Models for the prediction of successful induction of labor based on pre-induction sonographic measurement of cervical length

Objective.?To examine the effect of pre-induction cervical length, parity, gestational age at induction, maternal age and body mass index (BMI) on the possibility of successful delivery in women undergoing induction of labor.

Methods.?In 822 singleton pregnancies, induction of labor was carried out at 35 to 42^?+?6 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. The effect of cervical length, parity, gestational age, maternal age and BMI on the interval between induction and vaginal delivery within 24?hours was investigated using Cox's proportional hazard model. The likelihood of vaginal delivery within 24?hours and risk for cesarean section overall and for failure to progress was investigated using logistic regression analysis.

Results.?Successful vaginal delivery within 24?hours of induction occurred in 530 (64.5%) of the 822 women. Cesarean sections were performed in 161 (19.6%) cases, 70 for fetal distress and 91 for failure to progress. Cox's proportional hazard model indicated that significant prediction of the induction-to-delivery interval was provided by the pre-induction cervical length (HR?=?0.89, 95 % CI 0.88–0.90, p?<?0.0001), parity (HR?=?2.39, 95% CI 1.98–2.88, p?<?0.0001), gestational age (HR?=?1.13, 95% CI 1.07–1.2, p?= <?0.0001) and birth weight percentile (HR?=?0.995, 95% CI 0.99?– 0.995, p?=?0.001), but not by maternal age or BMI. Logistic regression analysis indicated that significant prediction of the likelihood of vaginal delivery within 24?hours was provided by pre-induction cervical length (OR?=?0.86, 95% CI 0.84–0.88, p?<?0.0001), parity (OR?=?3.59, 95% CI 2.47–5.22, p?<?0.0001) and gestational age (OR =?1.19, 95% CI 1.07–1.32, p?= <?0.0001) but not by BMI or maternal age. The risk of cesarean section overall was significantly associated with all the variables under consideration, i.e., pre-induction cervical length (OR?=?1.09, 95% CI 1.06–1.11, p?<?0.0001), parity (OR?=?0.25, 95% CI 0.17–0.38, p?<?0.0001), BMI (OR?=?1.85, 95% CI 1.24–2.74, p?=?0.0024), gestational age (OR?=?0.88, 95% CI 0.78–0.98, p?=?0.0215) and maternal age (OR?=?1.04, 95% CI 1.01–1.07, p?=?0.0192). The risk of cesarean section for failure to progress was also significantly associated with pre-induction cervical length (OR?=?1.11, 95% CI 1.07–1.14, p?<?0.0001), parity (OR?=?0.26, 95% CI 0.15–0.43, p?<?0.0001), gestational age (OR?=?0.83, 95% CI 0.73–0.96, p?=?0.0097) and BMI (OR?=?2.07, 95% CI 1.27–3.37, p?=?0.0036).

Conclusion.?In women undergoing induction of labor, pre-induction cervical length, parity, gestational age at induction, maternal age and BMI have a significant effect on the interval between induction and delivery within 24?hours, likelihood of vaginal delivery within 24?hours and the risk of cesarean section.     

Risk factors for intrauterine fetal death (1988–2009)

Objective.?To determine risk factors for intrauterine fetal death (IUFD).

Study design.?A retrospective population-based study, of all singleton deliveries between the years 1988–2009 was conducted. Intrapartum deaths, postpartum death, and multiple gestations were excluded. A multiple logistic regression model was used to determine independent risk factors.

Results.?During the study period, out of 228,239 singleton births, 1694 IUFD cases were recorded (7.4 per 1000 births). The following independent risk factors were identified in the logistic regression executed: Oligohydramnios (OR 2.6, 95% CI 2.1–3.2, p-value?<?0.001), polyhydramnios (OR 1.8, 95% CI 1.4–2.2, p-value?<?0.001), previous adverse perinatal outcome (OR 1.7, 95% CI 1.5–2.1, p-value?<?0.001), congenital malformations (OR 2.0, 95% CI 1.8–2.3, p-value?<?0.001), true knot of cord (OR 3.7, 95% CI 2.8–4.9, p-value?<?0.001), meconium stained amniotic fluid (OR 2.7, 95% CI 2.3–3.0, p-value<0.001), placental abruption (OR 2.9, 95% CI 2.4–3.5, p-value?<?0.001), advanced maternal age (OR 1.03, 95% CI 1.02–1.04, p-value?<?0.001), and hypertensive disorders (OR 1.24, 95% CI 1.0–1.4, p-value?=?0.026). Jewish ethnicity (versus Bedouin – OR 0.64, 95% CI 0.57–0.72, p-value?<?0.001), gestational diabetes (OR 0.7, 95% CI 0.5–0.8, p-value?=?0.001), previous cesarean section (OR 0.8, 95% CI 0.7–0.97, p-value?=?0.019), and recurrent abortions (OR 0.8, 95% CI 0.6–0.9, p-value?=?0.011) were negatively associated with IUFD.

Conclusion.?Several independent risk factors were identified, suggesting a possible cause of death. Other pathologic conditions that facilitate tighter pregnancy surveillance and active management were found protective, pointing the benefit of such management approaches in high-risk pregnancies.     

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.     

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 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.     

Does the presence of polycystic ovary syndrome increase the risk of obstetrical complications in women with gestational diabetes?

Objective.?To determine whether women with both polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) have an increased risk of obstetric complications compared with women with GDM alone.

Methods.?A retrospective cohort study of maternal/fetal outcomes in women with GDM and PCOS was compared with women with GDM alone. Outcomes were compared using Fisher's exact test for categorical variables and t-test for continuous variables. Logistic regression models allowed for the calculation of odds ratios and 95% confidence intervals (CIs) for each outcome, adjusted for confounding.

Results.?One hundred seventy one women were included in the study. Significantly more women with both GDM and PCOS had pregnancy-induced hypertension/preeclampsia (15.9% vs. 3.9%, p?=?0.019, OR?=?4.62, 95% CI?=?1.38–15.41). Multiple logistic regression revealed that this increase persisted after controlling for body mass index (p?=?0.028, OR?=?4.43, 95% CI?=?1.17–16.72) and parity (p?=?0.050, OR?=?3.45, 95% CI?=?1.00–11.92). Women with GDM and PCOS tended to have more preterm deliveries (25.0% vs. 11.8%, p?=?0.063). More infants of women with GDM and PCOS required phototherapy treatment for hyperbilirubinemia (25.0% vs. 7.9%, p?=?0.0066, OR?=?3.90, 95% CI?=?1.52–9.98). Logistic regression revealed that this association persisted after controlling for preterm delivery (OR?=?3.18, 95% CI?=?1.14–8.82, p?=?0.026).

Conclusions.?Mothers with both disorders should be monitored more carefully and counseled regarding their increased risk of both maternal and fetal complications.     

The effect of prepregnancy body mass index on birth weight,preterm birth,cesarean section,and preeclampsia in pregnant women

Objective: The objective of this study is to determine the impact of maternal prepregnancy BMI on birth weight, preterm birth, cesarean section, and preeclampsia among pregnant women delivering singleton life birth.

Methods: A cross-sectional study of 4397 women who gave singleton birth in Tehran, Iran from 6 to 21 July 2015, was conducted. Women were categorized into four groups: underweight (BMI?2), normal (BMI 18.5–25?kg/m²), overweight (BMI 25–30?kg/m²) and obese (BMI >30?kg/m²), and their obstetric and infant outcomes were analyzed using both univariate and multivariate logistic regression.

Results: Prepregnancy BMI of women classified 198 women as underweight (4.5%), 2293 normal (52.1%), 1434 overweight (32.6%), and 472 as obese (10.7%). In comparison with women of normal weight, women who were overweight or obese were at increased risk of preeclampsia (odds ratio (OR)?=?1.47, 95% CI?=?1.06–2.02; OR?=?3.67, 95% CI?=?2.57–5.24, respectively) and cesarean section (OR?=?1.21, 95% CI?=?1.04–1.41; OR?=?1.35, 95% CI?=?1.06–1.72, respectively). Infants of obese women were more likely to be macrosomic (OR?=?2.43, 95% CI?=?1.55–3.82).

Conclusion: Prepregnancy obesity is a risk factor for macrosomia, preeclampsia, and cesarean section and need for resuscitation.     

Trial of labor after cesarean section in twin pregnancies: Maternal and neonatal safety

Objective.?To assess maternal and perinatal morbidity in patients undergoing a trial of labor after cesarean section (TOLAC) in twin gestations.

Methods.?A retrospective study including all twin pregnancies with a single prior cesarean section was performed. Stratified analysis using a multiple logistic regression model was performed to control for confounders. Patients who had a clear medical indication for a cesarean section (i.e. previous corporeal cesarean section, breech or transverse presentation, placenta previa, placental abruption, and herpes infection) were excluded from the analysis.

Results.?During the years 1988–2007, 134 patients met the inclusion criteria. Of these, 25 patients underwent a trial of labor and the remaining 109 underwent a repeat cesarean delivery. There were no cases of uterine rupture, maternal mortality, or peripartum fever in our population. Higher rates of perinatal mortality were noted in patients undergoing a trial of labor (8% vs. 1.8%, p?=?0.042, OR?=?4.652, 95% CI?=?1.122–19.286). However, a trial of labor was not found to be an independent risk factor for perinatal mortality after controlling for confounders such as gestational age, ethnicity, and fetal malformations (adjusted OR?=?1.07, 95% CI?=?0.07–15.95, p?=?0.95).

Conclusions.?A TOLAC is not associated with an increased risk for maternal morbidity, including uterine rupture. Nevertheless, in our population TOLAC was noted as a risk factor for perinatal mortality, although residual confounding cannot be excluded. Further prospective randomized studies should evaluate the safety of TOLAC in twin gestations to establish appropriate guidelines.     

Maternal BMI and preterm birth: A systematic review of the literature with meta-analysis

Objectives.?To examine the association between high prepregnancy maternal body mass index (BMI) and the risk of preterm birth (PTB).

Methods.?A systematic review of the literature. We included cohorts and case-control studies published since 1968 that examined the association between BMI and PTB of all types, spontaneous (s), elective and with ruptured membranes (PPROM) in three gestational age categories: general (<37 weeks), moderate (32–36 weeks) and very (<32 weeks) PTB.

Results.?20,401 citations were screened and 39 studies (1,788,633 women) were included. Preobese (BMI, 25–29.9) and obese I (BMI, 30–34.9) women have a reduced risk for sPTB: AOR?=?0.85 (95% CI: 0.80–0.92) and 0.83 (95% CI: 0.75–0.92), respectively. Their risk for moderate PTB was 1.20 (95% CI: 1.04–1.38) and 1.60 (95% CI: 1.32–1.94), respectively. Obese II women (BMI, 35–40) have an increased risk for PTB in general (AOR?=?1.33, 95% CI: 1.12–1.57) moderate (AOR?=?2.43, 95% CI: 1.46–4.05) and very PTB (AOR?=?1.96, 95% CI: 1.66–2.31). Obese III women (BMI?>?40) have an even higher risk for very PTB (AOR?=?2.27, 95%CI: 1.76–2.94). High BMI does not modify the risk for PPROM and increases the risk for elective PTB.

Conclusions.?High maternal BMI may have different effects on different types of PTB.     

Pregnancy outcome in hyperemesis gravidarum – the role of fetal gender

Abstract

Objective: To determine whether the incidence, severity and effects of hyperemesis gravidarum (HEG) are related to fetal gender.

Method: A retrospective study of all pregnant women who were admitted with the diagnosis of HEG between 1994 and 2008 (N?=?545). The association between fetal gender and pregnancy outcome in pregnancies complicated by HEG was compared to that of a control group of women with singleton pregnancies matched by maternal age and parity in a 3:1 ratio (N?=?1635).

Results: Women with HEG with a female fetus were younger (28.2?±?4.8y versus 29.5?±?5.5y, p?=?0.003), were admitted earlier in pregnancy for HEG (admission?<?10w: 62.3% versus 53.4%, p?=?0.04), and were more likely to require TPN support (35.6% versus 26.9%, p?=?0.03) compared to women with HEG having a male fetus. Compared to controls, women with HEG were more likely to have a female rather than a male fetus (odds ratio (OR)?=?1.20) although this difference reached statistical significance only for the subgroup of women with HEG who were admitted prior to 10 weeks of gestation (OR?=?1.40, 95%-confidence interval (CI) 1.03–1.70) or who required TPN support (OR?=?1.593, 95% CI 1.15–2.0263). The presence of a male fetus in pregnancies complicated by HEG was associated with an increased risk for preterm delivery (OR?=?0.49, 95% CI 0.27–0.87), and composite neonatal morbidity (OR?=?0.38, 95% CI 0.20–0.74).

Conclusion: Although HEG appears to be more common and more severe in the presence of a female fetus, male fetuses appear to be more susceptible to the adverse effects of HEG on pregnancy outcome.     

Maternal anemia during pregnancy and subsequent risk for cardiovascular disease

Objective: To investigate the association between anemia during pregnancy and subsequent future maternal cardiovascular morbidity and mortality.

Methods: A retrospective cohort study was conducted, comparing women with and without anemia during pregnancy. Deliveries occurred during 1988–1998 and had followed for more than a decade. Incidence of long-term cardiovascular morbidity was compared between the two groups.

Results: During the study period, 47?657 deliveries met the inclusion criteria; of these 12?362 (25.9%) occurred in women with anemia at least once during their pregnancies. Anemia of pregnancy was noted as a risk factor for long-term complex cardiovascular events (OR?=?1.6, 95% CI 1–2.8, p?=?0.04). Using a Cox multivariable regression model, controlling for ethnicity and maternal age, anemia was found to be an independent risk factor for long-term maternal cardiovascular hospitalization (OR for total hospitalizations?=?1.2, 95% CI 1.1–1.4, p?Conclusions: Anemia of pregnancy is an independent risk factor for long-term cardiovascular morbidity in a follow-up period of more than a decade.     

Maternal perception of fetal movement type: the effect of gestational age and maternal factors

Objective: To assess maternal perception of fetal movement types and its association with maternal factors in normal pregnancies with good pregnancy outcome.

Methods: This study was conducted on 729 normotensive singleton pregnant women with good pregnancy outcome who had referred for prenatal visit. After completing a questionnaire, the participants were asked to count fetal movements for 1?h/3 times/day. They were also asked to identify the type of fetal movement: general body movement (GBM) (rolling and stretching/strong), isolated limb movement (ILM; simple flutter or kicks/weak), trunk movement (TM) (strong jab, startle/strong), or hiccup movement (HM) (high frequency and rapid/weak). All the participants were followed till delivery to exclude pregnant women with preterm birth and/or small for gestational age from the study.

Results: 90.8% of participants perceived GBM, which was independently associated with maternal unemployment (OR?=?2.28, 95% CI?=?1.18–4.4). 74.2% of participants perceived TM, which was associated with multiparity (OR?=?1.69, 95% CI?=?1.18–2.4). 86.3% perceived ILM, which was independently associated with maternal unemployment (OR?=?2.67, 95% CI?=?1.53–4.68), lower gestational age (OR?=?2.17, 95% CI?=?1.28–3.67), perception of fetal movements at night (OR?=?2.05, 95% CI?=?1.27–3.32), and multiparity (OR?=?1.68, 95% CI?=?1.04–2.72). 36.6% perceived HM, which was independently associated with higher gestational age (OR?=?1.71, 95% CI?=?1.2–2.44).

Conclusions: Most pregnant women could discriminate changes in fetal movement type that follow a general pattern through the third gestational trimester, however this can be affected by maternal employment, parity and time of perception.     

A 12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada: impact of endometriosis

The aim of this study was to provide a temporal-spatial reference of adverse pregnancy outcomes (APO) and examine whether endometriosis promotes APO in the same population. Among the 31?068 women who had a pregnancy between 1997 and 2008 in Eastern Townships of Canada, 6749 (21.7%) had APO. These APO increased significantly with maternal age and over time (r^2?=?0.522, p?=?0.008); and were dominated by preterm birth (9.3%), pregnancy-induced hypertension (8.3%) including gestational hypertension (6.5%), low birth weight (6.3%), gestational diabetes (3.4%), pregnancy loss (2.2%) including spontaneous abortion (1.5%) and stillbirth (0.6%), intrauterine growth restriction (2.1%) and preeclampsia (1.8%). Among the 31?068 pregnancies, 784 (2.5%) had endometriosis and 183 (23.3%) had both endometriosis and APO. Endometriosis has been shown to increase the incidence of fetal loss (OR?=?2.03; 95% CI?=?1.42–2.90, p?p?=?0.005) and stillbirth (OR?=?2.29; 95% CI?=?1.24–5.22, p?=?0.012). This study provides a temporal-spatial reference on APO, which is a valuable tool for monitoring, comparing and correcting. It is also the first study to highlight an impact of endometriosis on the incidence of spontaneous abortion and stillbirth.     

Maternal pre-pregnancy overweight status and obesity as risk factors for cesarean delivery

Objective.?To determine the extent to which, if at all, maternal pre-pregnancy adiposity and other anthropometric factors are related to risk of cesarean delivery.

Methods.?This hospital-based prospective cohort study included 738 nulliparous women who initiated prenatal care prior to 16 weeks gestation. Participants provided information about their pre-pregnancy weight and height and other sociodemographic and reproductive covariates. Labor and delivery characteristics were obtained from maternal and infant medical records. Risk ratios (RR) and 95% CI were estimated by fitting generalized linear models.

Results.?The proportion of cesarean deliveries in this population was 26%. Women who were overweight (BMI 25.00–29.99?kg/m²) were twice as likely to deliver their infants by cesarean section as lean women (BMI <?20.00?kg/m²) (RR?=?2.09; 95% CI 1.27–3.42). Obese women (BMI ??30.00?kg/m²) experienced a three-fold increase in risk of cesarean delivery when compared with this referent group (RR?=?3.05; 95% CI 1.80–5.18). The joint association between maternal pre-pregnancy overweight status and short stature was additive. When compared with tall (height ??1.63?m), lean women, short (?<?1.63?m), overweight (BMI ??25.00?kg/m²) women were nearly three times as likely to have a cesarean delivery (RR?=?2.79; 95% CI 1.72–4.52).

Conclusion.?Our findings suggest that nulliparous women who are overweight or obese prior to pregnancy, and particularly those who are also short, have an increased risk of delivering their infants by cesarean section.     

Pregnancy in women with systemic lupus erythematosus: a retrospective study of 111 pregnancies in Chinese women

Abstract

Objective.?The impact of pregnancy on lupus activity has been controversial especially in Chinese women. Research looking at predictive factors in this population are sparse. The aim of this study was therefore twofold: to determine the frequencies of abnormal pregnancy outcomes in a Chinese cohort and to identify clinical and laboratory factors predicting adverse fetal and maternal outcomes in Chinese women with systemic lupus erythematosus. Study design.?Data of 111 pregnancies of 105 systemic lupus erythematosus (SLE) patients from January 1990 to December 2008 in Peking Union Medical College Hospital in Beijing were analyzed retrospectively. Univariate analysis using chi-square test and logistic regression was used to assess the predictive value of each variable on binary outcomes. Lupus activity was based on SLE Disease Activity Index (SLEDAI) criteria. Results.?There were 23 elective, 2 spontaneous abortions, and 5 stillbirths, with 81 pregnancies resulting in live births including two multiple gestations. Three neonatal deaths were reported. Fetal loss rate including neonatal death was 11.1%. Fetal loss in active SLE group (17.0%) was significantly higher than those in inactive group (2.0%) (P?=?0.047). The incidence of premature birth in active SLE group was 25/47 (53.2%), which is significantly higher than those in inactive group (3/34, 8.8%) (P?P?Conclusion.?In general, lupus in pregnancy in the Chinese population is generally similar to other cohorts. Pregnancies can be successful in most women with SLE. However, an increase in SLE activity can occur in a significant number of patients, even those who are well controlled. Adverse fetal outcome including fetal loss, preterm birth, and SGA increases significantly with SLE flares during pregnancy with preeclampsia/eclampsia, thrombocytopenia, and active SLE serving independent predictors of adverse fetal and maternal outcome. Fetal echo should not just for heart block but for structural abnromalities as the structural malformation rate was significantly higher than general population, especially congenital heart disease.     

Maternal obesity and neonatal Apgar scores

Objective.?To determine whether maternal obesity in early pregnancy is associated with low neonatal 5-min Apgar scores while adjusting for confounders.

Methods.?Data were obtained from Maine State Birth Records Database. Analyses were restricted to information on 58,089 white women and their newborns. Maternal weight status was defined using the recorded early second trimester maternal body mass index (BMI) and defined as normal weight (BMI <25), overweight (BMI 25 to <30), obese (BMI 30 to <40), and morbidly obese (BMI ≥40). Logistic regression analysis was used to assess the association of maternal weight status with low Apgar score while adjusting for confounders.

Results.?Compared with newborns of normal weight women, the risk to receive low Apgar scores (4–6) is increased in newborns of obese (OR 1.4, 95% CI 1.1–1.7) and morbidly obese mothers (OR 2.0, 95% CI 1.5–2.7). The association did not achieve significance for newborns of overweight mothers (OR 1.2, 95% CI 0.99–1.4). No association was identified between maternal weight status and very low Apgar scores (0–3).

Conclusions.?Maternal obesity is associated with a significantly increased risk for decreased Apgar scores at birth. Further studies are needed to clarify the relationships among maternal obesity, complications of pregnancy, and neonatal outcome.     

Is the risk of obstetric anal sphincter injuries increased in vaginal twin deliveries?

Objective: Vaginal twin deliveries have a higher rate of intrapartum interventions. We aimed to determine whether these characteristics are associated with an increased rate of obstetric anal sphincter injuries compared with singleton.

Study design: Retrospective study of all twin pregnancies undergoing vaginal delivery trial was conducted from January 2000–September 2014. Sphincter injury rate compared with all concurrent singleton vaginal deliveries. Multivariable analysis was used to determine twin delivery association with sphincter injuries while adjusting for confounders.

Results: About 717 eligible twin deliveries. Outcome was compared with 33?886 singleton deliveries. Twin pregnancies characterized by a higher rate of nulliparity (54.8% versus 49.5%, p?=?0.005), labor induction (42.7% versus 29.1%, p?<?0.001), and instrumental deliveries (27.5% versus 16.7%, p?<?0.001), lower gestational (34.6?±?3.3 versus 38.8?±?2.3, p?<?0.001), and lower birth weight. Total breech extraction was performed in 29.0% (208/717) of twin deliveries. Overall obstetric sphincter injury rate was significantly lower in the twins group (2.8% versus 4.4%, p?=?0.03, OR?=?0.6, 95% CI 0.4–0.9), due to lower rate of 3rd degree tears in twins versus singletons (2.2% versus 4.0%, p?=?0.02), rate of 4th degree tears similar among the groups (0.6% versus 0.4%, p?=?0.5). In multivariable analysis, sphincter injuries were associated with nulliparity (OR?=?3.9, 95% CI 3.4–4.5), forceps (OR?=?6.8, 95% CI 5.8–7.8), vacuum (OR?=?2.9, 95% CI 2.5–3.3), earlier gestational age (OR?=?0.2, 95% CI 0.1–0.3), episiotomy (OR?=?0.8, 95% CI 0.7–0.9), and birth weight over 3500?g (OR?=?1.8, 95% CI 1.6–2.0). However, the association between twins (versus singletons) deliveries and sphincter injuries was lost after adjustment for delivery gestational age (OR?=?0.7, 95% CI 0.4–1.2).

Conclusion: Despite a higher rate of intrapartum interventions, the rate of sphincter injuries is lower in twins versus singleton deliveries, mainly due to a lower gestational age at delivery.     

Pregnancy in patients with sickle cell disease: maternal and perinatal outcomes

Objective: To compare obstetrical, hematological and neonatal outcomes of pregnant women with or without sickle cell disease (SCD).

Methods: A prospective study of 60 pregnancies of 58 women with SCD (29 SCD-SS and 29 SCD-SC) compared with 192 pregnancies in 187 healthy pregnant women was carried out from January 2009 to August 2011.

Results: Compared to controls, the SCD group had higher rate of preterm delivery (p?p?p?=?0.003), and urinary infection (p?=?0.001, OR?=?3.31, CI 1.63–6.73), higher prevalence of small for gestational age babies (p?=?0.019, OR?=?2.66, CI 1.15–6.17), and more frequent baby admissions to progressive care unit (p?p?=?0.056). All adverse events were more frequent in the SS subgroup. Babies from the SS subgroup had the lowest weight at birth (2080?g) compared to SC (2737?g; p?Conclusion: SCD pregnant women – especially those in the SS subgroup – are more prone to experience perinatal and maternal complications in comparison with pregnant women without SCD.     

Maternal ethnicity influences on neonatal respiratory outcomes after antenatal corticosteroid use for anticipated preterm delivery

Objective.?To explore the influence of maternal ethnicity on neonatal outcomes after antenatal corticosteroid administration.

Methods.?A retrospective review of ethnicity, maternal factors, and neonatal birth outcomes was performed for preterm births at a single institution. Cases were limited to women who received antenatal corticosteroids. The impact of ethnicity on specific neonatal respiratory outcomes and mortality was analyzed by bivariate comparisons and by logistic regression analysis.

Results.?Complete ethnicity data were obtained for 548 women. Controlling for gestational age at delivery, diabetes, whether the subject completed a course of steroids, and the dosing of the steroids, logistic regression demonstrated that ethnicity was independently associated with respiratory distress syndrome (compared to Caucasians: African-Americans OR 0.49 (95% CI 0.29–0.85); Filipinos OR 0.45 (95% CI 0.21–0.96).

Conclusions.?Ethnicity is independently associated with neonatal respiratory outcomes after antenatal corticosteroid use. Perhaps individualized dosing of antenatal corticosteroids is needed to further improve neonatal outcomes.     

Risk factors for neonatal brachial plexus paralysis

Purpose

The study was aimed to identify risk factors for neonatal brachial plexus paralysis.

Methods

A retrospective case?Ccontrol study was designed. A comparison was performed between cases of brachial plexus paralysis, with all consecutive deliveries during the same 5 months period, without brachial plexus paralysis. Statistical analysis was performed using the SPSS package.

Results

The prevalence of brachial plexus paralysis was 1.62/1,000 (9/5,525) vaginal births. Independent risk factors for brachial plexus paralysis were shoulder dystocia (OR?=?525; 95% CI 51?C4,977, P?P?4,000?g; OR?=?16.3; 95% CI 3.7?C70.2, P?P?P?=?0.032).

Conclusions

In our population, shoulder dystocia, macrosomia, labor dystocia, vacuum delivery and vaginal breech deliveries were significant risk factors for neonatal brachial plexus paralysis, while maternal characteristics such as obesity and diabetes were not. Despite our growing knowledge concerning the risk factors associated with brachial plexus paralysis, unfortunately, this condition cannot be predicted or prevented.