181: Mode of delivery and neonatal respiratory morbidity in near-term preterm births

Introduction: Antenatal corticosteroids are recommended by Royal College of Obstetrics and Gynaecology for caesarean section planned before thirty-eight plus six weeks gestation. However, these steroids are, not suggested for labour induced electively after thirty four weeks. Objective: This study’s aim is to enumerate the possibility of respiratory morbidity in neonates for various deliberated approaches of delivery between thirty-five and thirty eight weeks gestation. Methodology: This study was carried out during June 2018 and December 2020 at a tertiary obstetric unit and analysed 3796 neonates delivered between thirty-five and thirty eight weeks gestation for neonatal admission due to respiratory morbidity. Results: The risk for respiratory problems in spontaneous labour was 9.9% (16/161), 5.0% (12/238), 1.2% (5/426) and 0.64% (6/930) at thirty five, thirty six, thirty seven and thirty eight weeks of gestation respectively. For induced labour, it was 25% (4/16), 4.8% (5/104), 4.1% (13/318) and 0.82% (4/485) at thirty-five, thirty six, thirty seven and thirty eight weeks respectively. While the risk of respiratory morbidity in elective caesarean section, was 13.8% (4/29), 27.1% (13/48), 4.1% (5/122) and 2.8% (9/318) at thirty-five, thirty six, thirty seven and thirty eight weeks respectively. Overall chance of respiratory morbidity in neonates was 6% after elective caesarean section, 2.8% after labour induction and 2.2% after spontaneous labour (p< 0.0001). The number of neonates with respiratory problems born by elective C-section was only 31 out of total 132 (23.5%). Whereas this risk was 2.8% at 35-38 weeks and 5.0% at 35-37 weeks after induced labour. Conclusion: Elective delivery at 35-38 weeks is linked to respiratory morbidity in new born babies. More research is required to assess the role of prophylactic corticosteroids preceding elective induction of labour.

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Neonatal respiratory morbidity at / near term in relation to planned mode of delivery: a retrospective observational study

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/fetalneonatal-2012-301809.356 ◽

2012 ◽

Vol 97 (Suppl 1) ◽

pp. A109.1-A109

Author(s):

F Memon ◽

P Ayuk

Keyword(s):

Observational Study ◽

Mode Of Delivery ◽

Retrospective Observational Study ◽

Respiratory Morbidity ◽

Near Term

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Mode of Delivery and Infant Respiratory Morbidity Among Infants Born to HIV-1-Infected Women

Obstetrics and Gynecology ◽

10.1097/aog.0b013e3181e8f38a ◽

2010 ◽

Vol 116 (2, Part 1) ◽

pp. 335-343 ◽

Cited By ~ 8

Author(s):

Elizabeth G. Livingston ◽

Yanling Huo ◽

Kunjal Patel ◽

Susan B. Brogly ◽

Ruth Tuomala ◽

...

Keyword(s):

Mode Of Delivery ◽

Respiratory Morbidity ◽

Hiv 1

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Respiratory morbidity in twins by birth order, gestational age and mode of delivery

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0404 ◽

2016 ◽

Vol 44 (8) ◽

Cited By ~ 7

Author(s):

Katja Bricelj ◽

Natasa Tul ◽

Mateja Lasic ◽

Andreja Trojner Bregar ◽

Ivan Verdenik ◽

...

Keyword(s):

Birth Order ◽

Cesarean Delivery ◽

Gestational Age ◽

Mode Of Delivery ◽

Age Groups ◽

Assisted Ventilation ◽

Vaginal Birth ◽

National Database ◽

Respiratory Morbidity ◽

Cesarean Birth

AbstractObjective:To evaluate the relationship between respiratory morbidity in twins by gestational age, birth order and mode of delivery.Methods:All twin deliveries at <37 weeks, registered in a national database, in the period 2003–2012 were classified into four gestational age groups: 33–36, 30–32, 28–29, and <28 weeks. Outcome variables included transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS) and need for assisted ventilation.Results:A total of 1836 twins were born vaginally, and 2142 twins were born by cesarean delivery, for a grand total of 3978 twins. TTN did not appear to be related to birth order and to the mode of delivery. In contrast, RDS was more frequent among the second born twins in the vaginal birth groups born at 30–36 weeks [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.2–5.1 and OR 2.0, 95% CI 1.2–3.5 for 33–36 weeks and 30–32 weeks, respectively], whereas this trend was seen in the cesarean birth groups born earlier (OR 3.8, 95% CI 1.1–13.0 for 28–29 weeks). Cesarean delivery significantly increased the frequency of RDS in twin A as well as in twin B compared with vaginal birth, but only at gestational ages <30 weeks.Conclusion:Mode of delivery and birth order have a gestational age dependent effect on the incidence of RDS.

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Changes in pregnancy outcomes during the COVID-19 lockdown in Iran

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04050-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fahimeh Ranjbar ◽

Leila Allahqoli ◽

Soheila Ahmadi ◽

Robab Mousavi ◽

Maryam Gharacheh ◽

...

Keyword(s):

Health Care ◽

Birth Weight ◽

Low Birth Weight ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Health Care Services ◽

Mode Of Delivery ◽

Preterm Births ◽

Future Health ◽

Significant Difference

Abstract Background The Covid-19 pandemic response is influencing maternal and neonatal health care services especially in developing countries. However, the indirect effects of Covid-19 on pregnancy outcomes remain unknown. The aim of the present study was to compare pregnancy outcomes before and after the beginning of the Covid-19 pandemic in Iran. Methods We performed a retrospective analysis of the medical records of 2,503 pregnant women with singleton pregnancies, admitted to the maternity department of a women’s hospital in Tehran, Iran, during the pre-Covid-19 pandemic (February 19 to April 19, 2019) and the intra-Covid- 19 pandemic (February 19 to April 19, 2020) period. Results We included 2,503 women admitted to the hospital; 1,287 (51.4 %) were admitted before the Covid-19 lockdown and 1,216 (48.6 %) during the Covid-19 lockdown. There were no significant differences in stillbirth rates (p = 0.584) or pregnancy complications (including preeclampsia, pregnancy-induced hypertension and gestational diabetes) (p = 0.115) between pregnant women in the pre- and intra-pandemic periods. However, decreases in preterm births (p = 0.001), and low birth weight (p = 0.005) were observed in the pandemic period compared to the pre-pandemic period. No significant difference in the mode of delivery, and no maternal deaths were observed during the two time periods. Conclusions In our study we observed a decrease in preterm births and low birth weight, no change in stillbirths, and a rise in the admission rates of mothers to the ICU during the initial Covid-19 lockdown period compared to pre-Covid-19 lockdown period. Further research will be needed to devise plan for immediate post-pandemic care and future health care crises.

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Perinatal outcomes of intrahepatic cholestasis of pregnancy from two birth cohorts: A population-based study

Obstetric Medicine ◽

10.1177/1753495x211058321 ◽

2021 ◽

pp. 1753495X2110583

Author(s):

Sawsan Al-Obaidly ◽

Husam Salama ◽

Tawa Olukade ◽

Mai AlQubaisi ◽

Arabo Bayo ◽

...

Keyword(s):

Intrahepatic Cholestasis ◽

Perinatal Outcomes ◽

Preterm Births ◽

Population Based ◽

Labour Induction ◽

Respiratory Morbidity ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Birth Cohorts ◽

Retrospective Data Analysis ◽

Cholestasis Of Pregnancy

Background Intrahepatic cholestasis of pregnancy (ICP) is a complex liver disease with varying incidence worldwide. We compared ICP incidence and pregnancy outcomes with outcomes for normal pregnant controls. Methods We conducted a retrospective data analysis of perinatal registry data for the years 2011 and 2017 to compare the following outcome measures: stillbirths, labour induction, gestational diabetes, pre-eclampsia, antepartum haemorrhage, postpartum haemorrhage, preterm births, low Apgar score, acute neonatal respiratory morbidity, meconium aspiration and in-hospital neonatal death. Results The incidence of ICP was 8 per 1000 births from a total 31,493 singleton births with more cases in 2017 than in 2011. Women with ICP were almost six times more likely to have labour induced including significantly more moderate preterm births (defined as between 32 weeks and 36 weeks and 6 days of gestation)) seen more in 2011 than in 2017. Conclusion Women with ICP showed higher incidence of moderate preterm birth and induced labour but favourable maternal and neonatal outcomes.

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Case management of preterm deliveries: Birth-registry based study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.860 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Baghaturia ◽

M Kereselidze ◽

N Skhvitaridze ◽

T Lobjanidze

Keyword(s):

Length Of Stay ◽

Mode Of Delivery ◽

Health Sector ◽

Preterm Births ◽

Medical Personnel ◽

Study Data ◽

Quality Of Data ◽

Birth Registry ◽

Preterm Newborns

Abstract Modern studies are possible to determine the degree of newborn's prematurity. Evidence based data from 65 countries show the increasing trend of preterm births over the past 20 years. Numbers from the National Center for Disease Control and Public Health of Georgia indicate that of 51 183 infants born in 2018, 7 071 (14%) were delivered between 34 to 37 gestational weeks. The aim of this study was to determine the similarities and differences between preterm newborns delivered at 34-37 gestational weeks according the selected variables. This is the quantitative, retrospective study. Data source was the Georgian birth registry for the year 2018. Variables, as gestational age, mode of delivery, newborn weight, Apgar score, newborn diagnoses according the ICD-10, length of stay in maternity home, and others were used for descriptive statistics. In 2018, for preterm deliveries at 34-37 gestational weeks, 53.7% of newborns were delivered by cesarean section and 46.3% physiologically. Despite the similar characteristics, majority of cases had different length of stay at maternity homes, with variation from four to 66 days. The big concern was the quality of target variables - in 30% of cases occurred missing information. Inconsistent occurred in cross-checking of variables - newborns stay at hospital over the recommended data was not justified by provided diagnosis. The results show the big variance between the preterm newborns with the similar characteristics, delivered at 34-37 gestational weeks in Georgia, mainly for the length of stay. Study reveal necessity to provide awareness rising activities among medical personnel to provide reliable, timely and validated data. The major recommendation is to advice Georgian health sector representatives to develop a mechanism for monitoring and ensuring the measures to evaluate the quality of data, uploaded in the birth registry. Key messages Reliable, consistent and validated data are contributing to the rationalization of the healthcare associated resources and controlling costs. Ongoing monitoring of quality in Georgian birth registry should be top priority of responsible authorities.

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Effects of cytokine-suppressive anti-inflammatory drugs on inflammatory activation in ex vivo human and ovine fetal membranes

Reproduction ◽

10.1530/rep-13-0576 ◽

2014 ◽

Vol 147 (3) ◽

pp. 313-320 ◽

Cited By ~ 17

Author(s):

Lisa F Stinson ◽

Demelza J Ireland ◽

Matthew W Kemp ◽

Matthew S Payne ◽

Sarah J Stock ◽

...

Keyword(s):

Ex Vivo ◽

Preterm Births ◽

Intrauterine Infection ◽

Explant Culture ◽

Saline Control ◽

Γ Irradiation ◽

Ureaplasma Parvum ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Near Term

Intrauterine infection and inflammation are responsible for the majority of early (<32 weeks) spontaneous preterm births (PTBs). Anti-inflammatory agents, delivered intra-amniotically together with antibiotics, may be an effective strategy for preventing PTB. In this study, the effects of four cytokine-suppressive anti-inflammatory drugs (CSAIDs:N-acetyl cysteine (NAC), SB239063, TPCA-1 and NEMO binding domain inhibitor (NBDI)) were assessed on human and ovine gestational membrane inflammation. Full-thickness membranes were collected from healthy, term, human placentas delivered by Caesarean section (n=5). Using a Transwell model, they were stimulatedex vivowith γ-irradiation-killedEscherichia coliapplied to the amniotic face. Membranes from near-term, ovine placentas were stimulatedin uterowith lipopolysaccharide,Ureaplasma parvumor saline control and subjected to explant culture. The effects of treatment with CSAIDs or vehicle (1% DMSO) on accumulation of PGE2and cytokines (human interleukin 6 (IL6), IL10 and TNFα; ovine IL8 (oIL8)) were assessed in conditioned media at various time points (3–20 h). In human membranes, the IKKβ inhibitor TPCA-1 (7 μM) and p38 MAPK inhibitor SB239063 (20 μM) administered to the amniotic compartment were the most effective in inhibiting accumulation of cytokines and PGE2in the fetal compartment. NAC (10 mM) inhibited accumulation of PGE2and IL10 only; NBDI (10 μM) had no significant effect. In addition to the fetal compartment, SB239063 also exerted consistent and significant inhibitory effects in the maternal compartment. TPCA-1 and SB239063 suppressed oIL8 production, while all CSAIDs tested suppressed ovine PGE2production. These results support the further investigation of intra-amniotically delivered CSAIDs for the prevention of inflammation-mediated PTB.

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