Maternal and Neonatal Outcomes in Twin Deliveries with Prolonged Second-Stage Duration of the Presenting Twin: a Retrospective Cohort Study

Abstract Background The correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women. Methods A retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they were divided into subgroups. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (III and IV degree), hospitalization stay ≥90th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤ 7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery. Results There were 7109 parturients included in this study. The duration of first stage was 6.2(3.6–10.0) hours, the second stage was 0.3(0.2–0.7) hour, the total stage was 6.9(4.1–10.7) hours in multiparous women. At the first stage, the rates of overall adverse outcome were 21, 23.4, 28.8, 35.5, 38.4% in subgroups < 6 h, 6–11.9 h, 12–17.9 h, 18–23.9 h, ≥24 h, which increased significantly (X2 = 57.64, P < 0.001), and ARR (95% CI) were 1.10 (0.92,1.31), 1.33 (1.04,1.70), 1.80 (1.21,2.68), 2.57 (1.60,4.15) compared with subgroup < 6 h (ARR = 1); At the second stage, the rates of overall adverse outcome were 20.0, 30.7, 38.5, 61.2, 69.6% in subgroups < 1 h, 1–1.9 h, 2–2.9 h, 3–3.9 h, ≥4 h (X2 = 349.70, P < 0.001), and ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08) compared with subgroup < 1 h (ARR = 1)). At the total stage, the rates of overall adverse outcome were 21.5, 30.8, 42.4% in subgroups < 12 h, 12–23.9 h, ≥24 h (X2 = 84.90, P < 0.001), and ARR (95% CI) were 1.41 (1.16,1.72), 3.17 (2.10,4.80) compared with subgroup < 12 h (ARR = 1). Conclusions The prolonged stage of labor may lead to increased adverse outcomes in multiparous women, it was an independent risk factor of adverse maternal and neonatal outcomes.

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The Impact of Labor Stage Duration on Adverse Maternal and Neonatal Outcomes in Multiparous Women: A Retrospective Cohort Study

10.21203/rs.3.rs-22314/v1 ◽

2020 ◽

Author(s):

li wang ◽

hongxia Wang ◽

lu jia ◽

wenjie qing ◽

fan Li ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort ◽

Adverse Outcomes ◽

Neonatal Outcomes ◽

Stage Duration ◽

Second Stage Of Labor ◽

Second Stage ◽

Multiparous Women ◽

Maternal And Neonatal Outcomes ◽

The Impact

Abstract Background The duration of first and second stages of labor was increased in the consensus that American College of Obstetricians and Gynecologists (ACOG) published 2014. Studies showed increased adverse maternal and neonatal outcomes in nulliparous women with prolonged second stage of labor. It is not very clear that the impact of labor stage duration on multiparous women.Methods A retrospective cohort study was performed. Cephalic, term, singleton multiparous women were included, who planned for vaginal delivery. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (3rd and 4th degree), hospitalization stay ≥ 90%th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤ 7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery. We defined the total stage included the first and second stage of labor.Results There were 7109 parturients included, The duration of first stage was 6.2(3.6–10.0) hours in multiparous women, the second stage was 0.3(0.2–0.7) hours, the total stage was 6.9(4.1–10.7) hours. In the first stage, the rate of overall adverse outcomes was 21%, 23.4%, 28.8%, 35.5%, 38.4% in < 6 h, 6-11.9 h, 12-17.9 h, 18-23.9 h, ≥ 24 h, increased significantly (X2 = 57.64, P๤0.001). Compared with < 6 h, ARR(95%CI) were 1.10(0.92,1.31), 1.33(1.04,1.70), 1.80(1.21,2.68), 2.57(1.60,4.15);In the second stage, the rate of overall adverse outcomes increased from 20.0%, 30.7%, 38.5%, to 61.2%, 69.6% in < 1 h, 1-1.9 h, 2-2.9 h, 3-3.9 h, ≥ 4 h (X2 = 349.70, P๤0.001). Compared with < 1 h, ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08); In the total stage, the rate of overall adverse outcomes were 21.5%, 30.8%, 42.4% in < 12 h, 12-23.9 h, ≥ 24 h (X2 = 84.90, P๤0.001). Compared with < 12 h, ARR (95% CI) were 1.41(1.16,1.72), 3.17 (2.10,4.80).Conclusions The prolonged labor stage may lead to increased adverse outcomes in multiparous women, even in the first stage. The duration of labor stage was an independent risk factor for adverse maternal and neonatal outcomes.

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The Impact of Stage of Labor on Adverse Maternal and Neonatal Outcomes in Multiparous Women: A Retrospective Cohort Study

10.21203/rs.3.rs-22314/v2 ◽

2020 ◽

Author(s):

li wang ◽

hongxia Wang ◽

lu jia ◽

wenjie qing ◽

fan Li ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Adverse Outcome ◽

Neonatal Resuscitation ◽

Neonatal Outcomes ◽

Second Stage ◽

Multiparous Women ◽

Maternal And Neonatal Outcomes ◽

The Impact

Abstract Background: The correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women.Methods: A retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they were divided into subgroups. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (III and IV degree), hospitalization stay ≥90th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery. Results: There were 7109 parturients included in this study. The duration of first stage was 6.2(3.6-10.0) hours, the second stage was 0.3(0.2-0.7) hour, the total stage was 6.9(4.1-10.7) hours in multiparous women. At the first stage, the rates of overall adverse outcome were 21%, 23.4%, 28.8%, 35.5%, 38.4% in subgroups <6h, 6-11.9h, 12-17.9h, 18-23.9h, ≥24h, which increased significantly (X2=57.64, P<0.001), and ARR (95% CI) were 1.10 (0.92,1.31), 1.33 (1.04,1.70), 1.80 (1.21,2.68), 2.57 (1.60,4.15) compared with subgroup <6h (ARR=1); At the second stage, the rates of overall adverse outcome were 20.0%, 30.7%, 38.5%, 61.2%, 69.6% in subgroups <1h, 1-1.9h, 2-2.9h, 3-3.9h, ≥4h (X2=349.70, P<0.001), and ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08) compared with subgroup <1h (ARR=1)). At the total stage, the rates of overall adverse outcome were 21.5%, 30.8%, 42.4% in subgroups <12h, 12-23.9h, ≥24h (X2=84.90, P<0.001), and ARR (95% CI) were 1.41 (1.16,1.72), 3.17 (2.10,4.80) compared with subgroup <12h (ARR=1).Conclusions: The prolonged stage of labor may lead to increased adverse outcomes in multiparous women, it was an independent risk factor of adverse maternal and neonatal outcomes.

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The Impact of Stage of Labor on Adverse Maternal and Neonatal Outcomes in Multiparous Women: A Retrospective Cohort Study

10.21203/rs.3.rs-22314/v3 ◽

2020 ◽

Author(s):

Li Wang ◽

Hongxia Wang ◽

Lu Jia ◽

Wenjie Qing ◽

Fan Li ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Adverse Outcome ◽

Neonatal Resuscitation ◽

Neonatal Outcomes ◽

Second Stage ◽

Multiparous Women ◽

Maternal And Neonatal Outcomes ◽

The Impact

Abstract Background: The correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women.Methods: A retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they were divided into subgroups. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (III and IV degree), hospitalization stay ≥90th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery. Results: There were 7109 parturients included in this study. The duration of first stage was 6.2(3.6-10.0) hours, the second stage was 0.3(0.2-0.7) hour, the total stage was 6.9(4.1-10.7) hours in multiparous women. At the first stage, the rates of overall adverse outcome were 21%, 23.4%, 28.8%, 35.5%, 38.4% in subgroups <6h, 6-11.9h, 12-17.9h, 18-23.9h, ≥24h, which increased significantly (X2=57.64, P<0.001), and ARR (95% CI) were 1.10 (0.92,1.31), 1.33 (1.04,1.70), 1.80 (1.21,2.68), 2.57 (1.60,4.15) compared with subgroup <6h (ARR=1); At the second stage, the rates of overall adverse outcome were 20.0%, 30.7%, 38.5%, 61.2%, 69.6% in subgroups <1h, 1-1.9h, 2-2.9h, 3-3.9h, ≥4h (X2=349.70, P<0.001), and ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08) compared with subgroup <1h (ARR=1)). At the total stage, the rates of overall adverse outcome were 21.5%, 30.8%, 42.4% in subgroups <12h, 12-23.9h, ≥24h (X2=84.90, P<0.001), and ARR (95% CI) were 1.41 (1.16,1.72), 3.17 (2.10,4.80) compared with subgroup <12h (ARR=1).Conclusions: The prolonged stage of labor may lead to increased adverse outcomes in multiparous women, it was an independent risk factor of adverse maternal and neonatal outcomes.

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Comparison of Maternal and Neonatal Outcomes between Acute Fatty Liver of Pregnancy and Hemolysis, Elevated Liver Enzymes and Low Platelets Syndrome: A Retrospective Cohort Study

10.21203/rs.3.rs-111120/v1 ◽

2020 ◽

Author(s):

Sau Xiong Ang ◽

Chie-Pein Chen ◽

Fang-Ju Sun ◽

Chen-Yu Chen

Keyword(s):

Cohort Study ◽

Fatty Liver ◽

Retrospective Cohort Study ◽

Hellp Syndrome ◽

Retrospective Cohort ◽

Liver Enzymes ◽

Neonatal Outcomes ◽

Elevated Liver Enzymes ◽

Acute Fatty Liver ◽

Maternal And Neonatal Outcomes

Abstract Background: Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.Methods: This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were analyzed.Results: During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0% versus 23.8%) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7% versus 13.8%), acute kidney injury (61.9% versus 15.0%), disseminated intravascular coagulopathy (66.7% versus 8.8%), and sepsis (47.6% versus 10.0%) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1% versus 33.3%), neonatal respiratory distress syndrome (39.2% versus 8.3%) and neonatal sepsis (34.2% versus 12.5%) were noted in the HELLP syndrome group.Conclusions: AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

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