A comparison of symphysis-fundal height and ultrasound as screening tests for light-for-gestational age infants

The clinical efficiency of serial measurement of symphysis-fundal height (SFH) for the prediction of light-for-gestational age (LGA) infants was compared with that of a single measurement of fetal abdominal circumference (AC) by ultrasound in the third trimester. To make the tests comparable the lower cut-off point of AC was altered until the specificity matched that of SFH. The sensitivity of the AC measurement (83%) was slightly better than that of the SFH measurement (76%) but this difference was not statistically significant. Each test had a false positive rate of about 60% which is comparable with clinical assessment. Screening with both tests and predicting LGA with abnormal results from either test improved the sensitivity to 93% but, as expected, decreased the specificity to 67% and the positive predictive value to 32%. If ultrasound facilities permit both tests should be used otherwise SFH measurements only could screen for LGA with ultrasound back-up for those with low SFH results.     

A comparison of symphysis-fundal height and ultrasound as screening tests for light-for-gestational age infants

Summary. The clinical efficiency of serial measurement of symphysisfundal height (SFH) for the prediction of light-for-gestational age (LGA) infants was compared with that of a single measurement of fetal abdominal circumference (AC) by ultrasound in the third trimester. To make the tests comparable the lower cut-off point of AC was altered until the specificity matched that of SFH. The sensitivity of the AC measurement (83%) was slightly better than that of the SFH measurement (76%) but this difference was not statistically significant. Each test had a false positive rate of about 60% which is comparable with clinical assessment. Screening with both tests and predicting LGA with abnormal results from either test improved the sensitivity to 93% but, as expected, decreased the specificity to 67% and the positive predictive value to 32%. If ultrasound facilities permit both tests should be used otherwise SFH measurements only could screen for LGA with ultrasound back-up for those with low SFH results.     

Reducing genital tract trauma at birth: launching a clinical trial in midwifery

Genital tract trauma is a common outcome of vaginal birth, and can cause short-term and long-term problems for new mothers. Preventive measures have not been fully explicated. Midwives use a variety of hand maneuvers late in the second stage of labor, in the belief that genital trauma can be reduced. However, none of these care measures have been rigorously tested to determine if they are effective. A midwifery practice offers an ideal setting to study the relationship of hand techniques by the birth attendant to reduction of genital tract trauma.     

Five-dimensional long bones biometry for estimation of femur length and fetal weight at term compared to two-dimensional ultrasound: a pilot study

Background/objective: This study aimed to evaluate accuracy of five-dimensional long bones (5D LB) compared to two-dimensional ultrasound (2DUS) biometry to predict fetal weight among normal term women.

Methods: Fifty six normal term women were recruited at Ain Shams Maternity Hospital, Egypt from 14 May to 30 November 2015. Fetal weight was estimated by Hadlock’s IV formula using 2DUS and 5D LB. Estimated fetal weights (EFW) by 2DUS and 5D LB were compared with actual birth weights (ABW).

Results: Mean femur length (FL) was 7.07?±?0.73?cm and 6.74?±?0.67?cm by 2DUS and 5D LB (p?=?.02). EFW was 3309.86?±?463.06?g by 2DUS and 3205.46?±?447.85?g by 5D LB (p?=?.25). No statistical difference was observed between ABW and EFW by 2DUS (p?=?.7) or 5D LB (p?=?.45). Positive correlation was found between EFW by 2DUS, 5D LB, and ABW (r?=?0.67 and 0.7; p?p?=?.15).

Conclusions: 2DUS and 5D LB had same accuracy for fetal weight estimation at normal term pregnancy.     

Delivery room management of extremely low birth weight infants in Italy: comparison between academic and non-academic birth centres

Objective: International Guidelines provide a standardised approach to newborn resuscitation in the DR and, in their most recent versions, recommendations dedicated to management of ELBWI were progressively increased. It is expected that introduction in clinical practice and dissemination of the most recent evidence should be more consistent in academic than in non-academic hospitals. The aim of the study was to compare adherence to the International Guidelines and consistency of practice in delivery room management of extremely low birth weight infants between academic and non-academic institutions.

Methods: A questionnaire was sent to the directors of all Italian level III centres between April and August 2012.

Results: There was a 92% (n?=?98/107) response rate. Apart from polyethylene wrapping to optimise thermal control, perinatal management approach was comparable between academic and non-academic centres.

Conclusions: There were minor differences in management of extremely low birth weight infants between Italian academic and non-academic institutions, apart from thermal management. Although there was a good, overall adherence to the International Guidelines for Neonatal Resuscitation, temperature management was not in accordance with official recommendations and every effort has to be done to improve this aspect.     

Timing of operative vaginal delivery and associated perinatal outcomes in nulliparous women

Objective.?To compare perinatal outcomes in nulliparous women who had operative vaginal delivery early during second stage (1–3?h) to those who delivered vaginally with a prolonged second stage (>3?h).

Methods.?This is a retrospective cohort study of nulliparas with term, singleton, vaginal deliveries beyond the first hour of second stage. Women who underwent operative vaginal deliveries (OVD) during 1–3?h of the second stage were compared to women who delivered vaginally but with a second stage duration of >3?h. Perinatal outcomes were examined using chi-square test, and potential confounders were controlled for using multivariable logistic regression analysis.

Results.?Nulliparas delivered vaginally beyond 3?h of second stage had lower odds of third or fourth degree perineal lacerations (aOR?=?0.63, 95% CI 0.51–0.77), neonatal cephalohematoma (aOR?=?0.48, 95% CI 0.28–0.83) and admissions to intensive care nursery (aOR?=?0.70, 95% CI 0.49–0.99) compared to operative vaginal deliveries during 1–3?h of second stage.

Conclusion.?Compared to nulliparas who had operative vaginal deliveries performed early (1–3?h) in the second stage, women who delivered later (>3?h duration of second stage), either by spontaneous or operative vaginal delivery, had lower risk of third or fourth degree perineal lacerations without incurring risk of increased adverse neonatal outcomes.     

Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study

OBJECTIVES: The purpose of this study was to determine the frequency of perineal pain in the 6 weeks after vaginal delivery and to assess the association between perineal trauma and perineal pain.Study design This was a prospective cohort study of parturients at 1 day, 7 days,' and 6 weeks' post partum in an academic tertiary obstetric unit in Toronto, Canada. Four hundred forty-four women were followed up, including women with an intact perineum (n=84), first-/second-degree tears (n=220), episiotomies (n=97), or third-/fourth-degree tears (n=46). Primary outcome was the incidence of perineal pain on day of interview; secondary outcomes were pain score measurements and interference with daily activities. RESULTS: Perineal trauma was more common among primiparous women, those with operative vaginal deliveries, and those with epidural analgesia during the second stage of labor. The incidence of perineal pain among the groups during the first week was intact perineum 75% (day 1) and 38% (day 7); first-/second-degree tears 95% and 60%; episiotomies 97% and 71%; and third-/fourth-degree tears 100% and 91%. By 6 weeks, the frequency of perineal pain was not statistically different between trauma groups. CONCLUSION: Acute postpartum perineal pain is common among all women. However, perineal pain was more frequent and severe for women with increased perineal trauma.     

Comparison of magnetic resonance imaging to ultrasound in the estimation of birth weight at term

OBJECTIVE: This study was undertaken to compare magnetic resonance (MR) and ultrasound (US) fetal weight estimates obtained immediately before delivery with birth weight. STUDY DESIGN: Eighty women scheduled for a cesarean delivery underwent a fast acquisition MR and US for fetal weight estimation within 3 hours of delivery. Prospective MR calculation was based on the equation 0.12+1.031 g/mLxfetal volume (mL)=MR weight (g). US fetal weight estimation was calculated by the formula by Hadlock et al. Estimations were compared with birth weight. RESULTS: Correlation (95% CI) between birth weight and MR weight is 0.95 with a mean absolute error of 129 g (105-155) compared with the correlation between birth weight and US of 0.85 with a mean absolute error of 225 g (186-264). The correlation for birth weight and MR imaging is significantly greater than that of birth weight and US, P<.001. CONCLUSION: Birth weight estimation is more accurate by MR imaging than by US in term infants.     

The impact of obstetric gel on the second stage of labor and perineal integrity: a randomized controlled trial

Objective: Dianatal® is a bioadhesive gliding film which reduces the opposing force to vaginal childbirth. We aimed to investigate the safety, applicability, and impact of Dianatal® obstetric gel on second stage of labor and perineal integrity.

Methods: Low-risk singleton pregnancies at term were prospectively enrolled. Eligible women were randomly assigned to either labor management without using obstetric gel, or labor management using intermittent application of obstetric gel into the birth canal during vaginal examinations, starting at active phase of labor (≥4?cm dilation). The primary measured outcome was the length of second stage of labor.

Results: Overall, 200 cases were analyzed. Demographic, obstetrical, and labor characteristics were similar between the groups. Neither adverse events nor maternal or neonatal side effects were observed. The mean lengths of the active and second stages of labor were comparable between the obstetric gel-treated and the control groups (157 versus 219 min and 48 versus 56 min, respectively). None of the women had grade III/IV perineal tears. Maternal and neonatal outcomes were not negatively influenced by using obstetric gel. No difference was found after sub-group analysis for spontaneous vaginal delivery.

Conclusion: Dianatal® obstetric gel is safe in terms of maternal or neonatal use. Albeit a trend toward shorter labor stages using Dianatal® obstetric gel, no significant differences were noted among the groups. In order to further investigate the influence of the obstetric gel on labor stage interval, perineal integrity and maternal and neonatal outcomes, larger randomized clinical trials are needed to be carried out.     

Maternal age and incidence of low birth weight at term: a population study

A total of 184,567 singleton live births with gestational ages of 40 weeks were examined from the 1980-1984 Illinois birth certificate data to determine the independent effect of maternal age on the incidence of low birth weight at term. The incidence is highest in mothers less than 17 years of age (3.2%) and gradually declines with advancing maternal age to reach 1.3% in women aged 25 to 34 years. It increases to 1.7% for those greater than 35 years of age. To separate out the independent effect of maternal age on the incidence of low birth weight infants at term, the presence of other maternal factors, such as race, education, parity, marital status, and prenatal care, were adjusted by use of a series of multiple logistic regression analyses. All of these analyses consistently demonstrated that the adjusted risk for low birth weight at term is the lowest in teenagers and increases with advancing maternal age. These results indicate that the high incidence of this factor in young mothers apparently reflects their poor sociodemographic and prenatal care status. Advancing maternal age is associated with a decreased potential for fetal growth, possibly reflecting biologic aging of maternal tissues and systems or the cumulative effects of disease.     

Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial

Genital tract trauma after spontaneous vaginal childbirth is common, and evidence-based prevention measures have not been identified beyond minimizing the use of episiotomy. This study randomized 1211 healthy women in midwifery care at the University of New Mexico teaching hospital to 1 of 3 care measures late in the second stage of labor: 1) warm compresses to the perineal area, 2) massage with lubricant, or 3) no touching of the perineum until crowning of the infant's head. The purpose was to assess whether any of these measures was associated with lower levels of obstetric trauma. After each birth, the clinical midwife recorded demographic, clinical care, and outcome data, including the location and extent of any genital tract trauma. The frequency distribution of genital tract trauma was equal in all three groups. Individual women and their clinicians should decide whether to use these techniques on the basis of maternal comfort and other considerations.     

Five-year outcome of preterm and very low birth weight infants: a comparison between maternal and neonatal transport.

OBJECTIVE: To determine the 5-year outcome of very low birth weight infants referred to tertiary perinatal centers. METHODS: This study was part of a Dutch national collaborative survey of 1338 newborn infants younger than 32 weeks' gestation and/or with a birth weight of less than 1500 g born in 1983. Comparisons were made between maternal transport to university hospital perinatal centers versus delivery in local hospitals, and between neonatal transport to these centers versus treatment in local hospitals. For the 252 survivors meeting the entry criteria for this part of the study, adverse outcome at 5 years of age was evaluated by logistic regression analysis, including 26 perinatal risk factors as confounding variables. Outcome variables were disabilities and handicaps at 5 years as defined by the World Health Organization. RESULTS: There were no differences in handicaps and disabilities between infants born after maternal transport and those born in local hospitals. Handicaps and disabilities in neonates transported versus those treated in local hospitals were also not statistically different despite selection bias. CONCLUSIONS: The previously reported decrease in neonatal mortality risk after maternal transfer is not accompanied by an increased risk of adverse outcome for the survivors. In threatening very preterm delivery, maternal transport to a tertiary center is recommended.     

The association between birth weight at term and long-term endocrine morbidity of the offspring*

Objective: To investigate whether small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth weight at-term poses an increased risk for long-term pediatric endocrine morbidity.

Study design: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to endocrine morbidity of singleton children born SGA, appropriate-for-gestational-age (AGA), and LGA at-term. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders.

Results: During the study period, 235,614 deliveries met the inclusion criteria; of which 4.7% were SGA (n?=?11,062), 91% were AGA (n?=?214,249), and 4.3% were LGA neonates (n?=?10,303). During the follow-up period, children born SGA or LGA at-term had a significantly higher rate of long-term endocrine morbidity. Using a multivariable GEE logistic regression model, controlling for confounders, being delivered SGA or LGA at-term was found to be an independent risk factor for long-term pediatric endocrine morbidity (Adjusted OR?=?1.4; 95%CI?=?1.1–1.8; p?=?.015 and aOR?=?1.4; 95%CI?=?1.1–1.8; p?=?.005, respectively). Specifically, LGA was found an independent risk factor for overweight and obesity (aOR?=?1.7; 95%CI?=?1.2–2.5; p?=?.001), while SGA was found an independent risk factor for childhood hypothyroidism (aOR?=?3.2; 95%CI?=?1.8–5.8; p?=?.001).

Conclusions: Birth weight either SGA or LGA at-term is an independent risk factor for long-term pediatric endocrine morbidity.     

Fetal abdominal subcutaneous tissue thickness measured by ultrasound at term is associated with birth weight and mode of delivery

PURPOSE: To determine if measurement of fetal abdominal subcutaneous tissue thickness (FASTT) at term can predict birth weight, mode of delivery and perinatal outcome. METHODS: A prospective study with 352 normal, singleton pregnancies in the vertex presentation examined with real-time ultrasound at 37-39 weeks' gestation. RESULTS: FASTT was positively correlated with birth weight (Pearson's, r = 0.784, p < 0.001). Fetuses with low FASTT were more likely to be delivered through normal vaginal delivery (7.8 +/- 0.1 mm), while higher FASTT was correlated with operative vaginal delivery (7.9 +/- 0.2 mm) and cesarean section (8.6 +/- 0.3 mm) (ANOVA, p = 0.034). In contrast, FASTT was not correlated with intrapartum CTG, labor duration and Apgar scores. CONCLUSIONS: In normal pregnancies, FASTT at term is positively associated with birth weight. With increasing FASTT the likelihood of operative vaginal and cesarean delivery increases. FASTT is not associated with perinatal outcome.     

Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain

Objective: To investigate whether spontaneous vaginal birth with mediolateral episiotomy has any long-term impact on urinary and/or fecal incontinence, sexual dysfunction and perineal pain in primiparous women.

Methods: This matched case-control study included 150 women between 25 and 35 years old who had a singleton childbirth at least five years previously. Patients were grouped as; women who had a spontaneous vaginal delivery with mediolateral episiotomy (Group 1), an elective cesarean delivery (Group 2), and who had no delivery (Group 3). Controls were matched for age and delivery time. Urinary/fecal incontinence were questioned and Female Sexual Function Index (FSFI) questionnaire was completed. Total FSFI and domain scores were compared. Statistical evaluation was performed using One-way ANOVA test or χ² test. Statistical significance was defined as p?Results: No women had urinary/fecal incontinence nor sexual dysfunction. Mean total FSFI points in Group 1 were significantly lower than in Groups 2 and 3 (p?=?0.001). There were significant differences in sexual desire between groups 1 and 3 (p?=?0.005), in arousal and in orgasm between both groups 1 and 2 (p?=?0.001 and p?=?0.038, respectively) and groups 1 and 3 (p?=?0.001 and p?=?0.001, respectively). There was no significant difference between groups 2 and 3 in any parameters or total points.

Conclusions: Vaginal delivery with mediolateral episiotomy is not associated with urinary and/or fecal incontinence and sexual dysfunction but associated with a decreased sexual functioning as well as sexual desire, arousal and orgasm within postpartum five years.