instrument, we reviewed trial designs, inclusion and exclusion criteria, and maternal and neonatal outcome. Fixed or random effects model were used to pool both dichotomous and continuous outcomes where appropriate. Seven trials were identified; six met our inclusion criteria. A total of 2190 women enrolled into the trials were identified with 1110 receiving cerclage and 1080 managed expectantly. There were a total of 278 of 2190 (12.7%) deliveries before 34 weeks of gestation. The meta-analysis demonstrated a trend toward cervical cerclage preventing preterm delivery at less than 34 weeks (OR 0.77, 95% CI, 0.59, 0.99; P =.049). However, there was no demonstrable improvement in neonatal mortality (OR of 0.0.86, 95% CI, 0.56, 1.33; P =.50). There is a trend toward cervical cerclage reducing preterm births before 34 weeks. The use of cerclage is, however, associated with an increased risk of postpartum fever. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to compare the evidence on the use of cervical cerclage with preventing preterm births and to criticize the various articles evaluating the use of cervical cerclage.     

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.     

Neighbourhood Family Income and Adverse Birth Outcomes Among Singleton Deliveries

ObjectiveTo assess the association between neighbourhood family income and adverse birth outcomes.MethodsWe conducted a retrospective cohort study of 334 231 singleton births during 2004 and 2006 based on the Niday Perinatal Database from Ontario. Median neighbourhood family incomes from the 2001 Canadian census were linked with the Niday Perinatal Database by dissemination areas. Generalized estimating equations were applied to estimate the odds ratios of adverse birth outcomes associated with lower neighbourhood income, with adjustment for maternal confounding variables at the individual level.ResultsCompared with the highest neighbourhood income quintile, mothers from the lowest quintile were at increased risk of having small for gestational age neonates (OR 1.51; 95% CI 1.46 to 1.57), low birth weight (OR 1.43; 95% CI 1.36 to 1.50), preterm birth (OR 1.17; 95% CI 1.12 to 1.23), low Apgar score (< 7) at five minutes (OR 1.32; 95% CI 1.21 to 1.44), and stillbirth (OR 1.39; 95% CI 1.19 to 1.62). The risks of women from the lowest income quintiles delivering a macrosomic baby (OR 0.81; 95% CI 0.79 to 0.84) or a large for gestational age baby (OR 0.82; 95% CI 0.80 to 0.85) were significantly decreased. No difference in risk of congenital anomaly was found among different income quintiles.ConclusionA lower level of neighbourhood income is associated with increased risks of small for gestational age babies, low birth weight, preterm birth, low Apgar score at five minutes, and stillbirth.     

Obstetric characteristics and perinatal outcome of pregnancies with uterine leiomyomas

OBJECTIVE: To determine the rate, obstetric characteristics and perinatal outcome of pregnancies with uterine leiomyomas. STUDY DESIGN: A population-based study comparing all singleton deliveries between the years 1988 and 1999 in women with and without uterine leiomyomas was performed. Patients lacking prenatal care were excluded from the analysis. Multivariable analysis, adjusting for possible confounders, such as maternal age, parity and gestational age, was performed to investigate associations between uterine leiomyomas and selected outcomes. RESULTS: There were 105,909 singleton deliveries with 690 (0.65%) complicated by uterine leiomyomas during the study period. Using a multivariable analysis, the following conditions were significantly associated with uterine leiomyomas: nulliparity (odds ratio [OR]=4.0, 95% confidence interval [CI] 3.3-4.7, P<.001), chronic hypertension (OR=1.9, 95% CI 1.6-2.4, P<.001), hydramnios (OR=1.5, 95% CI 1.2-2.0, P<.001), diabetes mellitus (OR=1.4, 95% CI 1.1-1.7, P=.001) and advanced maternal age (OR=1.2, 95% CI 1.1-1.2, P<.001). Higher rates of perinatal mortality (2.2% vs. 1.2%, OR=1.8, 95% CI 1.1-3.2, P<.001) were found in the uterine leiomyoma group as compared to the control group. While adjusting for maternal age, parity, gestational age and malpresentation, pregnancies with uterine leiomyomas had higher rates of cesarean deliveries (OR=6.7, 95% CI 5.5-8.1, P<.001), placental abruption (OR=2.6, 95% CI 1.6-4.2, P<.001) and preterm deliveries (<36 weeks' gestation, OR=1.4, 95% CI 1.1-1.7, P=.009) as compared to pregnancies without uterine leiomyomas. Conversely, no significant differences were noted regarding perinatal mortality (OR=1.4, 95% CI 0.7-2.8, P=.351) after controlling for maternal age, parity and gestational age using a multivariable analysis. CONCLUSION: Uterine leiomyomas increase the risk of adverse pregnancy outcomes, thus emphasizing the importance of appropriate intrapartum management of these high-risk pregnancies.     

Subsequent obstetrics outcomes after intrauterine death during the first pregnancy

Abstract

Objective: We aimed to determine whether the risks of adverse outcomes were greater in women who had pregnancies ending in stillbirth than in those with no previous history of stillbirth.

Methods: This retrospective cohort study included all women who had undergone their first and second deliveries at Bakirkoy Women’s and Children’s Education and Research Hospital between 2002 and 2011. Women who delivered following a previous stillbirth after 20 complete weeks of gestation were compared with those who had delivered but had no history of stillbirth after 20 weeks of gestation.

Results: We compared 201 subsequent births to women with previous histories of stillbirth with 402 live births to women with no such history. The rates of pre-eclampsia [odds ratio (OR), 3.4; 95% confidence interval (CI), 1.5–7.4], HELLP syndrome (OR, 3.1; 95% CI, 1.2–9.6), low birth weight (OR, 1.6; 95% CI, 0.7–3.5) and malpresentation (OR, 2.9; 95% CI, 1.6–4.8) were significantly higher in the case group. Howewer, the rates of stillbirth were similar between the groups.

Conclusion: We found increased rates of obstetric and perinatal complications in subsequent pregnancies in women with histories of stillbirth. Thus, the results of this study suggest that pregnant women with histories of stillbirth should be followed closely, beginning in the early gestational period.     

Factors related to corticosteroid utilization in preterm birth

We sought to determine the rate of corticosteroid administration in preterm births in our institution and to describe factors associated with lack of corticosteroid exposure. We performed a retrospective case-control analysis. Of the 312 eligible women who delivered between 24 and 34 weeks' gestation, maternal corticosteroid administration was documented in 262 (84%) and no exposure in 50 (16%). A shorter admission to delivery interval (< 48 hours) decreased the likelihood of corticosteroid administration (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.03 to 0.28, P < 0.001). Use of tocolytics was associated with a lower risk of corticosteroid nonexposure (OR 0.21, 95% CI 0.04 to 0.69, P = 0.006). Lack of prenatal care was associated with an increased risk of corticosteroid nonexposure (OR 3.18, 95% CI 1.01 to 9.15, P = 0.01). The likelihood of corticosteroid administration was also decreased by gestational ages at the upper limit of the spectrum (33 to 34 weeks; OR 0.22, 95% CI 0.09 to 0.53, P < 0.001). The latter effect persisted after exclusion of premature rupture of membranes cases. In our population, factors associated with no maternal corticosteroid administration were shorter interval between admission and delivery, gestational age at the upper limit of the currently recommended interval for corticosteroid administration, and lack of prenatal care.     

Pregnancy and perinatal outcomes of first-trimester crown−rump length discordant IVF dichorionic twin pregnancies – a retrospective cohort study

Research QuestionThis study aimed to evaluate the association between discordance in crown–rump length (CRL) and adverse pregnancy and perinatal outcomes in dichorionic twin pregnancies.DesignThis was a retrospective cohort study of dichorionic twin pregnancies after IVF that showed two live fetuses at the first ultrasound scan between 6 ⁺⁵ and 8 weeks gestational age from 1 January 2015 to 31 December 2016. Study groups were defined by the presence or absence of 20% or more discordance in CRL. The primary outcomes were early fetal loss of one or both fetuses before 12 weeks and birthweight discordance. Secondary outcomes included fetal anomalies, fetal loss between 12 and 28 weeks, stillbirth, small for gestational age (SGA) at birth, low birthweight (LBW), very low birthweight (VLBW), admission to the neonatal intensive care unit (NICU) and preterm delivery (PTD).ResultsCRL-discordant twin pregnancies were more likely to end in the loss of one fetus before 12 weeks’ gestation (odds ratio [OR] 15.877, 95% confidence interval [CI] 10.495–24.019). Discordant twin pregnancies with twin deliveries had a significantly higher risk of birthweight discordance (OR 1.943, 95% CI 1.032–3.989). There was no significant difference in perinatal outcomes including fetal anomalies, PTD, LBW, VLBW, SGA, neonatal death and admission to NICU between singleton or twin deliveries.ConclusionsDiscordant twin pregnancies were at increased risk of one fetal loss prior to 12 weeks’ gestation. Except for birthweight discordance, there was no significant difference between CRL discordance and other adverse perinatal outcomes.     

Vaginal Douching,Bacterial Vaginosis,and Spontaneous Preterm Birth

ObjectiveVaginal douching and bacterial vaginosis (BV) are independently associated with spontaneous preterm birth. Because the interrelationships among these variables remain unclear, we sought to examine the associations in a prospective study.MethodsWe conducted a nested case-control study within a prospectively recruited cohort of pregnant women. We prospectively collected demographic and health status data, data on pre-pregnancy vaginal douching, vaginal smears for bacterial vaginosis as defined by Nugent’s criteria, fetal fibronectin at 26 weeks of pregnancy, and placental pathology at delivery. Spontaneous preterm births before 37 weeks’ gestation were selected as cases. All spontaneous births occurring after 37 weeks were potential control subjects. To limit costs, some tests were performed only in selected control subjects.ResultsPreterm birth occurred in 207 of 5092 women (4.1%). In bivariate analysis, BV was not associated with preterm birth (OR 1.2; 95% CI 0.5 to 2.4). Vaginal douching was significantly associated with bacterial vaginosis (P < 0.05) and preterm birth (P < 0.05). On multivariate analysis, vaginal douching was no longer associated with preterm birth, buta significant association with early preterm birth < 34 weeks (OR, 6.9; 95% CI 1.7 to 28.2) and preterm birth due to preterm labour (OR 3.0; 95% CI 1.1 to 8.5) persisted after controlling for the presence of bacterial vaginosis and placental inflammation.ConclusionVaginal douching and bacterial vaginosis were not associated with spontaneous preterm birth overall. However, vaginal douching appears to be an independent and potentially modifiable risk factor for early preterm birth (32-34 weeks), although the mechanism remains unclear.     

Examination of the association between male gender and preterm delivery

Objective

To examine possible reasons why a male fetus constitutes a risk factor for preterm delivery.

Study design

Retrospective study of deliveries from hospital database in a UK teaching hospital. The population comprised all deliveries >23 weeks over an 11-year period, excluding multiples, terminations and pregnancies with major abnormalities including indeterminate gender. Obstetric variables and outcomes were initially compared in male and female babies for preterm births in different gestation bands, extreme (<28 weeks), severe (29–32 weeks) and moderate (33–36 weeks). For each, the odds ratios with 95% confidence intervals for preterm delivery were calculated. Then, using binary logistic regression with adjusted odds ratios with 95% confidence intervals, putative causal pathways that might explain the male excess were tested.

Results

75,725 deliveries occurred, of which 4003 (5.3%) were preterm. Males delivered preterm more frequently (OR 1.13, 95% CI 1.06–1.20). This was due to spontaneous (OR 1.30, 95% CI 1.19–1.42) but not iatrogenic (OR 0.96, 95% CI 0.87–1.05) preterm birth. There was an increased risk of pre eclampsia among preterm females. Although males were larger, and male pregnancies were more frequently nulliparous and affected by some other obstetric complications (abruption, urinary tract infection), these did not account for their increased risk. Any effect of growth restriction could not be properly determined.

Conclusions

Being male carries an increased risk of spontaneous but not iatrogenic preterm birth. The reasons behind this remain obscure.     

Outcomes of Planned Hospital Birth Attended by Midwives Compared with Physicians in British Columbia

ABSTRACT: Background: The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada. Methods: All women planning a hospital birth attended by a midwife during the 2‐year study period who were of sufficiently low‐risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n =488). The comparison group included women meeting the same eligibility requirements but planning a physician‐attended birth in hospitals where midwives also practiced (n =572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data. Results: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39–0.86), narcotic analgesia (OR 0.26, 95% CI 0.18–0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16–0.30), amniotomy (OR 0.74, 95% CI 0.56–0.98), and episiotomy (OR 0.62, 95% CI 0.42–0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04–0.83) in the midwifery group. Conclusions: A shift toward greater proportions of midwife‐attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity. (BIRTH 34:2 June 2007)     

Is a cause of postpartum hemorrhage of using of tocolytic agents in preterm delivery?

Objective: Tocolytic agents are used to inhibit uterine contraction in preterm. The authors undertook this study to determine whether using of tocolytic agents before delivery is associated with increase postpartum hemorrhage in preterm delivered women.

Method: 296 singleton pregnancies delivered preterm from 24?+?1 to 37?+?0 weeks gestation were retrospectively reviewed. Hemoglobin (HB) and hematocrit (HCT) levels were checked before and after delivery to access postpartum blood loss. Multivariate logistic regression analysis was performed to determine whether delivery within the half-lives of tocolytic agents was associated with decreased HB and HCT levels.

Results: After adjusting for maternal age, parity, gestational age at delivery, birth weight, delivery method, and induction of labor, postpartum HB and HCT levels of those delivered within half-lives of tocolytic agents were found to be significantly diminished (HB: OR 3.306, 1.308–8.356 95% CI, p?=?0.011; HCT: OR 2.692, 1.077–6.726 95% CI, p?=?0.034). In addition, blood transfusion rates were elevated for deliveries made within the half-lives of tocolytic agents, (p?=?0.006).

Conclusions: Delivery within half-lives of tocolytic agents was found to be associated with low HB and HCT levels after delivery and higher blood transfusion rates in preterm delivered women.     

Obstetric outcomes in adolescent pregnancies: a racial/ethnic comparison

Abstract

Objective: To examine obstetric outcomes for adolescents among the major US racial/ethnic groups.

Methods: This is a retrospective cohort study of singleton births to nulliparous women aged 12 to 19 years from 1988 to 2008. The prevalence of preterm delivery, cesarean delivery, preeclampsia, gestational diabetes, low birth weight and low Apgar score were compared across African-American, Asian, Latina and White adolescents.

Results: 1865 adolescents were included in the analysis. Differences between racial/ethnic groups for rates of preterm delivery, cesarean delivery and gestational diabetes were statistically significant at p?<?0.05. African Americans had lower odds of preterm delivery (OR?=?0.58, 95% CI [0.38–0.90]) and gestational diabetes (OR?=?0.17, 95% CI [0.05–0.55]) than White adolescents. White adolescents had increased odds of cesarean delivery compared to African-American (OR?=?0.69, 95% CI [0.48–0.98]), Latina (OR?=?0.62, 95% CI [0.41–0.94]) and Asian adolescents (OR?=?0.41, 95% CI [0.25–0.68]). Although not statistically significant, White adolescents also had higher odds of low Apgar score. In the multivariate analysis, non-White adolescents continued to have improved outcomes, except in the case of low birth weight.

Conclusions: African-American, Asian and Latina adolescents may have similar or decreased risk of obstetric complications compared to White adolescents.     

Influence of mode of delivery on neonatal mortality and morbidity in spontaneous preterm breech delivery

Objective

To study the association between mode of delivery and neonatal outcome in singleton pregnancy with breech presentation and preterm birth, due to premature labour (PTL) and/or preterm premature rupture of the membranes (pPROM).

Design and methods

Information on preterm (gestational week 25–36) singleton births in breech presentation in Sweden during 1990–2002 was obtained from the Swedish Medical Birth Registry and the Swedish Hospital Discharge Registry. The study groups included 1975 caesarean and 699 vaginal deliveries with a diagnosis of PTL or pPROM, without pregnancy complications implying a high risk of fetal compromise. The rates of infant respiratory distress syndrome (IRDS), intraventricular haemorrhage (IVH), low Apgar scores, and neonatal deaths were compared between infants delivered vaginally and by caesarean section. Odds ratios were calculated with adjustment for gestational age, year of birth, maternal age and parity.

Results

The risk of neonatal death and the risk of an Apgar score below 5 min postnatally were both lower after caesarean delivery (OR 0.4; 95% CI 0.2–0.7, and OR 0.4; 95% CI 0.3–0.7, respectively), whereas the risk of IRDS was increased (OR 2.1; 95% CI 1.4–3.2). A diagnosis of IRDS was not associated with mortality (OR 0.8; 95% CI 0.5–1.5). IVH was not associated with mode of delivery (OR 1.2; 95% CI 0.5–2.8).

Conclusion

The lower neonatal mortality after CS supports a policy of caesarean delivery of the preterm breech.