New-Onset Hypertension in Late Pregnancy is Associated with Lower Fetal and Infant Mortality in Preterm Twins

Objective: To assess the association between new-onset hypertension in late pregnancy (NOH) and fetal and infant mortality in early preterm, late preterm, and full-term twins. Methods: We conducted a retrospective cohort study in 275, 316 twins in 1995–1997 based on multiple birth registration dataset of USA. Generalized estimating equations (GEEs) was used to evaluate the odds ratios (OR) of fetal and infant death (at individual level) associated with NOH, with adjustment of potential confounders at both twin set level and individual level. Results: The risks for early neonatal death (OR = 0.52, 95% CI: 0.36, 0.76) and late neonatal death (OR = 0.57, 95% CI: 0.37, 0.87) were decreased in early preterm twins born to mothers with NOH compared with early preterm twins born to mothers with normal blood pressure. The decreased risks for fetal death (OR = 0.40, 95% CI: 0.30, 0.53; OR = 0.46, 95% CI: 0.53, 0.65) and infant death (OR = 0.35, 95% CI: 0.28, 0.44; OR = 0.68, 95% CI: 0.51, 0.91) were associated with NOH in both early and late preterm twins, whereas no association between NOH and fetal/infant mortality were observed in full-term twins. Conclusion: NOH is associated with lower risk of fetal death and infant death in preterm twins.     

The impact of obesity on maternal morbidity and feto-infant outcomes among macrosomic infants

Objective.?To estimate the contribution of obesity to maternal complications, neonatal morbidity and mortality among macrosomic births.

Design.?A population-based retrospective cohort design using State of Missouri maternally linked birth cohort files.

Methods.?Using pre-gravid body mass index (BMI), we categorized mothers of 116,976 singleton macrosomic live births as non-obese (BMI?<?30) or obese (BMI?≥?30). We used logistic regression models to generate adjusted odd ratios for pregnancy and neonatal complications. We also estimated the proportion of potentially preventable excess maternal and neonatal complications that could be eliminated among obese women with infant macrosomia at various levels of pre-pregnancy obesity reduction.

Result.?Obese mothers with macrosomic infants were at elevated risk for chronic hypertension (odds ratio (OR)?=?6.78 [95% confidence interval (CI): 5.82–7.88]), insulin-dependent diabetes mellitus, (OR?=?2.60 [CI: 2.34–2.88]) other types of diabetes mellitus (OR?=?2.83 [CI: 2.65–3.02]) and preeclampsia (OR?=?2.49 [CI: 2.33–2.67]). Macrosomic infants of obese mothers were at greater risk for hyaline membrane disease (OR?=?2.14 [CI: 1.73–2.66]), extended assisted ventilation (OR?=?1.71 [CI: 1.44–2.04]), birth injury (OR?=?1.58 [CI: 1.37–1.84]) and meconium aspiration syndrome (OR?=?1.42 [CI: 1.09–1.87]). The proportion of preventable excess maternal morbidity was 60%, 45%, 30% and 15%, assuming an effective pre-conception intervention that could reduce obesity down to 0%, 25%, 50% and 75% of its current level, respectively. The corresponding proportion of preventable excess neonatal complications would be 40%, 30%, 20% and 10%, respectively.

Conclusion.?Among obese mothers with macrosomic births, a substantial proportion of maternal and neonatal morbidity could be averted through effective pre-conception interventions.     

The effect of gestational age on neonatal outcome in low-risk singleton term deliveries

Objective: To assess the association between gestational age at delivery and adverse neonatal outcome among term low-risk singleton neonates.

Methods: A retrospective cohort study design was used. The study group included all low-risk singleton term (37?+?0 to 41?+?6 weeks) newborns delivered in a single tertiary university-affiliated medical center over a 5-year period. Outcome of neonates delivered at 37?+?0 to 37?+?6 weeks of gestation (early term) and 41?+?0 to 41?+?6 weeks of gestation (late term) was compared to that of neonates delivered at 39?+?0–39?+?6 weeks of gestation (control).

Results: Overall, the outcome of 30?229 neonates was analyzed. The incidence of neonatal mortality was 1.0 per 1000 live-born neonates, with no significant difference between the various gestational age groups. Early term newborns were at higher risk for respiratory morbidity, hypoglycemia, hypocalcemia, thrombocytopenia and unexplained jaundice, and had higher rates of prolonged hospital stay, NICU admission, sepsis workup and antibiotic treatment. On multivariate analysis, early term delivery was an independent predictor for composite respiratory morbidity (OR=2.4, 95% CI 1.6–3.8, p?p?p?p?Conclusion: Even in low-risk singleton deliveries, early term is associated with an increased risk of neonatal morbidity.     

Uterine rupture and risk factors for caesarean delivery following induced labour in women with one previous lower segment caesarean section

Objective: To determine the outcome of induction of labor, specifically incidence of uterine rupture and reliable predictors of repeat caesarean delivery, in women undergoing induction of labor after previous caesarean section. Methods: A review of obstetric and perinatal records of 167 women who had their labor induced after one transverse lower uterine incision performed at previous caesarean delivery in a referral tertiary hospital in Nigeria between January 2006 and December 2009. Results: The incidence of uterine rupture was 2.4%. Independent risk factors for repeat caesarean delivery were absence of prior vaginal delivery (OR 3.7; 95% CI 1.9–7.1), duration of latent phase >2?h (OR 4.3; 95% CI 1.7–11.2), postdated pregnancy (OR 2.2; 95% CI 1.1–4.0) and previous caesarean for non-recurrent indication (OR 2.1; 95% CI 1.1–4.0). Conclusion: Choice of appropriate delivery option for this cohort of women based on the identified risk factors is essential to minimize the incidence of failed vaginal birth and its associated adverse maternal and neonatal outcome.     

Prevalence of anemia in pregnant women and its effect on neonatal outcomes in Northeast India

Abstract

Objectives: To determine the prevalence of anemia in pregnant women and characterize its effect on neonatal outcome in Northeast India.

Patients and methods: Four hundred and seventy mothers and their newborn infants during a one month period were included. The association between maternal hemoglobin (Hb) at delivery and neonatal outcomes were determined.

Results: Anemia (Hb?<?110?g/L) was present in 421 (89.6%) mothers with 35 (8.3%) having severe anemia(Hb?<?70?g/L). After adjusting for maternal and neonatal variables, each 10?g/L decrease in maternal Hb was associated with 0.18 week decrease in gestational length (p?=?0.003) and 21?g decrease in birth weight (p?=?0.093). Severe maternal anemia was associated with 0.63week (95% CI, 0.03–1.23week) shorter gestation, 481?g (95% CI, 305–658?g) lower birth weight and 89% increased risk of small-for-gestation (OR 1.89, 95% CI, 1.25–2.86)in the offspring, compared with those born to mothers without anemia (p?<?0.001).

Conclusion: Maternal anemia was highly prevalentin this population. Lower gestational age and birth weight, and increased risk of small-for-gestation were associated with maternal anemia, especially when maternal Hb was <80?g/L. Maternal anemia needs urgent attention to improve neonatal outcome in this population.     

The effect of the pre-pregnancy weight of the mother and the gestational weight gain on the bilirubin level of term newborn

Objective: Jaundice is a problem in newborns. There are many maternal and infant-related factors affecting neonatal jaundice. The maternal pre-pregnancy weight, maternal body mass index (BMI) and gestational weight gain may have an effect on the newborn bilirubin levels. We research the effect of the maternal pre-pregnancy weight and gestational weight gain on the bilirubin levels of the newborn infants in the first 2 weeks prospectively.

Methods: Term and healthy infants who were born between 38 and 42 weeks in our clinic were included in the study. Maternal pre-pregnancy BMIs were calculated. Babies were divided into three groups according to their mothers’ advised amount of gestational weight gain. Total serum bilirubin (TSB) values of the newborns were measured in the 2nd, 5th and 15th postnatal days.

Results: In our study, the 5th and 15th day capillary bilirubin level of the babies with mothers who gained more weight than the advised amount during pregnancy were found statistically significant higher compared to the other two groups (p?<?0.05). Similarly, the hematocrit level of the babies with mothers who gained more weight than the advised amount were found statistically significant higher compared to the other two groups (p?<?0.05).

Conclusions: We conclude that the babies with mothers who gained more weight than the advised amount were under risk for newborn jaundice. Therefore, these babies should be monitored more closely for neonatal jaundice and prolonged jaundice.     

Characteristics of obstetric intensive care unit admissions in New Jersey

Objective.?To assess the demographic characteristics, risk factors and perinatal outcomes among maternal intensive care unit (ICU) admissions in New Jersey from 1997 to 2005.

Methods.?Data were obtained from a perinatal linked database from MCH epidemiology programme in New Jersey. Chi-square test was used for bivariate analysis and stepwise logistic regression was used to assess the influence of the potential risk factors and pregnancy complications.

Results.?There were 15 447 (1.54%) ICU admissions and 23 maternal deaths (0.15%) among the 1 004 116 pregnancies. Analysis of demographic factors revealed that maternal age, race and smoking were significantly associated with ICU admission. Regression analysis adjusting for maternal age, parity, gravida, race, smoking status, maternal education and place of delivery found the following predictors for ICU admission, preeclampsia (odds ratio (OR): 2.8, 95% confidence interval (CI): 2.6–3.0), eclampsia (OR: 6.8, 95% CI: 5.4–8.6), placenta previa (OR: 3.0, 95% CI: 2.7–3.4), abruption (OR: 8.9, 95% CI: 8.3–9.6), multifetal pregnancy (OR: 4.2, 95% CI: 4.1–4.4), diabetes (OR: 3.1, 95% CI: 2.7–3.5), acute renal failure (OR: 22.1, 95% CI: 13.3–36.6) and cesarean delivery (OR: 1.9, 95% CI: 1.5–2.4). Infants born to ICU admitted mothers had higher rates of NICU admission, neonatal intubations and lower Apgar scores compared with infants born to non-ICU admitted mothers.

Conclusion.?Pregnancy complications are predictive of ICU admission amongst pregnant patients after adjusting for demographic factors.     

Labor epidural analgesia is independent risk factor for neonatal pyrexia

Objective.?To explore whether epidural analgesia (EA) in labor is independent risk factor for neonatal pyrexia after controlling for intrapartum pyrexia.

Methods.?Retrospective observational study of 480 consecutive term singleton infants born to mothers who received EA in labor (EA group) and 480 term infants delivered to mothers who did not receive EA (NEA group).

Results.?Mothers in the EA group had significantly higher incidence of intrapartum pyrexia [54/480 (11%) vs. 4/480 (0.8%), OR?=?15.1, p?<?0.0001] and neonatal pyrexia [68/480 (14.2%) vs. 15/480 (3.1%), OR?=?5.1, p?<?0.0001]. Neonates in the EA group had a median duration of pyrexia of 1 h (maximum 5 h) with a peak temperature within 1 h. Stepwise logistic regression analysis showed that maternal EA was independent risk factor for neonatal pyrexia (>37.5°C) after controlling for intrapartum pyrexia (>37.9°C) and other confounders (OR?=?3.44, CI?=?1.9–6.3, p?<?0.0001). Sepsis work-up was performed significantly more frequently in infants in the EA group [11.7% vs. 2.5%, OR?=?5.2, CI?=?2.7–9.7, p?<?0.0001] with negative blood cultures.

Conclusions.?EA in labor is an independent risk factor for pyrexia in term neonates. It is unnecessary to investigate febrile offspring of mothers who have had epidurals unless pyrexia persists for longer than 5 h or other signs or risk factors for neonatal sepsis are present.     

BMI of the firstborn offspring at age 12 reflects maternal LDL and HDL cholesterol levels at term pregnancy and postpartum

Abstract

Objective: The aim of this study was to assess the relationship between the body mass index (BMI) of the firstborn offspring at age 12 and maternal lipid levels at term and at 6 months postpartum.

Design and Methods: The study included children born in the 2nd Department of Obstetrics and Gynecology of the Medical University of Warsaw between 1 November 1991 and 31 May 1993. The end point was BMI in the upper quartile – considered high BMI of the firstborn offspring at age 12.

Results: The risk of high BMI in the offspring at age 12 significantly increased with an increase in the LDL-C level at term (OR?=?2.41 per SD increase, 95% CI: 1.01–5.80; p?<?0.049), a decrease in the HDL-C% at term (OR?=?0.35 per SD increase, 95% CI: 0.14–0.84; p?<?0.019) and a decrease in the HDL-C level at 6 months postpartum (OR?=?0.25 per SD increase, 95% CI: 0.08–0.82; p?<?0.022), regardless of maternal weight status before pregnancy and at 6 months postpartum, gestational weight gain, the offspring’s gender and birth weight.

Conclusion: LDL and HDL cholesterol levels at term are markers of maternal adaptation to a first pregnancy and predict the future growth of firstborn offspring.     

Do we know enough? A quality assessment of the Finnish intervention to prevent obstetric anal sphincter injuries

Objective: Especially in the Nordic countries, increases in obstetric anal sphincter injuries (OASIS) have prompted standard use of the Finnish intervention for their prevention. We performed a quality assessment of the introduction of the intervention in a Danish hospital setting.

Methods: All vaginal deliveries by primiparous women the year before (N?=?343) and after (N?=?334) the introduction were compared in a retrospective, observational design. Fisher’s exact test, Student’s t-test, and multiple logistic regression analysis were performed.

Results: No significant difference in OASIS (OR: 0.5; 95% CI: 0.3–1.1) was found. The post-implementation group saw a significant increase in episiotomy (OR: 1.8; 95% CI: 1.1–2.9) and the length of second stage labor (p?<?0.05) while intact perineum (OR: 0.5; 95% CI: 0.3–0.9), use of upright positions for birth (OR: 3.2; 95% CI: 1.8–5.5), and neonatal blood gas levels were significantly reduced (p?<?0.05).

Conclusions: Introduction of the Finnish intervention was not followed by a significant reduction of OASIS, but a downward trend was seen. The study results raise questions about potential side effects of the Finnish intervention on neonatal outcomes, intact perineum, and women’s free choice of birth positions. More knowledge on effect and side effects from high-evidence studies are needed.     

Incidence,predictors and outcomes of congenital diaphragmatic hernia: a population-based study of 32 million births in the United States

Abstract

Objectives: To evaluate the incidence, risk factors and neonatal outcomes associated with a congenital diaphragmatic hernia (CDH).

Study design: We conducted a population-based cohort study using the CDC’s Linked Birth-Infant Death and Fetal Death data files on all births and foetal deaths in USA between 1995 and 2002. We estimated the yearly incidence of CDH and measured its adjusted effect on various outcomes using unconditional logistic regression analysis.

Results: About 32?145?448 births during the 8-year study period met the study’s inclusion criteria. The incidence of CDH was 1.93/10?000 births. Risk factors for the development of CDH included foetal male gender [OR 1.12, 95% CI: 1.06, 1.17], maternal age beyond 40 [OR 1.51, 95% CI: 1.26, 1.80], Caucasian ethnicity [OR 1.15, 95% CI: 1.10, 1.21], smoking [OR 1.34, 95% CI: 1.22, 1.46] and alcohol use during pregnancy [OR 1.37, 95% CI: 1.05, 1.79]. As compared to foetuses with no CDH, foetuses with CDH were at an increased risk of preterm birth [OR 2.90, 95% CI: 2.72, 3.11], intrauterine growth restriction [OR 3.84, 95% CI: 3.51, 4.18], stillbirth [OR 9.65, 95% CI: 8.20, 11.37] and overall infant death [OR: 94.80, 95% CI: 88.78, 101.23]. The 1-year mortality was 45.89%.

Conclusion: Congenital diaphragmatic hernia is strongly associated with an increased risk of adverse pregnancy, foetal and neonatal outcomes. These findings may be helpful in counselling pregnancies affected by CDH, and may aid in the understanding of the burden of this condition at the public health level.     

Breastfeeding predicts the risk of childhood obesity in a multi-ethnic cohort of women with diabetes

Objective.?To determine whether breastfeeding reduced the risk of childhood obesity in the infants of a multi-ethnic cohort of women with pregestational diabetes.

Methods.?In this retrospective cohort study, women with pregestational diabetes were mailed a questionnaire about breastfeeding and current height and weight of mothers and infants. Predictors of obesity (weight for age >85 percentile) were assessed among offspring of index pregnancies, using univariate and multivariable logistic regression.

Results.?Of 125 women, 81 (65%) had type 1 diabetes and 44 (35%) had type 2 diabetes. The mean age of offspring was 4.5 years. On univariate analysis, significant predictors of obesity in offspring were type 2 diabetes (odds ratio, OR 2.4, 95% confidence interval, CI 0.99–5.72); maternal body mass index (BMI)?>?25 (OR 4.4, 95% CI 1.4–19.4); and any breastfeeding (OR 0.22, 95% CI 0.07–0.72). After multivariable adjustment, breastfeeding (OR 0.20, 95% CI 0.06–0.69) and having an overweight/obese mother (OR 3.49, 95% CI 1.03–16.2) remained independently associated with childhood obesity.

Conclusion.?Breastfeeding significantly decreased the likelihood of obesity in offspring of mothers with pregestational diabetes, independent of maternal BMI and diabetes type. Women with diabetes should be encouraged to breastfeed, given the increased risk of obesity in their children.     

Preparation for Discharge,Maternal Satisfaction,and Newborn Readmission for Jaundice: Comparing Postpartum Models of Care

ABSTRACT: Background: Physiological jaundice generally appears between the third and fifth days of life. The danger of hyperbilirubinemia is therefore a major challenge when postpartum hospital stays are short, and part of the responsibility for screening for signs of jaundice is assumed by the mother. The objective of this study was to identify the model of postnatal continuity of care most likely to prepare mothers for discharge, to reduce newborn readmission for jaundice, and to enhance maternal satisfaction. Methods: An epidemiological study was conducted in regions operating under 3 different models of postnatal continuity of care. Eligible mothers were those who had spent less than 60 hours in hospital after an uncomplicated vaginal delivery. Of this group, 70.8 percent participated in telephone interviews conducted 1 month after their deliveries (n = 1,096). Newborns who had presented with signs of jaundice were identified through statements from their mothers. Results: Of the participating newborns, 45.5 percent presented with signs of jaundice, and 3.2 percent were readmitted for jaundice during the first week of life. The follow‐up procedures used in regions operating under a community‐based model most closely followed the recommendations of health authorities and featured a high level of mothers’ satisfaction. In the region operating under a mixed hospital model, mothers reported signs of jaundice significantly more often, and postdischarge services received by mothers were less effective at allaying their fears compared with other models. Phototherapy was offered in the home only in the region operating under a mixed ambulatory model, and no readmissions for jaundice were recorded in this region. Conclusions: An effective coordination between community‐based perinatal services and hospital‐linked home phototherapy in the form of an integrated network appears to be an essential condition for improved monitoring of newborns’ health since it fosters a follow‐up that is focused not only on jaundice but also on mothers’ and newborns’ needs while reducing the costs generated by newborn readmissions. (BIRTH 34:2 June 2007)     

Do tall women beget larger babies?

Objective: To evaluate the possible relationship between maternal height and fetal size.

Patients and methods: We used a population-based cohort of apparently healthy mothers of singletons to evaluate quartiles of the maternal height distribution for parity, being overweight or obese, and for gestational age and birth weight parameters. We also generated birth weight by gestational age curves for each quartile.

Results: We analyzed data of 198?745 mothers. Mother from the four quartiles had similar parity, pre-gravid BMI, and gestational age at birth. Short mothers had a significantly higher rate of VLBW and LBW and 2501–4000?g infants, for an OR?=?1.38 (95% CI: 1.17–1.62), OR?=?2.2 (95% CI: 2.05–2.37) and OR?=?1.82 (95% CI: 1.73–1.87) between the shortest and tallest mothers, respectively. By contrast, the opposite trend was noticed for birth weights >4000?g, for an OR?=?2.77 (95% CI: 2.65–2.89) between the tallest and shortest mothers. A very similar “growth curve” was apparent until 33?weeks, when a slower growth velocity was observed for shorter compared with taller women.

Conclusions: Maternal stature does not appear to be associated with gestational age but significantly influences birth weight. Height-related differences between mothers appears to begin after 33 weeks’ gestation.     

Predictors of caesarean section – a cross-sectional study in Hungary

Purpose: The aim of this study was to analyse the factors associated with caesarean section (CS) at the Department of Obstetrics and Gynaecology, University of Szeged, Hungary.

Study design: Data collection was based on self-administered questionnaire and medical records related to the deliveries in the year of 2014. Maternal age, education level, marital status, pre-gestational body mass index (BMI), infertility treatment, previous CS, gestational diabetes mellitus (GDM), pre-pregnancy hypertension and pregnancy-induced hypertension (HT/PIH) were examined. The participation rate was 67.3%, multiple pregnancies and questionnaires with missing data were excluded (n?=?1493). Univariate and multivariate comparisons were performed.

Results: There were 1125 (45.4%) CSs out of 2479 deliveries. CS rate: 40.0%. Underweight 109 (7.1%), normal 921 (60.2%), overweight 320 (20.9%) obese 181 (11.8%). HT/PIH: 7.6% (n?=?117), GDM: 10.1% (n?=?155). The odds of CS were significantly higher among obese mothers (OR: 1.81) compared with the normal weight group. Increasing maternal age (OR: 0.97) and being underweight (OR: 0.59) significantly decreased, previous CS (OR: 12.19), infertility treatment (OR: 1.91) and HT/PIH (OR: 1.87) significantly increased the probability of CS.

Conclusions: Pre-gestational obesity, infertility treatment, previous CS and HT/PIH had significant effect on the mode of delivery.     

Neonatal respiratory morbidity in late-preterm births in pregnancies with and without gestational diabetes mellitus

Objective: To evaluate neonatal respiratory morbidity in infants born late-preterm to mothers with or without gestational diabetes mellitus (GDM).

Methods: Analysis of a population-based cohort of all live-born singletons, born at 34 0/7 to 36 6/7 weeks to mothers with and without GDM, focusing on transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS).

Results: The study group comprised 363 (4.7%) singletons born to mothers with GDM and the controls were 7400 born to mothers without GDM. Mothers with GDM were older (31.4?±?5.1 versus 29.5?±?5.1 years, p?p?Conclusion: GDM, per se, is not a major contributor to RDS in late pre-term infants. Rather, the combination of prematurity and cesarean birth act independently to increase the risk of respiratory morbidity.     

The influence of interpregnancy interval on the subsequent risk of stillbirth and early neonatal death

OBJECTIVE: To study whether interpregnancy interval is associated with increased risks of stillbirth and early neonatal death and whether this possible association is confounded by maternal characteristics and previous reproductive history. METHODS: In a Swedish nationwide study of 410,021 women's first and second singleton deliveries between 1983 and 1997, we investigated the influence of interpregnancy interval on the subsequent risks of stillbirth and early neonatal death. Odds ratios (ORs) with 95% confidence intervals (CIs) estimated using unconditional logistic regression were adjusted for maternal characteristics and previous pregnancy outcome categorized into stillbirth, early neonatal death, preterm, or small for gestational age delivery. RESULTS: Compared with interpregnancy intervals between 12 and 35 months, very short interpregnancy intervals (0-3 months) were, in the univariate analyses, associated with increased risks of stillbirth and early neonatal death (crude OR 1.9; 95% CI 1.3, 2.7; and 1.8; 1.2, 2.8, respectively). However, after adjusting for maternal characteristics and previous reproductive history, women with interpregnancy intervals of 0 to 3 months were not at increased risks of stillbirth (adjusted OR 1.3; 95% CI 0.8, 2.1) or early neonatal death (adjusted OR 0.9; 95% CI 0.5, 1.6). Women with interpregnancy intervals of 72 months and longer were at increased risk of stillbirth (adjusted OR 1.5; 95% CI 1.1, 2.1) and possibly early neonatal death (adjusted OR 1.3; 95% CI 0.9, 2.1). CONCLUSION: Short interpregnancy intervals appear not to be causally associated with increased risk of stillbirth and early neonatal death, whereas long interpregnancy intervals were associated with increased risk of stillbirth and possibly early neonatal death.     

Maternal and neonatal profile of late-preterm survivors in a poorly resourced country

Objective.?To determine maternal indicators and adverse perinatal outcomes among late-preterm infants during birth hospitalization in a low-income country.

Methods.?Cross-sectional study of late-preterm and term survivors in a tertiary maternity hospital in southwest Nigeria using multivariable logistic regression analysis and population attributable risk (PAR) percentage. Adjusted odds ratios (OR) and 95% confidence intervals (CI) of significant factors are stated.

Results.?Of 4176 infants enrolled, 731 (17.5%) were late preterm and 3445 (82.5%) were full-term. Late-preterm delivery was independently associated with mothers who were unmarried (OR: 1.71, CI: 1.06–2.75), lacked formal education (OR: 1.75, CI: 1.06–2.89), human immunodeficiency virus positive (OR: 1.61, CI: 1.17–2.20), with hypertensive disorders (OR: 3.07, CI: 2.32–4.08), antepartum hemorrhage (OR: 3.66, CI: 1.97–6.84), and were unlikely to have induced labor (OR: 0.010, CI: 0.01–0.69). Hypertensive disorders and antepartum hemorrhage had a combined PAR of 48.4%. Infants born late preterm were more likely to have low 5-min Apgar scores (OR: 1.70, CI: 1.01–2.83), sepsis (OR: 1.62, CI: 1.05–2.50), hyperbilirubinemia (OR: 1.56, CI: 1.05–2.33), admission into special care baby unit (OR: 1.85, CI: 1.38–2.48), and nonexclusive breast-feeding (OR: 1.49, CI: 1.49, CI: 1.18–1.89).

Conclusions.?These findings suggest that late-preterm infants in low-resource settings are at risk of severe morbidity and suboptimal feeding. Education and close monitoring of high-risk mothers are warranted to prevent avoidable late-preterm delivery and facilitate the proactive management of unavoidable late-preterm births.     

Is there a difference in the maternal and neonatal outcomes between patients discharged after 24 h versus 72 h following cesarean section? A prospective randomized observational study on 2998 patients

Objective: To compare the incidence of postpartum maternal and neonatal complications and hospital readmission in patients discharged 24 versus 72?h after cesarean section.

Methods: Using randomization, 1495 patients were discharged after 24?h and 1503 patients were discharged after 72?h. All patients fulfilled the discharge criteria. Patients were assessed 6 weeks after delivery, any maternal or neonatal problems or hospital readmissions during this time interval were reported.

Results: There was no difference in maternal hospital readmission between the two groups, but there was a significantly higher neonatal readmission rate in the 24-h group mainly due to neonatal jaundice. As for the complications reported after 6 weeks, the only two significant outcomes were initiating breast feeding, being significantly higher in the 72-h group [OR and 95% CI 0.77 (0.66–0.89)] and the mood swings being significantly lower in the 72-h group [OR and 95% CI 2.28 (1.94–2.68)].

Conclusion: Our recommendation is still in favor of late discharge, after cesarean delivery. Bearing in mind, that an early 24-h discharge, after cesarean delivery is feasible, but with special care of the neonate, with early visit to the pediatrician and early establishment of effective lactation.     

Neonatal outcomes following elective caesarean delivery at term: a hospital-based cohort study

Objective: To assess neonatal outcomes following elective caesarean delivery (CD) at term (≥37?+?0 weeks gestation).

Methods: A retrospective cohort study was conducted in a single Irish maternity hospital. Elective CDs at term between August 2008 and July 2012 were reviewed. Outcome measures were admission to the neonatal intensive care unit (NICU), length of stay, respiratory complications, hypoglycaemia, jaundice, newborn sepsis and medical interventions.

Results: A total of 4242 women had an elective CD at term, accounting for approximately 15% of all term deliveries. Admission rate to the NICU at 37 weeks gestation was 21.8% versus 10% at 39 weeks (p for trend <0.0001). Similar trends of decreasing risk with later gestational age were noted for the other outcomes. An increased odds of admission to the NICU at 37 weeks [adjusted odds ratio (OR) 2.48 (95% CI 1.28, 4.79)] and at 38 weeks [OR 1.34, 95% CI 1.02, 1.77] compared to the reference of 39 weeks gestation was found.

Conclusions: This study supports evidence that, with regard to neonatal outcome, 39 weeks gestational age is the optimal delivery time. Heightened awareness of the increased risk of neonatal morbidity, when delivery is performed electively before 39 weeks, is warranted among healthcare workers.