TOLAC-associated Maternal and Neonatal Morbidity: has Contemporary TOLAC Labor Management Increased Risk?

AbstractBackgroundIn monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS.MethodsThe study population consisted of monochorionic twin pregnancies with preterm birth (24–37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups.ResultsDuring the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups.ConclusionThe spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.

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The role of the renin–angiotensin–aldosterone system in preeclampsia: genetic polymorphisms and microRNA

Journal of Molecular Endocrinology ◽

10.1530/jme-12-0216 ◽

2013 ◽

Vol 50 (2) ◽

pp. R53-R66 ◽

Cited By ~ 19

Author(s):

Jie Yang ◽

Jianyu Shang ◽

Suli Zhang ◽

Hao Li ◽

Huirong Liu

Keyword(s):

Genetic Polymorphisms ◽

Large Scale ◽

Salt Water ◽

Prognostic Significance ◽

Neonatal Morbidity ◽

Well Being ◽

Normal Pregnancy ◽

Placental Perfusion ◽

Familial Predisposition ◽

Increased Risk

The compensatory alterations in the rennin–angiotensin–aldosterone system (RAAS) contribute to the salt–water balance and sufficient placental perfusion for the subsequent well-being of the mother and fetus during normal pregnancy and is characterized by an increase in almost all the components of RAAS. Preeclampsia, however, breaks homeostasis and leads to a disturbance of this delicate equilibrium in RAAS both for circulation and the uteroplacental unit. Despite being a major cause for maternal and neonatal morbidity and mortality, the pathogenesis of preeclampsia remains elusive, where RAAS has been long considered to be involved. Epidemiological studies have indicated that preeclampsia is a multifactorial disease with a strong familial predisposition regardless of variations in ethnic, socioeconomic, and geographic features. The heritable allelic variations, especially the genetic polymorphisms in RAAS, could be the foundation for the genetics of preeclampsia and hence are related to the development of preeclampsia. Furthermore, at a posttranscriptional level, miRNA can interact with the targeted site within the 3′-UTR of the RAAS gene and thereby might participate in the regulation of RAAS and the pathology of preeclampsia. In this review, we discuss the recent achievements of genetic polymorphisms, as well as the interactions between maternal and fetal genotypes, and miRNA posttranscriptional regulation associated with RAAS in preeclampsia. The results are controversial but utterly inspiring and attractive in terms of potential prognostic significance. Although many studies suggest positive associations with genetic mutations and increased risk for preeclampsia, more meticulously designed large-scale investigations are needed to avoid the interference from different variations.

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Pregnancy Outcomes after Early Amniotomy among Class III Obese Gravidas Undergoing Induction of Labor

American Journal of Perinatology ◽

10.1055/s-0038-1675331 ◽

2018 ◽

Vol 36 (05) ◽

pp. 449-454

Author(s):

Daniel Pasko ◽

Kathryn Miller ◽

Victoria Jauk ◽

Akila Subramaniam

Keyword(s):

Cesarean Delivery ◽

Pregnancy Outcomes ◽

Neonatal Morbidity ◽

Induction Of Labor ◽

Obese Women ◽

Class Iii ◽

Membrane Rupture ◽

Nulliparous Women ◽

Increased Risk ◽

Class Iii Obesity

Objective We sought to evaluate differences in pregnancy outcomes following early amniotomy in women with class III obesity (body mass index ≥40 kg/m2) undergoing induction of labor. Study Design This is a retrospective cohort study of women with class III obesity undergoing term induction of labor from January 2007 to February 2013. Early amniotomy was defined as artificial membrane rupture at less than 4 cm cervical dilation. The primary outcome was cesarean delivery. Secondary outcomes included length of labor, a maternal morbidity composite, and a neonatal morbidity composite. A subgroup analysis examined the effect of parity. Multivariable logistic regression was used to adjust for covariates. Results Of 285 women meeting inclusion criteria, 107 (37.5%) underwent early amniotomy and 178 (62.5%) underwent late amniotomy. Early amniotomy was associated with cesarean delivery after multivariable adjustments (adjusted odds ratio [aOR], 2.05; 95% confidence interval [CI], 1.21–3.47). There were no significant differences in length of labor or maternal and neonatal morbidity between groups. When stratified by parity, early amniotomy was associated with increased cesarean delivery (aOR, 3.10; 95% CI, 1.47–6.58) only in nulliparous women. Conclusion Early amniotomy among class III obese women, especially nulliparous women, undergoing labor induction may be associated with an increased risk of cesarean delivery.

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Effects of Maternal food Insecurity on Birth Weight of Neonates: A Prospective Cohort

Annals of King Edward Medical University ◽

10.21649/akemu.v23i4.2233 ◽

2018 ◽

Vol 23 (4) ◽

pp. 524-530

Author(s):

Ayesha Saeed ◽

Mobina Naqvi ◽

Ahsan Javed

Keyword(s):

Food Security ◽

Birth Weight ◽

Low Birth Weight ◽

Food Insecurity ◽

Prospective Cohort ◽

Multinomial Logistic Regression ◽

Neonatal Morbidity ◽

Household Food Security ◽

Increased Risk

Pakistani population is seriously malnutritioned and is hunger redisposed. Based on the Global Hunger Index Pakistan is ranked at 107 of 118 countries .Food insecurity is among major causes of under-nutrition and has been associated with low birth weights. This study aimed to assess the effect of maternal foodinsecurity on birth weight of neonates in Lahore, Pakistan.Ina prospective cohort conducted at Shalamar Hospital Lahore; from April to August 2016, written informed consents were obtained from 103 eligible pregnant women. Data on demography was collected through a structured questionnaire and exposure wasassessed through 6-items Version of U.S. Household Food Security Survey and cohort was followed until delivery, and birth weight was recorded. Follow up could be completed for 50 women only and response rate was 49%. Descriptive statistics were calculated, and relative risk and multinomial logistic Regression were applied using SPSS version 22. Mean maternal age was 28.100+4.824 years, mean education was 12.400+2.138 years, mean BMI was 29.420+5.075 and mean household income was PKR 25641+16251.543. With these characteristics, the mean birth weight of2.814+0.551 kg was recorded. Four percent (n=2) had very low food security and 34% (n=17) women had low food security. Importantly, food unsecured women had a 5.439 times increased risk of delivering a low birth weight neonate (RR=5.439, CI=1.710-17.296, p=0.002). Regression analysis indicated a significant association (AOR 16.076, CI=2.381-108.564, p=0.004).Based onthese studies, it was concluded that food insecurity in pregnancy is associated with low birth weight in neonates. Antenatal screening of food insecurity and timely provision food supplements through social welfare can help reduce neonatal morbidity and mortality.

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Assessment of knowledge on non-pharmacological methods of pain relief during labour among nurses working in maternity and children hospital, Nepal

Journal of Chitwan Medical College ◽

10.3126/jcmc.v7i3.23691 ◽

2017 ◽

Vol 7 (3) ◽

pp. 25-28

Author(s):

Amshu Dhakal ◽

Shrooti Shah ◽

Babita Singh

Keyword(s):

Pain Relief ◽

Well Being ◽

Cross Sectional Study ◽

Labor Pain ◽

Labor Management ◽

Cross Sectional ◽

Self Confidence ◽

Increased Risk ◽

Women And Children ◽

Self Administered Questionnaire

Background: Labor pain is a universal phenomenon and it is associated with the contraction of uterus. Rather than making the pain disappear with pharmacotherapy, the nurses can assist the laboring women to cope up with, build their self-confidence and maintain a sense of mastery of well-being. Thus, nurses must have knowledge to assess pain to implement pain relief strategies. Methods: A descriptive cross-sectional study was carried out among 52 nurses of Siddhartha Women and Children Hospital, Butwal, Nepal to assess Knowledge about Non-pharmacological Methods of Pain Relief during Labor using structured self-administered questionnaire. The reliability of the tool after pretesting was 0.883. Descriptive statistics was used to analyze the data. Results: Among 52 nurses, 36.5% were 18-22 years of age, 46.2% of them had qualification of Proficiency certificate level Nursing, 40.4% had experience of 3 years- 6 years. In this study, 46.2% had satisfactory knowledge about non-pharmacological methods of pain relief during labor, 32.6% had fair knowledge and remaining 21.2% had poor knowledge. Conclusion: This study concluded that less than half of the nurses had satisfactory knowledge about non-pharmacological methods of pain relief during labor. Since, there is an increased risk of complications resulting from pain and anxiety during labor, management of pain is very essential thus nurse’s knowledge on these methods is crucial. Hence, the nurses should be encouraged to enhance knowledge related to management of labor pain.

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Birthweight thresholds for increased risk for maternal and neonatal morbidity following vaginal delivery: a retrospective study

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-018-4924-0 ◽

2018 ◽

Vol 298 (6) ◽

pp. 1123-1129

Author(s):

Eran Ashwal ◽

Alexandra Berezowsky ◽

Sharon Orbach-Zinger ◽

Nir Melamed ◽

Amir Aviram ◽

...

Keyword(s):

Retrospective Study ◽

Vaginal Delivery ◽

Neonatal Morbidity ◽

Increased Risk

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Obesity, Second Stage Duration, and Labor Outcomes in Nulliparous Women

American Journal of Perinatology ◽

10.1055/s-0039-1697586 ◽

2019 ◽

Author(s):

Antonina I. Frolova ◽

Nandini Raghuraman ◽

Molly J. Stout ◽

Methodius G. Tuuli ◽

George A. Macones ◽

...

Keyword(s):

Maternal Morbidity ◽

Secondary Analysis ◽

Neonatal Morbidity ◽

Fetal Distress ◽

Obese Women ◽

Stage Duration ◽

Second Stage ◽

Nulliparous Women ◽

Increased Risk ◽

Labor Outcomes

Abstract Objective To estimate second stage duration and its effects on labor outcomes in obese versus nonobese nulliparous women. Study Design This was a secondary analysis of a cohort of nulliparous women who presented for labor at term and reached complete cervical dilation. Adjusted relative risks (aRR) were used to estimate the association between obesity and second stage characteristics, composite neonatal morbidity, and composite maternal morbidity. Effect modification of prolonged second stage on the association between obesity and morbidity was assessed by including an interaction term in the regression model. Results Compared with nonobese, obese women were more likely to have a prolonged second stage (aRR: 1.48, 95% CI: 1.18–1.85 for ≥3 hours; aRR: 1.65, 95% CI: 1.18–2.30 for ≥4 hours). Obesity was associated with a higher rate of second stage cesarean (aRR: 1.78, 95% CI: 1.34–2.34) and cesarean delivery for fetal distress (aRR: 2.67, 95% CI: 1.18–3.58). Obesity was also associated with increased rates of neonatal (aRR: 1.38, 95% CI: 1.05–1.80), but not maternal morbidity (aRR: 1.06, 95% CI: 0.90–1.25). Neonatal morbidity risk was not modified by prolonged second stage. Conclusion Obesity is associated with increased risk of neonatal morbidity, which is not modified by prolonged second stage of labor.

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The Relationship of Assisted Reproductive Technology on Perinatal Outcomes in Triplet Gestations

American Journal of Perinatology ◽

10.1055/s-0038-1660457 ◽

2018 ◽

Vol 35 (14) ◽

pp. 1388-1393 ◽

Cited By ~ 1

Author(s):

Jaimin Shah ◽

Tania Roman ◽

Oscar Viteri ◽

Ziad Haidar ◽

Alejandra Ontiveros ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Assisted Reproductive Technology ◽

Distress Syndrome ◽

Perinatal Death ◽

Periventricular Leukomalacia ◽

Perinatal Outcomes ◽

Neonatal Morbidity ◽

Reproductive Technology ◽

Increased Risk

Objective To assess whether assisted reproductive technology (ART) is associated with increased risk of adverse perinatal outcomes in triplet gestations compared with spontaneous conception. Study Design Secondary analysis of a multicenter randomized trial for the prevention of preterm birth in multiple gestations. Triplets delivered at ≥ 24 weeks were studied. The primary outcome was the rate of composite neonatal morbidity (CNM) that included one or more of the following: bronchopulmonary dysplasia, respiratory distress syndrome, necrotizing enterocolitis, culture proven sepsis, pneumonia, retinopathy of prematurity, intraventricular hemorrhage, periventricular leukomalacia, or perinatal death. Results There were 381 triplets (127 women) of which 89 patients conceived via ART and 38 patients spontaneously. Women with ART were more likely to be older, Caucasian, married, nulliparous, have higher level of education, and develop pre-eclampsia. Spontaneously conceived triplets were more likely to delivery at an earlier gestation (31.2 ± 3.5 vs 32.8 ± 2.7 weeks) (p = 0.009) with a lower birth weight (p < 0.001). After adjusting for confounders, no differences were noted in culture proven sepsis, perinatal death, CNM, respiratory distress syndrome, or Apgar score < 7 at 5 minutes. All remaining perinatal outcomes were similar. Conclusion Triplets conceived by ART had similar perinatal outcomes compared with spontaneously conceived triplets.

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Influence of Estimated Fetal Weight on Labor Management

American Journal of Perinatology ◽

10.1055/s-0039-1695011 ◽

2019 ◽

Vol 37 (03) ◽

pp. 252-257

Author(s):

Elisa T. Bushman ◽

Norris Thompson ◽

Meredith Gray ◽

Robin Steele ◽

Sheri M. Jenkins ◽

...

Keyword(s):

Cesarean Delivery ◽

Secondary Analysis ◽

Physical Exam ◽

Fetal Weight ◽

Secondary Outcome ◽

Labor Management ◽

Increased Risk ◽

Tertiary Center ◽

The Impact ◽

Estimated Fetal Weight

Abstract Objective Prior studies suggest knowledge of estimated fetal weight (EFW), particularly by ultrasound (US), increases the risk for cesarean delivery. These same studies suggest that concern for macrosomia potentially alters labor management leading to increased rates of cesarean delivery. We aimed to assess if shortened labor management, as a result of suspected macrosomia (≥4,000 g), leads to an increased rate of cesarean delivery. Study Design This is a secondary analysis of a retrospective cohort study at a single tertiary center in 2015 of women with singleton pregnancies ≥36 weeks with documented EFW by US within 3 weeks or physical exam on admission. Women were excluded if an initial cervical exam was ≥6 cm or no attempt was made to labor. In addition, patients were excluded for the diagnosis of hypertension, diabetes, or prior cesarean delivery, as these comorbidities influence the use of US, labor management, and cesarean delivery independent of fetal weight. Patients were classified as EFW of ≥4,000 and <4,000 g. Secondary analysis examined the impact of US within 3 weeks of admission when compared with physical exam at the time of admission. The primary maternal outcomes were duration of labor and cesarean delivery. Duration of labor was evaluated as total time from 4 cm to delivery (with 4-cm dilation being a surrogate marker for active labor), length of time allowed from 4 cm until the first documented cervical change (or delivery), and time in second stage of labor (complete dilation to delivery). Cesarean delivery for arrest of labor was a secondary outcome. Student's t-test, Mann–Whitney U-test, chi-squared test, and Fisher's exact test were used for univariate data analysis as appropriate. Results Of 1,506 patients included, 54 (3.5%) had EFW of ≥4,000 g. Women with EFW of ≥4,000 g had a larger body mass index, higher fetal birth weight, were more likely to be undergoing induction of labor, had a more advanced gestational age, and were more likely to have had an US within 3 weeks of delivery. They were more likely to undergo cesarean delivery (29.6 vs. 9.3%, adjusted odds ratio [AOR]: 2.7, 95% confidence interval [CI]: 1.3–5.5) despite not having shortened labor times. When analyzing this population by method of obtaining EFW, those with EFW based on US rather than external palpation were more likely to undergo cesarean delivery (13.1 vs. 7.9%, AOR: 1.5, 95% CI: 1.01–2.12), again without having shortened labor times. Conclusion EFW of ≥4,000 g and use of US to estimate fetal weight do not appear to shorten labor management despite being associated with an increased risk of cesarean delivery.

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