32: Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term: a prospective cohort study

Abstract Background: The umbilical coiling index (UCI) is a measure of the number of coils in the umbilical cord in relation to its length. Hypercoiled cords with a UCI of >0.3 coils/cm have been associated with adverse fetal and neonatal outcomes. Aims: The primary aim is to determine the accuracy of UCI measured on second trimester ultrasound in predicting UCI at birth. The secondary outcome is to investigate the association between hypercoiling of the umbilical cord on prenatal ultrasound and adverse maternal, fetal and neonatal outcomes. Methods: This was a prospective cohort study of uncomplicated singleton pregnancies. Seventy two patients were included in the study. UCI was measured in the second trimester ultrasound, and compared to UCI measured postnatally. Outcomes of patients with hypercoiled cords on ultrasound were compared to outcomes of patients with normocoiled cords. Results: Our results failed to show a strong correlation between the UCI determined with ultrasound, and the UCI determined with examination of the umbilical cord after delivery. We also did not demonstrate that measurement of the UCI on second trimester ultrasound is able to predict adverse maternal, fetal or neonatal outcomes. Conclusion: This study suggests that measurement of the umbilical coiling index should not be part of routine second trimester sonography in patients with uncomplicated singleton pregnancies, with no other medical or surgical comorbidities.

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Taking the plunge: Water immersion for labour and birth amongst women with moderate obstetric risk factors: A prospective cohort study

10.22541/au.163016246.62890479/v1 ◽

2021 ◽

Author(s):

Emma Seed ◽

Lauren Kearney ◽

Edward Weaver ◽

Rachael Nugent

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Outcome Measures ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Water Immersion ◽

Perinatal Outcomes ◽

Neonatal Morbidity ◽

Significant Difference ◽

Mode Of Birth

Objective: This study investigated maternal and fetal outcomes following warm water immersion (WWI) and/or waterbirth compared with land birth for women with moderate obstetric risk factors. Design: Prospective cohort study. Setting: Maternity hospital, Australia, 2019-2020 Population: 1665 participants, some with ‘risk factors’ for adverse perinatal outcomes requiring continuous electronic fetal monitoring (CEFM) during labour. Method: Multivariate logistical regressions were used to determine the odds of neonatal and maternal outcome measures between three groups: waterbirth, WWI and land birth Main outcome measures: Neonatal morbidity and mortality, including neonatal unit admission (NNU). Maternal clinical outcome measures, including mode of birth, perineal injury, postpartum haemorrhage, length of labour and morbidity. Results: NNU admissions for a suspected infectious condition were significantly higher in the land birth group (p=0.035). After accounting for labour duration, epidural use, previous birth mode, and labour onset, no significant difference was detected between land births and WWI/water births in the odds of NNU admission (p=0.200). No babies were admitted to NNU with signs of water inhalation or drowning. Women birthing on land had a higher mean blood loss (p=0.036) and were more likely to be febrile (2% v 0%; p=0.007); Obstetric anal sphincter injury was similar between groups. Pharmacological analgesia use was lower in the WB/WWI group (p<0.001). There was 1 cord avulsion in the waterbirth group (0.41%). Mode of birth was similar between groups (p=0.697). Conclusion: Despite moderate obstetric risk factors such as oxytocin administration and induction of labour; maternal and neonatal outcomes were similar between groups.

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Maternal and Perinatal Outcomes in Childbirths with Meconium Stained Amniotic Fluid in a Low-resource Setting: A Prospective Cohort Study

Archives of Current Research International ◽

10.9734/acri/2019/v17i130102 ◽

2019 ◽

pp. 1-11

Author(s):

Gregory E. Halle-Ekane ◽

Phyllis N. Fon ◽

Paul N. Koki ◽

Alexis A. Tazinya ◽

Rodrigue Ekollo ◽

...

Keyword(s):

Cohort Study ◽

Amniotic Fluid ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Neonatal Intensive Care ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Neonatal Morbidity ◽

Resource Setting ◽

Meconium Stained Amniotic Fluid

Meconium stained amniotic fluid (MSAF) can be associated with a high maternal and perinatal mortality. There is paucity of data on maternal and fetal outcomes of MSAF in Cameroon. Aim: The study was to determine the maternal and perinatal outcomes in patients with MSAF. Study Design: Prospective cohort study. Place and Duration of Study: The study carried out in the Limbe Regional Hospital maternity, Cameroon from 10th January 2017 to 20th April 2017. Methodology: Fifty- two mothers who had MSAF and their neonates, were matched with controls (without MSAF) in a 1:1 ratio after matching for: age, gestational age, parity and body mass index. Risk ratio (RR) of MSAF on the various perinatal outcomes were calculated by multivariate logistic regression with MSAF (-) being the reference. Data was analyzed with Epi Info 7. Results: Two hundred and three deliveries were conducted during the study period with fifty-two with MSAF enrolled in the study. The proportion of participants with MSAF was 19.1%. Parturients who had thick MSAF were 3 times more likely to have caesarean sections (RR: 3.2, 95% CI= 1.1 - 10.2, p = 0.04). Two (3.9%) parturients with chorioamnionitis had MSAF. The neonatal complications were: non- reassuring fetal heart rate (RR=4.4, 95%CI: 1.1-16.8, p=0.02), neonatal sepsis (RR=3.7, 95%CI: 1.4-9.8, p=0.01) and neonatal intensive care unit admissions (RR=2.9, 95%CI: 1.2-6.9, p=0.02), were associated with MSAF. Two (3.9%) had meconium aspiration syndrome on clinical examination. No maternal death was recorded. However, a perinatal death occurred in a parturient with MSAF. Conclusion: The proportion of parturients with MSAF was high. MSAF was associated with increased maternal and neonatal morbidity. We recommend larger and robust cohort studies to further refine our findings.

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