Please exit safely: maternal and twin pair neonatal outcomes according to delivery mode when twin A is vertex*

Objective: To investigate maternal and infant outcomes associated with delivery mode for twins with a cephalic presenting twin.

Methods: Linked birth certificate and ICD hospital discharge data were analyzed retrospectively for 5573 mothers and their respective twin pairs born live at 34–42 weeks’ gestation, with twin A vertex, in Washington State from 1997–2007. Relative risks (RR) and 95% confidence intervals of adverse maternal and twin pair outcomes were calculated for vaginal delivery or cesarean during labor in comparison to cesarean without labor.

Results: Vaginal delivery or cesarean during labor was associated with significantly elevated rates of maternal hemorrhage (RR?=?2.8 [2.2,3.7]), infection (RR?=?2.2 [1.5,3.3]), twin pair birth injury (RR?=?2.6 [1.2,5.4]) and low 5-min Apgar scores (RR?=?1.4 [1.1,1.8]) and with significantly lower rates of ventilation among preterm twin pairs only (RR?=?0.8 [0.7,0.9]). The lowest rate of combined poor short-term outcomes occurred in mothers and twin pairs delivered by cesarean without labor (23%) and the highest rates occurred in those with operative vaginal or cesarean during labor (39% and 34%, respectively). Among women in labor, 35% of nulliparas achieved spontaneous vaginal delivery of both twins compared to 63% of non-nulliparas.

Conclusion: For nulliparous women who carry twins to term, planned cesarean may improve outcomes.     

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.     

Risk factors associated with respiratory disorders in late preterm infants

Objective: Late preterm infants are still high risk for respiratory problems. The aim of this study was to identify risk factors associated with respiratory problems in Japanese late preterm infants.

Methods: In this retrospective multicenter study, we included singleton late preterm deliveries at 34+^0/7–36+^6/7 weeks of gestation. We excluded cases with congenital anomalies. We defined neonatal respiratory disorders (NRD) as the combination of the need for mechanical ventilation or the use of nasal continuous positive airway pressure. We examined the perinatal risk factors associated with NRD.

Results: We included 683 late preterm infants. We found that 13.7%, 6.8% and 2.6% of the infants with NRD were born at 34, 35 and 36 weeks of gestation, respectively. In a multivariate logistic regression analysis adjusting for confounders, the gestational age (GA) at birth (adjusted odds ratio 0.40 per week [95% confidence interval, 0.25–0.61]), cesarean birth (4.18 [2.11–8.84]), and a low Apgar score (33.3 [9.93–121.3]) were independent risk factors associated with NRD.

Conclusions: An earlier GA, cesarean delivery, and a low Apgar score are independent risk factors associated with NRD in singleton late preterm infants. Patients with late preterm deliveries exhibiting these risk factors should be managed in the intensive delivery setting.     

Maternal cytokines and disease severity influence pregnancy outcomes in women with rheumatoid arthritis

Objectives: To assess the influence of maternal cytokine levels, disease activity and severity on preterm delivery, small for gestational age (SGA) and cesarean delivery in pregnant women with rheumatoid arthritis (RA).

Methods: A prospective study in 47 pregnant women with RA and 22 healthy pregnant controls. The main outcome measures were birth weight in relation to maternal serum levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and RA activity and severity at three different time points: preconception and during the first and third trimesters.

Results: During the third trimester, IL-10 was detectable in 23.4% of patients with RA, IL-6 in 76.6%. Mean birth weight born to mothers with RA was higher when IL-10 level was high compared with low (p?=?0.001), and lower when IL-6 was high compared with low (p?=?0.035). Also increase in disease activity score-28 (in 60.1%, p?=?0.001), Health Assessment Questionnaire–Disability Index (in 87.5%, p?=?0.013), and pain score (56.9?±?11.4, p?=?0.003) associated with increased risk of SGA. High patient’s global scale was associated with unfavorable pregnancy outcome (preterm, SGA, and cesarean).

Conclusion: High maternal IL-10 levels are associated with higher birth weight and high IL-6 levels are associated with lower birth weight (SGA). Among women with RA, disease activity and severity are predictive of unfavorable pregnancy outcomes suggesting that better disease management early in the pregnancy could improve pregnancy outcomes.     

Racial disparities in cervical length for prediction of preterm birth in a low risk population

Purpose: Racial minorities experience higher rates of spontaneous preterm birth (sPTB). Our objective was to evaluate whether there are racial discrepancies in the incidence of second trimester short cervical length (≤25?mm).

Materials and methods: Retrospective cohort of women with singleton gestations without prior sPTB undergoing universal second trimester transvaginal ultrasound cervical length (CL) screening between January 2012 and December 2013. Black women were compared to non-Hispanic white women. Our primary outcome was the incidence of CL ≤25?mm. Secondary outcomes were incidence of PTB ≤37 weeks, delivery mode, birth weight and neonatal intensive care unit (NICU) admission.

Results: Black women (n?=?1092) differed from non-Hispanic white women (n?=?659) with respect to maternal age (26.0 versus 30.7 years), gravidity (3.1 versus 2.1), prepregnancy BMI (29.6 versus 25.0?kg/m²), and smoking status (9.8% versus 16%), respectively (p?Conclusions: Black women had a 2.8-fold increased risk of CL ≤25?mm compared non-Hispanic white women in a low-risk population.     

Predictors of eclampsia in California

Objective: Eclampsia is a rare yet dangerous complication of the hypertensive disorders of pregnancy. The objective was to elucidate the predictors of eclampsia in a large cohort of pregnant women with gestational hypertension or preeclampsia.

Methods: This was a retrospective cohort study of 143?093 pregnancies with preeclampsia or gestational hypertension in California during 2005–2008 of which 1719 had eclampsia. Predictors included race/ethnicity, parity, chronic hypertension (CHTN), diabetes mellitus, gestational diabetes mellitus (GDM), preterm delivery <32 weeks, maternal age?≥?35, maternal age?≤?20, socioeconomic status, education, and <5 prenatal visits. Univariate and multivariate analyses were performed.

Results: Factors that increased the risk of eclampsia included Black (OR 1.46 [1.19–1.80]) and Hispanic race (OR 1.56 [1.35–1.79]), nulliparity (OR 1.59 [1.42–1.77]), maternal age?≤?20 (OR 1.85 [1.61–2.11]), preterm delivery <32 weeks (OR 1.41 [1.16–1.70]), and <5 prenatal care visits (1.74 [1.46–2.07]). Factors that decreased the risk of eclampsia included CHTN (OR 0.06 [0.03–0.10]), GDM (OR 0.80 [0.67–0.96]), maternal age?≥?35 (OR 0.70 [0.59–0.82]), and college education (OR 0.83 [0.74–0.94]).

Conclusions: Black and Hispanic race, nulliparity, maternal age?≤?20, preterm delivery <32 weeks, and <5 prenatal care visits increase the risk of eclampsia while CHTN, GDM, maternal age ≥?35, and college education are protective. The protective effect of CHTN is the most striking. The mechanisms are likely different and warrant further investigation.     

Grossesse et fibrome : quelles complications ?

ObjectiveWe have observed the association between uterine leiomyomas and complications during pregnancy, delivery and post-partum among our patients over the last 10 years.Patients and methodsWe realized a retrospective case-control study comparing pregnancy and delivery outcomes in women with and without leiomyomas. In order to strengthen our observations, we conducted both univariate and multivariate analyses, and carefully respected 3 matching criteria between the two groups: age, parity and date of delivery.ResultsOver a ten-year period, 117 (0.38%) women with at least one leiomyoma would give birth – among the 30,805 births registered in our unit. By multivariate analysis, the presence of leiomyomas was significantly associated with women's age over 35 (adjusted odds ratio [AOR] 2.48, 95% confidence interval (CI) [1.31–4.67]), smoking (AOR=4.3, [1.82–10.13]), cystitis (AOR = 6.55, [2.12–20.16]), hydramnios (AOR = 5.12, [1.57–16.65]), threatened preterm labor (AOR = 3.99, [1.66–9.56]), first trimester bleeding (AOR = 3.92, [1.62–13.26]), anaemia during pregnancy (AOR = 2.97, [1.30–6.78]), labor dystocia (AOR = 11.79, [2.80–49.56]), retained placenta (AOR = 4.25, [1.49–12.11] and neonatal pediatric intensive care (AOR = 4.44, [1.19–16.60]). Regarding cesarean delivery, the multivariate analysis found that women with several leiomyomas underwent 8.48 times more cesarean sections than women with a single leiomyoma (p = 0.001).Discussion and conclusionOur study shows how specific features are to be kept in mind regarding obstetric outcomes for women with leiomyomas. These results emphasise the need for good perinatal care and raise the question of the treatment of those leiomyomas before pregnancy with the development of non-invasive procedures.     

Adverse maternal and neonatal outcomes in women with preeclampsia in Iran

Background: Preeclampsia is relatively a common complication in pregnancy and is characterized by high blood pressure and protein in urine during pregnancy. Consistent with the adverse outcomes followed by preeclampsia, this study designed to investigate the how preeclampsia is associated with preterm, low birth weight (LBW), cesarean section, and weigh gain during pregnancy.

Methods: In this population-based cross-sectional study, 5166 deliveries from 103 hospitals in Tehran (Capital of Iran) were included in the analysis in 2015. The independent variable was preeclampsia during pregnancy and weight gain during pregnancy, preterm birth, cesarean section, and LBW were considered as interested outcomes. The data were analyzed by statistical Stata software (version 13, Stata Inc., College Station, TX).

Results: Adjusted results showed that the mean of weight gain in women with preeclampsia was significantly higher than women without preeclampsia (mean difference: 1.77?kg, 95%CI: 0.76–12.78, p?=?.001). The adjusted odds ratio for preterm birth, cesarean section, and LBW were 4.19 (95%CI: 2.71–6.48, p?=?.001), 1.92 (95%CI: 1.24–2.98, p?=?.003), and 1.19 (95%CI: 0.61–2.31, p?=?.599), respectively.

Conclusion: Weight gain in women with preeclampsia was higher than women without preeclampsia and also the odds of preterm birth, cesarean section and LBW in women with preeclampsia was higher than women without preeclampsia.     

Pregnancy outcome in women aged 40 years or more

Objective: The study aimed to analyze the pregnancy outcome of women aged 40 years or more. Methods: A matched retrospective cohort study comparing women aged 40 years or more with a control group aged 20 to 30 years is described. Multivariate logistic regression models were fitted for the prediction of preterm birth and cesarean delivery. Results: Pregnancy-induced hypertension, preeclampsia and placenta previa were similar in both groups, but a higher rate of gestational diabetes was found in elderly patients (odds ratio [OR] 3.820, 95% confidence interval [CI] = 1.400–10.400; p < 0.0001). Preterm delivery was significantly more frequent in elderly women (OR 1.847, 95% CI = 1.123–3.037; p = 0.020). Gestational diabetes and pregnancy-induced hypertension were strongly associated with preterm delivery and advanced maternal age was not an independent risk factor for preterm delivery. The cesarean delivery rate was significantly higher in the study group (OR 3.234, 95% CI = 2.266–4.617; p < 0.0001). The variables most influencing the cesarean delivery rate were maternal age, analgesia, parity, premature rupture of the membranes and gestational hypertension. No significant differences were detected in neonatal birth weight and Apgar score. Conclusions: Patients aged 40 years or more have been demonstrated to carry a favorable pregnancy and neonatal outcome, similar to younger patients. The risk of cesarean delivery was higher in patients with advanced maternal age, in nulliparous and in women with a previous cesarean section. The risk of preterm delivery was not related to age but it was strongly associated with gestational diabetes and pregnancy-induced hypertension.     

Maternal anemia effects during pregnancy on male and female fetuses: are there any differences?

Objective: Sideropenic anemia is a common pregnancy disorder. The relationship between anemia and adverse pregnancy outcome are contradictory, and it is related to the severity of the hemoglobin deficit. The aim of the study was to evaluate the relationship between maternal mild anemia at third trimester of pregnancy, fetal birth weight and fetal gender.

Study design: A retrospective study including 1131 single physiological term pregnancies was conducted. According to maternal Hb levels during the third trimester, pregnant women enrolled were divided in two groups: Group A (n?=?156) with Hb?≤?11?g/dl and Group B (n?=?975) with Hb?≥?11,1?g/dl.

Results: Maternal characteristics, gestational age at delivery, Apgar score and post-partum hemorrhage were similar between groups. However, when neonatal sex was considerate, female newborns of anemic women had a higher birth weight (p?=?0.01). Moreover, anemic women showed a significantly higher rate of emergency cesarean section (p?=?0.006), in particular when the newborn was a male (p=?0.03).

Conclusion: Maternal mild anemia in third trimester of pregnancy correlates with fetal birth weight, influencing fetal growth and delivery outcome on the basis of fetal gender. Even though the reason of this phenomenon is still unknown, these new data may represent a novel parameter to add significant prognostic information in relation to maternal mild anemia and neonatal outcome.     

IGF-1 is associated with fetal growth and preterm delivery in type 1 diabetic pregnancy

Aim: No data on IGF-1 and either preterm or preeclampsia have been reported so far in diabetic pregnancies. We evaluated consecutive measurements of IGF-1 for preeclampsia, preterm delivery and birth weight in type 1 diabetic pregnancy.

Setting: In an outpatient university clinic, 97 pregnant women were consecutively recruited for evaluation of indicators for deterioration of diabetes status and adverse perinatal outcome. At every visit, a blood sample for measurement of IGF-1 was drawn.

Results: IGF-1 levels from week 14 to 32 was consistently lower in women who delivered preterm compared with women whose delivered after gestational week 36; the increase in 2nd and 3rd trimester was steeper in those delivering at term than in women delivering preterm (p?=?0.032). IGF-1 in preeclampsia did not show the same relation in diabetic women (p?=?0.74). The lowest tertile of birth weight ratio (0.8–1.2) was associated with lower IGF-1 from week 14 to 32 (p?=?0.047, adjusted for preterm delivery and preeclampsia).

Conclusion: We found low IGF-1 levels associated with preterm delivery and low birth weight.     

Association of maternal serum progesterone in early pregnancy with low birth weight and other adverse pregnancy outcomes

Objective: To investigate the association of serum progesterone in first trimester with low birth weight (LBW, birth weight <2500?g) and other adverse pregnancy outcomes including hypertensive disorders of pregnancy, preterm delivery, premature rupture of membranes at term, and preterm premature rupture of membranes in a general population.

Methods: We conducted a cohort study of 263 women with low-risk singleton intrauterine pregnancies who had a spot serum progesterone measurement in the first trimester in a Singapore tertiary maternity hospital. Study outcomes were retrieved from clinical records. Follow-up data were available for 131 women. Univariate and multivariate logistic regression analyses were performed to assess the association of low serum progesterone (<35?nmol/L) with LBW and other adverse pregnancy outcomes.

Results: Low serum progesterone was associated with a significantly increased risk of LBW (adjusted odds ratio: 5.28 [1.02, 27.3]; p=0.047). Low serum progesterone was associated with a significantly increased risk of hypertensive disorders of pregnancy in univariate analysis (unadjusted odds ratio: 8.43 [1.31, 54.2]; p=0.025).

Conclusion: Low serum progesterone in the first trimester is a significant risk factor for LBW and possibly other placental dysfunction disorders such as hypertensive disorders of pregnancy. Further studies with larger sample sizes are needed to confirm the associations.     

Effect of second trimester and third trimester weight gain on immediate outcomes in neonates born to mothers with gestational diabetes: a retrospective observational study from India

Abstract

Aim: To evaluate the effect of second trimester and third trimester rate of weight gain on immediate outcomes in neonates born to mothers with Gestational Diabetes Mellitus (GDM).

Method and material: This retrospective observational study enrolled 593 eligible mothers. The records of all pregnant women booked before 24?weeks and screened for diabetes were eligible if they were diagnosed with Gestational Diabetes Mellitus (GDM) anytime during pregnancy. All the necessary maternal and neonatal details were collected from hospital database. The rate of weight gain was calculated at 18–24?weeks, 28–30?weeks, and that before delivery. The enrolled women were categorized into: poor weight gain, normal weight gain, and increased weight.

Results and discussion: The mean birth weight, length, and head circumference of neonates were significantly lower in women who had poor rate of weight gain in comparison with normal weight gain group. The mean prepregnancy BMI was significantly high in women with increased rate of weight gain when compared to normal weight gain women in second and third trimester. Regression analysis done to evaluate the independent effect of weight gain on C section and neonatal complications, showed that the independent predictors for cesarean section were previous cesarean section or 12.5 (95% CI 6.7–23) and conception by assisted reproductive technologies or 1.75 (95% CI 1.01–4.3), and the neonatal complications were influenced by birth weight or 1.5 (95% CI 1.1–2.2) and weight gain during second trimester or 1.26 (95% CI 1–1.6).

Conclusion: In women with GDM, reduced weight gain during pregnancy is associated with small for gestational age neonates. Caesarean section is predicted by previous C-section, and mode of conception whereas neonatal complications were predicted by birth weight and maternal weight gain during second trimester.     

Exercise During Pregnancy and Cesarean Delivery: North Carolina PRAMS, 2004–2005

Background: The current rate of cesarean delivery in the United States is 31 percent. Previous studies have suggested that exercise during pregnancy may be associated with a lower risk of cesarean delivery, but sample sizes were small and methods often inadequate. This study examined whether or not an association exists between prenatal exercise and delivery mode using data from the 2004 and 2005 North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Methods: PRAMS postpartum questionnaire responses about frequency of exercise during the last 3 months of pregnancy for 1,955 women without a prior cesarean delivery were linked to birth certificates. Results: Among 1,342 women delivering at term, exercise was not associated with delivery mode in this data set: compared with women exercising less than once a week, neither women exercising one to four times per week nor those exercising five times or more per week had an altered risk of cesarean (risk ratio [RR] [95% confidence limit] [CL] 0.89 [0.69–1.15], 1.04 [0.66–1.64], respectively, adjusted for parity, gestational age, hypertension). Among 613 women delivering preterm, the results were also not statistically significant, but a compelling trend toward a protective effect could be seen (RR [95% CL] 0.65 [0.38–1.13], 0.62 [0.29–1.33]). Conclusions: Maternal self‐reported frequency of exercise during pregnancy was not associated with a reduced risk of cesarean delivery. Larger studies with better exposure ascertainment may provide a more definitive answer.     

Azurocidin levels in maternal serum in the first trimester can predict preterm prelabor rupture of membranes

Abstract

Objective: To determine the possible association between azurocidin in maternal serum in the first trimester of pregnancy and subsequent spontaneous preterm labor, preterm prelabor rupture of membranes, and iatrogenic preterm delivery.

Methods: Women who underwent first trimester screening for chromosomal abnormalities between January and November 2011 were included in the study, and a sample of maternal serum was obtained. In total, 1905 women were followed-up through the local record system, and 13 women with spontaneous preterm labor, 17 women with preterm prelabor rupture of membranes (PPROM), and 16 women with iatrogenic preterm delivery were identified. Twenty-two women with uncomplicated pregnancies who delivered at term were selected as controls. Maternal serum azurocidin levels in women were determined using ELISA.

Result: Women with PPROM had lower azurocidin levels (median 0.91?ng/mL, range 0.2–2.07) than women who delivered at term (median 1.63?ng/mL, range 0.4–10.98; p?=?0.02). No differences in azurocidin levels between women with labor at term and those with either spontaneous preterm labor (median 1.46?ng/mL, range 0.19–2.59; p?=?0.42) or iatrogenic preterm delivery (median 1.60?ng/mL, range 0.66–7.96; p?=?0.27) were found.

Conclusions: Low levels of azurocidin in maternal serum in the first trimester were associated with subsequent PPROM.     

Reduction of twin pregnancy to singleton: does it improve pregnancy outcome?

Objective.?To compare pregnancy complications, obstetrical and neonatal outcome of twin pregnancies reduced to singleton, with both non-reduced twin pregnancies and singleton pregnancies.

Methods.?A retrospective case–control study was performed at the Obstetrics and Gynecology Ultrasound unit of a tertiary referral medical center. Patient's population included 32 bi-chorionic bi-amniotic twin pregnancies reduced to singleton and 35 non-reduced twin pregnancies. Thirty-six patients with singleton pregnancies comprised the second control group. Main outcome measures were rates of pregnancy complications, preterm delivery (both before 37 weeks of gestation and before 34 weeks of gestation), late abortions, intra-uterine growth retardation, cesarean section, mean birth weights, and mean gestational age at delivery.

Results.?The reduced twin pregnancies group had similar rates of total pregnancy complications, preterm deliveries, and cesarean section as non-reduced twins. Gestational age at delivery and mean birth weight were also similar to non-reduced twins and significantly different compared with singletons. Preterm delivery and late abortion incidences were significantly higher when reduction was beyond 15 weeks gestation.

Conclusions.?Reduction of twin pregnancy to singleton does not change significantly pregnancy course and outcome. Favorable obstetrical and neonatal outcomes could be achieved by performing early, first trimester reductions.     

First trimester thyroid stimulating hormone as an independent risk factor for adverse pregnancy outcome

Purpose: Maternal thyroid gland dysfunction may adversely affect pregnancy outcome. We aimed to examine the association between subclinical thyroid dysfunction, both hypothyroidism and hyperthyroidism, to adverse pregnancy outcome.

Materials and methods: Retrospective cohort study of all women with an available first trimester thyroid function testing and known pregnancy outcome, categorized to subclinical hypothyroidism, or hyperthyroidism and evaluated for complication during gestation and delivery.

Results: Four thousand five hundred and four women were included in the final analysis – 3231 were euthyroid, 73 (1.6%) were categorized as subclinical hyperthyroidism and 1200 (26.6%) had subclinical hypothyroidism. Low thyroid-stimulating hormone (TSH) levels, i.e. subclinical hyperthyroidism, correlates with higher rates of placental abruption and extremely low birth weight, below 1500?g. Also, the risk for preterm delivery prior to 34 gestational weeks is higher among women with subclinical hypothyroidism, with greater risk among those with a higher TSH level. (OR 1.81, 95% CI 1.0–3.28 for TSH 2.5–4.0 mIU/L and OR 2.33, 95% CI 1.11–4.42 for those with TSH?>?4 4.0 mIU/L).

Conclusions: Subclinical hypothyroidism is associated with an increased risk for preterm delivery prior to 34 gestational weeks. Additionally, subclinical hyperthyroidism may also have a role in adverse pregnancy outcome – low birth weight and placental abruption – although this needs to be further explored.     

Comparison of perinatal outcomes of selective termination in dichorionic twin pregnancies performed at different gestational ages

Objective: To determine the perinatal outcomes of selective termination in dichorionic twin pregnancies discordant for major but non-lethal fetal anomalies performed at different gestational ages.

Methods: Thirty-one dichorionic twin pregnancies that underwent selective termination for discordant major but non-lethal fetal anomalies between January 2004 and February 2015 were retrospectively reviewed. The patients were grouped into three, according to the gestational age at which selective termination of pregnancies was performed; Group 1 (15–19 weeks), Group 2 (20–24 weeks) and Group 3 (30–33 weeks). Perinatal outcomes in all the three groups were reviewed and analyzed.

Results: The overall live birth, term birth and pregnancy loss rate were 93.6%, 54.8% and 9.6%, respectively. The overall live birth rate was 66.6% in Group 1, this rate was 100% in Group 2 and Group 3 (p?=?0.01). The rate of pregnancy loss was significantly higher in Group 1 (p?=?0.01). The overall preterm delivery rate was 38.7%. While the overall preterm delivery rate was significantly higher in Group 3 (p?=?0.04), the rate of extremely and very preterm birth was significantly lower (p?=?0.03).

Conclusion: Late selective feticide performed during the third trimester of pregnancy seems to be a safe approach and can be offered as an alternative method to reduce the total pregnancy loss and extremely and early pre-term birth rates.     

Fish oil supplementation improves pregnancy outcomes and size of the newborn: a meta-analysis of 21 randomized controlled trials

Objective: To observe the effects of fish oil on related pregnancy outcomes.

Methods: A systematic search of the Medline, EMBASE and Cochrane’s library databases was conducted for the randomized controlled trials published till February 2015 that compared the effects of fish oil supplementation with a control diet in women during pregnancy.

Results: Twenty-one studies comprising 10?802 pregnant women were included. Dietary fish oil was associated with a 5.8-day increase in gestational age of the newborn, a 22% reduced risk for early preterm delivery (risk ratio [RR]?=?0.78, 95% CI: 0.64–0.95, p?=?0.01) and a 10% reduction in preterm delivery (RR?=?0.90, 95% CI 0.81–1.00, p?=?0.05). Fish oil supplementation was associated with higher infantile birth weight (51.23?g), birth length (0.28?cm) and head circumference (0.09?cm), and a 23% lower risk of low birth weight. No benefit from fish oil supplementation was found with regard to risk of intrauterine growth restriction or stillbirth.

Conclusions: Dietary fish oil during pregnancy was associated with reduced risk of preterm delivery and improved size of the newborn. Fish oil during pregnancy may be an effective prophylactic for preterm delivery.     

Non-medical factors affecting antenatal preferences for delivery route and actual delivery mode of women in southwestern Iran

Objective: Assessment of the contribution of non-medical factors to mode of delivery and birth preference in Iranian pregnant women in southwestern Iran.

Study design: This cohort study used data from a structured questionnaire completed in early pregnancy and information about the subsequent delivery obtained through personal contact. Women were recruited by random sampling from antenatal clinics when scheduling visits over the course of 5 weeks from December 2012 to February 2013 and were followed-up 1 month after birth. Of the 2199 women recruited, 99.63% were eligible for the study.

Results: Of the 748 women who expressed a desire to deliver their babies by cesarean section (CS) in early pregnancy, 87% had an elective cesarean section. The logistic regression analyses showed that normative beliefs (odds ratio [OR] 1.792, 95% confidence interval (1) 1.073–2.993), control beliefs (OR: 0.272, 95% CI: 0.162–0.459), and evaluation of outcomes (OR: 0.431, 95% CI: 0.268–0.692) favored the preference for cesarean section. The desire for delivery by elective cesarean section was associated with normative beliefs (OR: 1.138; 95% CI: 1.001–1.294), control beliefs (OR: 0.804; 95% CI: 0.698–0.927), and expectations about maternity care (OR: 0.772; 95% CI: 0.683–0.873), medical influences (OR: 1.150; 95% CI: 1.023–1.291), evaluation of outcome (OR: 0.789; 95% CI: 0.696–0.894), age, preference for cesarean section (OR: 5.445; 95% CI: 3.928–7.546), spouse educational level, and number of live births.

Conclusions: A woman’s preference for delivery by cesarean section influenced their subsequent mode of delivery. Asking women in early pregnancy about their preferred mode of delivery provides the opportunity to extend their supports which might reduce the rate of elective cesarean section. This decision is affected by age, spouse educational level, number of live births, and preconceived maternal attitudes about delivery.