scholarly journals 342: The impact of episiotomy on adverse perinatal outcomes in spontaneous vaginal deliveries

2020 ◽  
Vol 222 (1) ◽  
pp. S230
Author(s):  
Sydney Thayer ◽  
Sarah Owens ◽  
Keenan Yanit ◽  
Bharti Garg ◽  
Aaron B. Caughey
2020 ◽  
Vol 135 ◽  
pp. 113s
Author(s):  
Sarah N. Owens ◽  
Sydney Marie Thayer ◽  
Keenan Yanit ◽  
Bharti Garg ◽  
Aaron B. Caughey

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shigeki Koshida ◽  
Shinsuke Tokoro ◽  
Daisuke Katsura ◽  
Shunichiro Tsuji ◽  
Takashi Murakami ◽  
...  

AbstractMaternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11–0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.


2017 ◽  
Vol 45 (2) ◽  
Author(s):  
Cenk Gezer ◽  
Atalay Ekin ◽  
Gokhan Goynumer ◽  
Kaan Pakay ◽  
Hicran Acar ◽  
...  

AbstractObjective:To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes.Methods:In this case-control study, 412 women who underwent CVS at 11–14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution.Results:The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4–2.7, P=0.008].Conclusion:The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.


Author(s):  
Catarina Policiano ◽  
Jorge Mendes ◽  
Andreia Fonseca ◽  
Joana Barros ◽  
Sara Vargas ◽  
...  

Objective To evaluate the accuracy of 35-37 weeks‘ ultrasound for fetal growth restriction (FGR) detection and the impact of 30th-33rd weeks vs 35th-37th weeks ultrasound on perinatal outcomes. Design A prospective randomized trial Setting Tertiary referral hospital in Portugal. Population Low risk pregnant women Methods We enrolled 1061 women: 513 in the control group (ultrasound at 30th-33rd weeks) and 548 in the study group (with an additional ultrasound at 35th-37th weeks). FGR was defined as an estimated fetal weight (EFW) below 10th percentile. We calculated the overall accuracy of the 35-37 weeks’ ultrasound and compared perinatal outcomes between both groups. Main outcome measure Detection of late FGR Results The ultrasound at 35-37 weeks had an overall accuracy of FGR screening of 94%. Spearman’s correlation coefficient between EFW and birthweight centile was higher for at 35-37 weeks’ ultrasound (ρ = 0.75) compared with 30-33 weeks’ ultrasound (ρ = 0.44). The study group had a lower rate of operative vaginal deliveries (24.4% vs 39.3%, p = 0.005) and cesarean deliveries for nonreassuring fetal status (16.8% vs 38.8%, p < 0.001). For FGR prediction, the area under the receiver-operating characteristics curve of EFW centile at 35-37 weeks’ ultrasound was 0.90 (95% CI, 0.86-0.95). Conclusions A later ultrasound (35-37 weeks) had a higher correlation between EFW and birthweight centiles and was associated with a lower rate of cesarean and operative deliveries for nonreassuring fetal status compared to an earlier ultrasound, which reinforces that antenatal identification of FGR allows close monitoring and appropriate management.


2019 ◽  
Vol 22 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Annabel C. M. Sheehan ◽  
Mark P. Umstad ◽  
Stephen Cole ◽  
Thomas J. Cade

AbstractIt has been suggested that the risk of adverse perinatal outcomes in twin pregnancies is exacerbated by concomitant gestational diabetes mellitus (GDM). This study aimed to assess the risk incurred by twin pregnancy and by a diagnosis of GDM, separately, on the development of poor perinatal outcomes. A retrospective cohort study was conducted on all pregnant women at a tertiary center between 2016 and 2017. The impact of GDM and twin pregnancies on perinatal outcomes — birth weight above the 90th centile for gestational age, cesarean delivery, clinical neonatal hypoglycemia, and premature delivery (before 37 weeks’ gestation) — was assessed using univariate and multivariate analyses. Overall, 13,527 women were eligible for the study; 11,915 were uncomplicated singleton pregnancies; 1379 of these had GDM; 194 were twin pregnancies, and 39 of these had GDM. Univariate analyses showed that twin pregnancies were associated with a higher risk of all perinatal outcomes except macrosomia. In the multivariate analyses, twin pregnancy was a much higher predictor of cesarean delivery (OR 8.40, 95% CI [6.25, 11.49], p < .0001) and preterm birth (OR 58.82, 95% CI [31.25, 125], p < .0001) compared to GDM but GDM was a higher predictor of neonatal hypoglycemia (OR 4.87, 95% CI [3.74, 6.29], p < .0001). Twin pregnancy is more strongly associated with all adverse perinatal outcomes except macrosomia. GDM does not increase risk of adverse perinatal outcomes except for neonatal hypoglycemia.


Author(s):  
Vijay M. Kansara ◽  
Kunal D. Kadakar ◽  
Akash S. Chikani ◽  
Pinal A. Pateliya

Background: Current study was carried out to assess the impact of isolated oligohydramnios on perinatal outcomes and mode of delivery.Methods: A retrospective observational cohort study was conducted at term pregnancy with sonographic finding of isolated oligohydramnios (AFI <5 cm) were recruited for the study. Uterine anomaly and high risk pregnancies were excluded from the study. The mode of delivery and perinatal outcome were compared with control group of pregnancy with normal amniotic fluid (AFI >5-25 cm).Results: When compared to the normal AFI, women with oligohydramnios had significantly lower birth weight babies and were delivered at a significantly earlier gestational age. However there was no difference in the APGAR scores at birth and NICU admissions between the two groups. Reactive NST had more chances of good APGAR score at 1 and 5 minute and that lower the AFI more the probability of nonreactive NST and abnormal Doppler. The number of inductions and caesareans done for foetal reasons were significantly higher in the exposed group.Conclusions: Obstetric and perinatal outcome remains similar in both isolated oligohydramnios with reactive NST as well as in patients with normal amniotic fluid index. Isolated oligohydramnios is not associated with adverse perinatal outcomes. However, it increases the risk for labour induction and caesarean section.


2020 ◽  
Vol 35 (7) ◽  
pp. 1553-1561
Author(s):  
Jinliang Zhu ◽  
Zhongwei Wang ◽  
Lixue Chen ◽  
Ping Liu

Abstract STUDY QUESTION Is the vanishing of a co-twin after or before the ultrasonic registration of cardiac activity at approximately 6–8 weeks of gestation associated with adverse perinatal outcomes? SUMMARY ANSWER The timing of the demise of a co-twin after the registration of cardiac activity is an independent risk factor for adverse perinatal outcomes. WHAT IS KNOWN ALREADY A significant body of evidence has confirmed that vanishing twin (VT) pregnancies are associated with higher levels of risk for preterm birth (PTB), low birthweight (LBW), small-for-gestational age (SGA) and perinatal mortality, compared with singleton pregnancy. However, the impact of co-twin vanishing, before or after the presence, of cardiac activity, on perinatal outcomes has yet to be extensively investigated. STUDY DESIGN, SIZE, DURATION We retrospectively reviewed the medical records of 38 876 singletons delivered from ART cycles between 2006 and 2018, at the Peking University Third Hospital. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 35 188 singletons were delivered from the singleton pregnancy group, 2256 singletons from the VT pregnancy group after that cardiac activity was noted, and 1432 singletons were delivered from the VT pregnancy group before cardiac activity could be registered. Using the Poisson model, the adjusted risk ratio (aRR) was used to estimate the incidence of PTB, LBW, SGA and perinatal mortality, in the pregnancies of two types of VT compared with singleton pregnancies after correction for potential confounding factors. MAIN RESULTS AND THE ROLE OF CHANCE The vanishing of a co-twin after the registration of cardiac activity was associated with an increased risk of perinatal mortality when compared with the group of singleton pregnancies (0.5% vs 0.2%; P = 0.006); this association still existed after adjustment for potential confounders (aRR 2.19, 95% CI 1.12–4.30; P = 0.023). Furthermore, it was significantly associated with a higher risk of PTB (all cycles aRR 2.00, 95% CI 1.77–2.24; P &lt; 0.001; fresh transfer aRR 2.06, 95% CI 1.78–2.38; P &lt; 0.001; frozen transfer aRR 1.87, 95% CI 1.52–2.28; P &lt; 0.001), LBW (all cycles aRR 2.47, 95% CI 2.12–2.88; P &lt; 0.001; fresh transfer aRR 2.50, 95% CI 2.07–3.02; P &lt; 0.001; frozen transfer aRR 2.39; 95% CI 1.83–3.12; P &lt; 0.001) and SGA (all cycles aRR 1.56, 95% CI 1.35–1.80; P &lt; 0.001; fresh transfer aRR 1.53, 95% CI 1.29–1.81; P &lt; 0.001; frozen transfer aRR 1.62, 95% CI 1.24–2.11; P &lt; 0.001). However, prior to the presence of cardiac activity, the vanishing of a co-twin was not associated with a higher risk of perinatal mortality (all cycles aRR 0.71, 95% CI 0.17–2.92; P = 0.636; fresh cycles aRR 0.51, 95% CI 0.07–3.70; P = 0.502; frozen cycles aRR 1.29, 95% CI 0.17–9.66; P = 0.803), PTB (all cycles aRR 1.11, 95% CI 0.91–1.34; P = 0.301; fresh cycles aRR 1.10, 95% CI 0.87–1.39; P = 0.447; frozen cycles aRR 1.13, 95% CI 0.81–1.58; P = 0.467), LBW (all cycles aRR 1.19, 95% CI 0.91–1.55; P = 0.207; fresh cycles aRR 1.08, 95% CI 0.77–1.51; P = 0.668; frozen cycles aRR 1.45, 95% CI 0.93–2.25; P = 0.100) and SGA (all cycles aRR 1.09, 95% CI 0.89–1.35; P = 0.405; fresh cycles aRR 0.97, 95% CI 0.75–1.26; P = 0.839). Pregnancies involving the two types of VT were significantly different in terms of PTB (all cycles aRR 1.80, 95% CI 1.45–2.24; P &lt; 0.001; fresh cycles aRR 1.88, 95% CI 1.44–2.45; P &lt; 0.001; frozen cycles aRR 1.65, 95% CI 1.13–2.40; P = 0.009), LBW (all cycles aRR 2.08, 95% CI 1.55–2.79; P &lt; 0.001; fresh cycles aRR 2.32, 95% CI 1.61–3.36; P &lt; 0.001; frozen cycles aRR 1.65, 95% CI 1.01–2.70; P = 0.046) and SGA (all cycles aRR 1.70, 95% CI 1.36–2.11; P &lt; 0.001; fresh cycles aRR 1.87, 95% CI 1.42–2.45; P &lt; 0.001). LIMITATIONS, REASONS FOR CAUTION The present data are not able to differentiate between co-twin demise occurring in the first or second trimester. Because the second trimester ultrasound scan is not an integral aspect of IVF assessment, this information was not available in the database. WIDER IMPLICATIONS OF THE FINDINGS Adverse perinatal outcomes in ART babies can be avoided by replacing one embryo at a time. It is possible to apply selective single embryo transfer strategy for all while maintaining acceptable success rates. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Natural Science Foundation of China for Young Scholars (Reference number: 31801251). No competing interests to declare. TRIAL REGISTRATION NUMBER not applicable.


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