Risk factors for neonatal transfers from the Sapopemba free-standing birth centre to a hospital in São Paulo, Brazil

Objectiveto identify risk factors associated with neonatal transfers from a free-standing birth centre to a hospital.Designepidemiological case–control study.Settingmidwifery-led free-standing birth centre in São Paulo, Brazil.Participants96 newborns were selected from 2840 births between September 1998 and August 2005. Cases were defined as all newborns transferred from the birth centre to a hospital (n=32), and controls were defined as newborns delivered at the same birth centre, during the same time period, and who had not been transferred to a hospital (n=64).Measurements and findingsdata were collected from medical records available at the birth centre. Univariate and multivariate analyses were performed using logistic regression. The multivariate analysis included outcomes with p<0.25, specifically: smoking during pregnancy, prenatal care appointments, labour complications, weight in relation to gestational age, and one-minute Apgar score. Of the foregoing outcomes, those that remained in the full regression model as a risk factor associated with neonatal transfer were: smoking during pregnancy [p=0.009, odds ratio (OR)=4.1, 95% confidence interval (CI) 1.03–16.33], labour complications (p<0.001, OR=5.5, 95% CI 1.06–28.26) and one-minute Apgar score ?7 (p<0.001, OR=7.8, 95% CI 1.62–37.03).Key conclusions and implications for practicesmoking during pregnancy, labour complications and one-minute Apgar score ?7 were confirmed as risk factors for neonatal transfer from the birth centre to a hospital. The identified risk factors can help to improve institutional protocols and formulate hypotheses for other studies.     

Association of maternal pre-pregnancy weight with birth defects: Evidence from a case–control study in Western Australia

Background: Maternal obesity confers increased risks of poor pregnancy outcomes. There are limited Australian data on the risk of birth defects associated with maternal pre-pregnancy obesity.
Methods: Population-based case–control study of 418 controls, 111 cases with heart defects (and of these, 38 had conotruncal heart defects), 27 with neural tube defects, 86 cases with urinary tract defects, 48 cases with orofacial clefts, and 20 with limb reduction defects. Maternal pre-pregnancy weight and height were self-reported.
Results: Women with pre-pregnancy obesity (body mass index 30+) had a twofold increased odds of having an infant with neural tube defects, conotruncal heart defects, orofacial clefts and limb reduction defects and 30–40% increase in heart defects generally and urinary tract defects. None of the estimates was statistically significant.
Conclusions: Our findings were consistent with similar, statistically significant studies in the literature. Weight reduction prior to pregnancy in obese women may be a means of primary prevention of birth defects.     

Oral and cervical HPV infection in HIV-positive and HIV-negative women attending a sexual health clinic in São Paulo,Brazil

Objective

To investigate the prevalence of HPV infections in the oral and cervical mucosa of HIV-positive and HIV-negative women attending a sexual health clinic.

Methods

One-hundred HIV-positive women and 100 HIV-negative women were recruited from a sexual health clinic in São Paulo, Brazil. All participants were given an oral and cervical examination. Cytologic samples were evaluated via HPV DNA test.

Results

In oral samples, HPV DNA was observed in 11 women from the HIV-positive group and 2 from the HIV-negative group. High-risk HPV subtypes were prevalent in both groups and no difference between groups was detected. HPV DNA was detected in cervical scrapings from 41 HIV-positive women and 45 HIV-negative women (P = 0.67). No participants showed oral lesions, whereas 15 HIV-positive and 17 HIV-negative women presented with macroscopic genital lesions.

Conclusion

HPV is detected more often in cervical scrapings than in oral samples. However, HPV oral shedding is more frequent in HIV-positive than in HIV-negative individuals. Concurrence of infection (high and low risk) was not observed in oral and cervical mucosa.     

Placental histology in spontaneous and indicated preterm birth: A case control study

IntroductionPlacental pathology is an important contributor in preterm birth, both spontaneous and indicated. The aim of this study was to describe and compare placental histological features of spontaneous preterm birth versus indicated preterm birth.MethodsA case control study was performed at the University Medical Center Utrecht. Women with spontaneous or indicated preterm birth (17–37 weeks of gestation) delivered in 2009 were included. Women with a pregnancy complicated by congenital and/or chromosomal abnormalities were excluded. Placentas were systematically examined by an expert pathologist blinded for pregnancy outcome, except for gestational age. Placental histological abnormalities were classified into infectious inflammatory lesions and maternal vascular malperfusion lesions and compared between spontaneous and indicated preterm birth. Analysis was stratified for immature (17–23⁺⁶ weeks), extremely (24–27⁺⁶ weeks), very (28–31⁺⁶ weeks) and moderate/late (32–36⁺⁶ weeks) preterm birth.ResultsWe included 233 women, 121 women with spontaneous preterm birth and 112 women with indicated preterm birth. Among women with spontaneous extremely preterm birth, higher rates of severe chorioamnionitis were found (56.0% vs. 0%). Furthermore, a shift from infectious-inflammatory lesions to maternal vascular malperfusion lesions was seen after 28 weeks; in women with spontaneous very and moderate/late preterm birth, maternal vascular malperfusion lesions were the main finding (46.8% and 47.7% respectively). In women with indicated preterm birth, maternal vascular malperfusion lesions were most often contributing through all gestational age categories.ConclusionMaternal vascular malperfusion lesions are most frequent in both spontaneous and indicated very and moderate/late preterm birth. In spontaneous extreme preterm birth chorioamnionitis is the main finding.     

Cumulative live birth rate after two single frozen embryo transfers (eSFET) versus a double frozen embryo transfer (DFET) with cleavage stage embryos: a retrospective cohort study

Purpose

According to the latest ART report for Europe, about 13 % of pregnancies after frozen embryo transfer are multiple. Our objective was to analyse the impact on the multiple pregnancy rate of two eSFET (elective single frozen embryo transfers) versus a DFET (double frozen embryo transfer) in women aged under 38 years, who had not achieved pregnancy in their fresh transfer and who had at least two vitrified embryos of A/B quality.

Methods

This study was conducted from January 2010 to June 2013 at a public hospital. The couples were divided into three groups. Group DFET: the first cryotransfer of two embryos (105 women); cSFET group: the only cryotransfer of a single vitrified embryo (60 women); eSFET group, individually vitrified embryos: 20 patients included in a clinical trial of single-embryo fresh and frozen transfer and 21 patients who chose to receive eSFET.

Results

The clinical pregnancy rate was 38.1 % in the DET group and the cumulative clinical pregnancy rate was 43.3 % in the eSFET group. There were no significant differences between the DFET and eSFET groups (30.0 vs 34.1 %) in cumulative live birth delivery rate. The rate of multiple pregnancies varied significantly between the DFET and eSFET groups (32.5 vs 0 %, p < 0.05).

Conclusions

For good-prognosis women aged under 38 years, taking embryo quality as a criterion for inclusion, an eSFET policy can be applied, achieving acceptable cumulative clinical pregnancy and live birth rates and reducing multiple pregnancy rates.     

Tormented by ghosts from their past’: A meta-synthesis to explore the psychosocial implications of a traumatic birth on maternal well-being

Background

women can experience an array of serious and enduring morbidities following a difficult or traumatic childbirth. These complications have a negative impact on maternal behaviours and infant and family well-being.

Objective

to undertake a meta-synthesis of existing qualitative research to explore the psychosocial implications of a traumatic birth on maternal well-being.

Method

a systematic review across 10 databases was undertaken: Nursing and Allied Health Source, Medline, the Allied and Complementary Medicine Database (AMED), Embase, PsychINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), International Bibliography of Social Sciences (IBSS), Science Direct, Academic Search Complete and Health Management Information Consortium. Quality appraisal was conducted and Noblit & Hare's meta-ethnographic method adopted to identify first, second and third order constructs within the selected papers.

Findings

13 papers were included in the final synthesis. Three third order constructs were identified and are described as ‘consumed by demons’ (through the intense negative emotions and responses they endured and the subsequent dysfunctional coping strategies employed); an ‘embodied sense of loss’ (through women's loss of self and family ideals) and ‘shattered relationships’ (which reflected the fractious and difficult relationships that women described with their infants and partners). A line of argument synthesis was developed which revealed how women are ‘tormented by ghosts’ from their past.

Conclusions and implications for practice

this synthesis reveals how a traumatic birth experience can lead to women being drawn into a turmoil of devastating emotions that have long-term, negative repercussions on self-identity and relationships. Professionals require training, awareness and skill development to prevent against trauma and to enable them to identify and sensitively respond to women's psychosocial concerns. Further insights and research into the timing and type of interventions to resolve postnatal morbidity following a traumatic birth are needed.     

Homocysteine,red cell,and plasma folate concentrations and birth weight in Italian women: results from a prospective study

Objective.?A prospective cohort study conducted in Italy on homocysteine and red cell folate levels in pregnancy and pregnancy outcome.

Methods.?A cohort of pregnant women was identified in 21 Italian obstetric centers. Women were eligible at 8th–10th week of gestation. All women were followed up to delivery in order to collect information on pregnancy outcome and birth weight (BW).

Results.?Two hundred forty-four women were included in the analysis. In women not reporting current use of folate at study entry, the median homocysteine levels (μmol/l) were 7.9, 8.1, and 8.5 at the 8th–10th, 16th, and 22nd week of gestation, respectively; the median red cells folate levels (nmol/dl) were 3.9, 6.1, and 7.0. The mean BW tended to be lower in the 2nd and 3rd tertile of homocysteine levels in comparison with the 1st tertile (p?<?0.05 at the 8th–10th and 22nd week). The mean week of gestation at birth was higher in subjects in the 2nd and 3rd tertile of red cell folate at the 8th–10th and 16th week of gestation.

Conclusion.?This study estimated homocysteine and plasma folate levels in Italian pregnant women and suggested that homocysteine level was associated with BW.     

Impacts of therapeutic hypothermia on cardiovascular hemodynamics in newborns with hypoxic-ischemic encephalopathy: a case control study using echocardiography

Purpose: The effects of therapeutic hypothermia (TH) on hemodynamics in newborns with hypoxic-ischemic encephalopathy (HIE) were evaluated.

Materials and methods: Thirty-two neonates (gestational age, 39.4?±?1.3 weeks) who had TH for HIE and echocardiographic hemodynamic assessments during TH and post-TH period were studied. Gestational-age-matched 34 healthy neonates were enrolled for comparison.

Results: During TH, patients had significantly decreased left ventricular cardiac output (LVCO), descending aorta blood flow (DABF), and DABF/LVCO ratio, and increased resistive index of DA compared to controls. Upper body blood flow (UBBF) remained unchanged but UBBF/LVCO ratio significantly increased during TH. Urine output decreased significantly during TH and increased after rewarming, and showed significant positive correlation with DABF/LVCO ratio. Sixteen patients (50%) showed hypoxic-ischemic (HI) lesions on brain magnetic resonance imaging (MRI) and had significantly increased UBBF/LVCO ratio during TH compared to patients without HI lesions. Patients with UBBF/LVCO ratio >55% had significantly higher risk of having HI lesions on brain MRI (odds ratio 13.0; 95% CI, 2.4–70.2).

Conclusions: Decrease in cardiac output and descending aorta blood flow, and preferential cerebral redistribution of cardiac output along with an increase in systemic peripheral vascular resistance may affect systemic organ perfusion and cerebral metabolism.     

Incidence changes in risk factors associated with the decreasing number of birth-related clavicle fractures in Finland: A nationwide retrospective birth cohort from 2004 to 2017

Background

A clavicle fracture is one of the most common birth injuries. The objective of this study was to examine whether the decreased incidence of birth-related clavicle fractures in Finland is because of temporal changes in their predisposing factors.

Methods

For this nationwide population-based study, we used the Finnish Medical Birth Register and the Care Register for Health Care databases. The study population included all singleton, live-born newborn born spontaneously or by vacuum-assisted delivery, in cephalic presentation ≥37⁺⁰ weeks of gestation. The incidences of clavicle fractures, pregnancy characteristics, and risk assessments for fracture were calculated and compared between two time periods: 2004–2010 and 2011–2017.

Results

A total of 629 457 newborn were born vaginally between 2004 and 2017. The clavicle fracture incidence decreased from 17.6/1000 to 6.2/1000 live births. Shoulder dystocia, diabetes, and birthweight ≥4000 g were the strongest predisposing factors. The incidence of birthweight ≥4000 g decreased, meanwhile type 1 diabetes and shoulder dystocia remained stable and gestational diabetes, type 2 diabetes, and maternal obesity increased in the later study period. The incidence of clavicle fractures without known predisposing factors declined. Simultaneously, the cesarean birth rate remained stable (13.2%–13.1%), although the rate of vacuum-assisted deliveries increased (8.5%–9.5%).

Discussion

The incidence of clavicle fractures decreased, even though the incidence of most risk factors remained stable or increased, and the cesarean birth rate remained stable. This decline may be related to the reduction of fracture incidence among deliveries without known risk factors, and the decrease in birthweight ≥4000 g.     

Factors associated with spontaneous perineal lacerations in deliveries without episiotomy in a university maternity hospital in the city of Recife,Brazil: a cohort study

Objectives: The objective of this study is to determine factors associated with spontaneous perineal laceration in low-risk pregnant women who delivered vaginally without episiotomy in a university maternity hospital in Recife, Pernambuco, Brazil.

Methods: A prospective cohort study was conducted with 222 low-risk, full-term pregnant women admitted in labor with a single fetus in cephalic presentation. Women with malformed fetuses were excluded from the study. The variables analyzed were: the frequency and severity of lacerations, the women’s biological, sociodemographic, clinical and obstetrical characteristics, neonatal characteristics, and data on their deliveries and procedures. For the data analysis, risk ratios and their 95% confidence intervals were calculated. A significance level of 5% was adopted and multiple regression analysis was performed.

Results: Spontaneous first-degree perineal tears were registered in 47% of the women, second-degree tears in 31%, and third degree tears in only 1.8%. There were no cases of fourth-degree tears. Having experienced normal childbirth previously constituted a protective factor against vaginal tearing (OR?= 0.46; 95%CI: 0.23–0.91; p?=?.027).

Conclusion: The principal protective factor against spontaneous lacerations was having experienced normal childbirth previously. Intrapartum strategies aimed at protecting the perineum and pelvic floor muscle training during prenatal care should be encouraged in these women.     

Bone densitometry status and its associated factors in peri and post menopausal females: A cross sectional study from a tertiary care centre in India

Objective

Osteoporosis is a skeletal disorder characterized by diminished bone strength that increases the risk of fracture at instances of trivial trauma. Asians have a lower bone mass than the west. The present study was designed to add data from India on women above the age of 40 years with respect to low bone mineral density (BMD) and its associated high risk factors.

Parental occupations and other risk factors associated with nonchromosomal single,chromosomal single,and multiple birth defects: a population-based study in Singapore from 1994 to 1998

OBJECTIVE: The purpose of this study was to evaluate the association between the prevalence of birth defects among maternal and paternal occupation groups in Singapore for live births between January 1, 1994, and December 31, 1998, and to determine whether there are certain demographic risk factors and maternal and/or paternal occupation groups that are associated with an increased risk for birth defects versus chromosomal single birth defect, nonchromosomal single birth defect, and multiple birth defects. STUDY DESIGN: This was a retrospective study. Information on live births (Singapore National Registry of Births and Deaths) and birth defect cases (National Birth Defects Register) were studied. Other information included the mother's date of birth, ethnic group, highest educational qualification, and the occupation of the mother and the father. Cox regression analysis was used to determine whether certain demographic and occupational factors were associated with the three groups of birth defects. RESULTS: Of a total of 237,755 live births, there were 3276 birth defect cases (nonchromosomal single birth defect, 1869 cases; chromosomal single birth defect, 197 cases; and multiple birth defects, 1210 cases). Increased risks for all types of birth defects were observed with advancing gestational age. Occurrence of nonchromosomal single birth defect and multiple birth defects were significantly higher for multiple births compared to singleton births. Significant associations were found with the use of "legislators, senior officers, and managers" as reference: Maternal occupation of "cleaners, laborers, and related workers" with chromosomal single birth defect anomalies (adjusted risk ratio, 4.86; 95% CI, 1.07-22.14); paternal occupation of "plant and machine operators and assemblers" (adjusted risk ratio, 1.50; 95% CI, 1.14-1.98) with nonchromosomal single birth defect; "production craftsmen and related workers" and "cleaners and laborers and related workers" with nonchromosomal single birth defect (adjusted risk ratio, 1.42; 95% CI, 1.10-1.82; and adjusted risk ratio, 1.43; 95% CI, 1.07-1.91 respectively); and multiple birth defects (adjusted risk ratio, 1.42; 95% CI, 1.03-1.94; and adjusted risk ratio, 1.47; 95% CI, 1.03-2.09, respectively). CONCLUSION: Maternal delivery age is an important risk factor for all birth defects. Mothers and fathers who work as "cleaners and laborers and related workers" appear to have a higher risk of giving birth to children with chromosomal single birth defect and nonchromosomal single birth defect and multiple birth defects, respectively. Further in-depth study would be needed to confirm these observations.     

Outpatient versus inpatient cervical ripening with a slow-release dinoprostone vaginal insert in term pregnancies on maternal,neonatal, and birth outcomes: A systematic review

Backgrounds

Outpatient induction of labor (IOL) is an alternative choice offered to pregnant women requiring cervical ripening. Outpatient IOL can provide solutions in terms of women empowerment, but most importantly promotes as normal labor as possible, within the medical context of the IOL. The objectives of this systematic review were to assess safety and effectiveness of cervical ripening performed with a slow-release dinoprostone vaginal insert in term pregnancies in two settings: the outpatient (home) versus the inpatient (hospital).

Methods

The electronic databases Cinahl, Embase, Medline and Maternity and Infant Care were searched to detect studies that met the inclusion criteria. Both reviewers collected the data and assessed the quality of the studies and assessed the pooled odds ratio using a 95% confidence interval and a random-effects model. Primary outcomes were linked to maternal and neonatal morbidity. Secondary outcomes were related to birth outcomes.

Results

No statistical difference was seen between the outpatient and inpatient setting in terms of maternal complications, neonatal morbidity, cesarean section, and labor onset <24 h. Women in the outpatient setting were significantly less likely to experience uterine hyperstimulation, and they were also significantly more likely to require oxytocin to augment or induce their labor than the women in the inpatient setting. Women in the outpatient setting were more satisfied with the cervical ripening experience.

Conclusions

Cervical ripening with a slow-release dinoprostone vaginal insert in term pregnancies in the outpatient setting appears as safe as the inpatient setting in terms of maternal, neonatal, and birth outcomes.