How to date pregnancy?

Accurate gestational assessment is essential for adequate growth assessment, appropriate aneuploidy screening and correct management of term. Based on expert opinion and beside ART pregnancies, it is recommended to use crown-rump length (CRL) to determine date of conception whenever there is an appropriate measurement taken at 11-14 weeks. This allows accurate dating at approximately 5 days in 95% of cases.     

Can we predict delivery date with obstetric ultrasound?

Abstract

Objective: The long-term prediction of delivery date with obstetric ultrasound.

Method: The cervical length (CL) and the fetal vertebral, middle cerebral and umbilical resistance indices were measured in 317 pregnancies between 30 and 37 weeks. Subsequently, multivariate analysis was applied to calculate the best model for the prediction of delivery date.

Results: The best model included the examinations of the CL and the middle cerebral artery resistance index. In comparison with estimated delivery date (EDD) based on the last menstrual period, a small improvement was detected, particularly in earlier deliveries, however 34% of predictions still had an error of more than 5 days.

Conclusions: Long-term sonographic prediction of delivery date depends mainly on the CL and improves the prediction of the EDD. However, it is still too inaccurate for clinical use.     

How common is real repeated implantation failure? An indirect estimate of the prevalence

Research questionWhat is the real prevalence of repeated implantation failure (RIF) and what reliable estimates can be given on the risk of false–positive diagnosis after two or three failed IVF attempts.DesignA recent theoretical model suggested that commonly used definitions (two or three failed IVF attempts in good-prognosis couples) may expose couples to substantial odds of overdiagnosis and overtreatment. This model, however, was theoretical and based on unproven assumptions that the pregnancy rate in the non-RIF population was 30% and the prevalence of RIF was 10%. In the present study, we applied this model to real data to distinguish the real prevalence of RIF and to provide more reliable estimates on the risk of false–positive diagnosis after two or three failed IVF attempts. To this aim, we retrospectively selected 1221 good-prognosis couples and evaluated pregnancy rates up to the third cycle.ResultsThe clinical pregnancy rate at first, second and third IVF cycle was 52%, 41% and 28%, respectively. A pregnancy rate of 61% was extrapolated in the non-RIF population and 15% among women who had experienced RIF. Therefore, the rate of false–positive diagnoses of RIF after two, three and six failed cycles would be 46%, 25%, and 2%, respectively.ConclusionsOur analyses show that estimated prevalence of RIF is 15%. The frequently used definition of RIF based on three failed attempts (but not two) in good-prognosis couples seems justified. Physicians, however, should bear in mind that couples may be inappropriately labelled with this condition in one out of four cases.     

Educating skilled birth attendants in Mexico: do the curricula meet international confederation of midwives standards?

Although the majority of births in Mexico are attended by skilled birth attendants, maternal mortality remains moderately high, raising questions about the quality of training and delivery care. We conducted an exhaustive review of the curricula of three representative schools for the education and clinical preparation of three types of birth attendant - obstetric nurses, professional midwives and general physicians - National Autonomous University of Mexico (UNAM) School of Obstetric Nursing; CASA Professional Midwifery School; and UNAM School of Medicine, Iztacala Campus. All curricular materials were measured against the 214 indicators of knowledge and ability in the International Confederation of Midwives (ICM) skilled attendant training guidelines. The CASA curriculum covered 83% of the competencies, 93% of basic knowledge and 86% of basic abilities, compared with 54%, 59% and 64% for UNAM Obstetric Nursing School and 43%, 60% and 36% for UNAM School of Medicine, respectively. Neither the Obstetric Nursing School nor the School of Medicine documented the quantity or types of clinical experience required for graduation. General physicians attend the most births in Mexico, yet based on our analysis, professional midwives had the most complete education and training as measured against the ICM competencies. We recommend that professional midwives and obstetric nurses should be formally integrated into the public health system to attend deliveries.     

Practising midwifery independently: For the majority of midwives?

This paper explores the proposition that all midwives can practise independently regardless of their place of practice or employment status. That independence can be defined by the way in which the midwife practises is discussed. The theory of midwifery as a partnership is reviewed and its effects on midwifery as a profession will be explored. How this relates to Victoria and the absence of regulations will also be discussed. The need for continuity of care and women centred practice will be analysed in this context. Advocacy, as used by midwives, will be examined, as will midwife empowerment of the woman and the midwife.     

Can the importance of midwives be measured in deaths?

The devastating consequences of maternal mortality are nowhere more evident than in Uganda, where more than 6000 mothers die as a result of childbearing every year (WHO 2010). Maternal death not only devastates the families concerned but harms future generations in terms of economic and social stability. Most of the maternal deaths in sub-Saharan Africa could be prevented by the attendance of a midwife. In Gulu, Northern Uganda, 60 per cent of women birth unattended. The facts surely speak for themselves. The world needs midwives now more than ever. Midwives have the potential to affect health on an individual and global scale and we should not underestimate the potential of the profession.     

What to do after a failed attempt of vacuum delivery?

OBJECTIVES: To determine whether there is a difference in maternal and neonatal outcomes if a sequential operative vaginal or cesarean delivery follows failed vacuum delivery. STUDY DESIGN: A cross sectional study. We have analyzed maternal and neonatal outcomes of 215 vacuum extractions (group 1), 106 forceps assisted deliveries (group 2), 28 deliveries in which failed vacuum extraction were followed by forceps delivery (group 3) and 22 deliveries in which failed vacuum extraction were followed by cesarean delivery (group 4). RESULTS: Compared to other groups, patients in group 4 had significantly more post partum anemia, meconium stained amniotic fluid and hospital stay (both maternal and neonatal) as well as lower pH. Apgar scores were similar in groups 3 and 4. Incidence of respiratory distress syndrome, cephalhematoma and jaundice were similar in neonates of all groups. CONCLUSIONS: If an attempted vacuum delivery has failed, the risk of adverse neonatal outcome is increased with either subsequent forceps or cesarean delivery. It should remain in the judgment of the attending obstetrician to choose the method most suitable under the given circumstances.     

What do midwives think about interprofessional working and learning?

Objective

this study describes the views of midwives and educators regarding interprofessional working and learning within midwifery care.

Design

qualitative methods using semi-structured interviews and focus groups.

Participants

39 participants, drawn from three participant groups - midwifery educators, newly qualified midwives and Heads of Midwifery - from four university sites throughout the UK took part in the research.

Findings

midwives are called upon to work collaboratively with other professionals during the daily provision of maternity care. Midwives are aware of the competencies required for effective collaboration and are supportive of the inclusion of interprofessional education in the training of student midwives. However, the relevance of this education was questioned by some participants because it is not apparent whether its inclusion will result in midwives who are better able to collaborate.

Key conclusions

midwives are supportive of interprofessional learning for students but are uncertain whether it will result in changes in practice.

Implications for practice

interprofessional education may support collaboration in practice, but future educational research aimed at understanding how learning is applied to practice is needed.     

Does the mode of delivery affect the birthweight? [corrected

OBJECTIVE(S): To investigate whether the mode of delivery effects the birthweight. STUDY DESIGN: In this retrospective study, 3092 singleton live births following uncomplicated pregnancies were analyzed. Birthweights were expressed as multiples of the median (MoM) for the relevant gestational week. The birthweight of children born vaginally was compared with those born by cesarean section. RESULTS: The birthweight of children born vaginally was lower than that of those born by cesarean section. However, this difference was not observed at all gestational ages. Increasing cesarean rates and birthweights throughout years were observed, and the women, who delivered by cesarean section, were older than those, who delivered vaginally. CONCLUSION(S): It appears that mode of delivery has negligible effect on birthweight.     

Preference toward future mode of delivery: how do antepartum preferences and prior delivery experience contribute?

Objective: Examine postpartum preferences toward future mode of delivery (MOD), considering recent MOD, antepartum preferences, and demographics.

Study design: Prospective cohort study where a survey was distributed in outpatient obstetrics clinics to pregnant women over 18 years at 28 weeks gestation or later. Surveys gathered demographics, obstetric history, and preference toward vaginal delivery (VD) versus cesarean delivery (CD). Women were again surveyed at 6–8 weeks postpartum. Chi-square test compared proportions, and logistic regression controlled for potential confounders.

Results: A total of 299 women returned postpartum surveys and expressed preferences. Comparing women who experienced VD versus CD, the majority who had a VD (92.1%) would choose this again, while only 1.9% preferred CD. Among the CD group, preferences were mixed: 29.4% desired repeat CD, 34.1% preferred VD, and 36.5% were undecided (p?<?0.001). Adjusted odds were 34.4 (95% CI 9.4–126.1) for preferring VD over CD among women who experienced a recent VD, adjusting for parity, age, ethnicity, education, possible depression, and type of provider.

Conclusions: The majority of women preferred VD postpartum. Of the minority who desired CD, antenatal preference for cesarean and prior experience with CD were important factors. This highlights the impact of individual desires and experience, and underscores importance of antenatal counseling.