293 The impact of the mode of delivery on the perinatal outcomes of the nonvertex second twins

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.

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INACTIVE HEPATITIS B CARRIER AND PREGNANCY OUTCOMES

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70i6.2909 ◽

2020 ◽

Vol 70 (6) ◽

pp. 1874-79

Author(s):

Rabiah Anwar ◽

Kashif Razzaq

Keyword(s):

Hepatitis B ◽

Gestational Hypertension ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Carrier Status ◽

Emergency Cesarean ◽

Increased Risk ◽

Significant Difference ◽

The Impact ◽

Hepatitis B Carrier

Objective: To assess the impact of hepatitis B carrier status on pregnancy and perinatal outcome. Study Design: Cross sectional study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital,Karachi, from Feb 2017 to Jan 2018. Methodology: A total of 9526 women delivered during study period. 9305 women fulfilling the inclusion criteriawere included in study. Two hundred and twenty one (221) women were excluded because of not fulfilling theinclusion criteria. Out of study group, 9104 women were HBsAg negative while 201 had positive hepatitis Bcarrier status. Antenatal complications (such as gestational diabetes, gestational hypertension, pre eclampsia),mode of delivery (vaginal delivery, elective cesarean, emergency cesarean) and perinatal outcomes (pretermdelivery, low birth weight at delivery, live birth rate, APGAR score at 1 and 5 min) were observed amonghepatitis B carrier and noncarrier. Results: There was no significant difference in point prevalence of major antenatal complications, mode ofdelivery and perinatal outcomes in HBsAg carriers and noncarriers. A slightly higher rate of preterm birth wasobserved in hepatitis B carriers (4.9%) as compared to noncarriers (2.6%). Conclusion: Hepatitis B carriers have slightly increased risk of preterm delivery.

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Fetal head circumference versus fetal weight at term as a predictor of labour outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20215104 ◽

2021 ◽

Vol 11 (1) ◽

pp. 201

Author(s):

Nishita Shettian ◽

Nikita Pitty

Keyword(s):

Head Circumference ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Fetal Weight ◽

Fetal Head ◽

Birth Canal ◽

Second Stage Of Labour ◽

Efficient Management ◽

Electronic Delivery ◽

The Impact

Background: Several models have been proposed to predict the need for an LSCS. With reference to this, the impact of the size of the fetal head traversing the birth canal is an important determinant of delivery outcomes. We examined the association between the head circumference and mode of delivery and perinatal outcomes, when compared to birth weight predicted by scan.Methods: This was a retrospective study, on 800 electronic delivery records between December 2019 and May 2021. Sociodemographic data, obstetrical parameter, term scan findings of head circumference and estimated fetal weight, and labour and perinatal outcomes were collected and analysed.Results: HC >95th centile was found to be comparatively more predictive and statistically significant compared to EFW >95th centile in the prediction of LSCS, with the most common indication being cephalopelvic disproportion. Prolonged second stage of labour was statistically significant in both cohort A and B, undergoing vaginal delivery. It was also noted that a significant number of newborns in cohort A required NICU admissions, while NICU admissions after emergency LSCS was significantly higher in the cohort B (p=0.0032) though the overall 5 and 10 minute APGAR scores and duration of stay were comparable in the groups classified on basis of EFW and HC.Conclusions: The above statistics observed on an Indian population may aid obstetricians in the planning of the mode of delivery, improve pre-labor counselling and efficient management of mothers of large babies.

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Effect of maternal asthma exacerbations on perinatal outcomes: a population-based study

ERJ Open Research ◽

10.1183/23120541.00295-2020 ◽

2020 ◽

Vol 6 (4) ◽

pp. 00295-2020

Author(s):

Annelies L. Robijn ◽

Bronwyn K. Brew ◽

Megan E. Jensen ◽

Gustaf Rejnö ◽

Cecilia Lundholm ◽

...

Keyword(s):

Caesarean Section ◽

Severe Asthma ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Asthma Severity ◽

Population Based ◽

Treatment Regime ◽

Asthma Exacerbations ◽

Poor Outcomes ◽

The Impact

BackgroundAlthough there is a growing body of literature about the impact of asthma exacerbations during pregnancy on adverse perinatal outcomes, it is still unclear whether asthma exacerbations themselves or asthma severity are the driving factor for negative outcomes. This study aimed to estimate the associations between maternal asthma exacerbations and perinatal outcomes, and whether this differed by asthma treatment regime as a proxy for severity.MethodsWe included births of women with asthma in Sweden from July 2006 to November 2013 (n=33 829). Asthma exacerbations were defined as unplanned emergency visits/hospitalisations or a short course of oral corticosteroids. Adjusted odds ratios (aOR) were estimated for the associations between exacerbations during pregnancy and perinatal outcomes (small for gestational age (SGA), preterm birth, birthweight and mode of delivery), stratified by preconception treatment regime.ResultsExacerbations occurred in 1430 (4.2%) pregnancies. Exacerbations were associated with reduced birthweight (aOR 1.45, 95% CI 1.24–1.70), and elective (aOR 1.50, 95% CI 1.25–1.79) and emergency caesarean section (aOR 1.35, 95% CI 1.13–1.61). Multiple exacerbations were associated with a 2.6-fold increased odds of SGA (95% CI 1.38–4.82). Amongst women treated prepregnancy with combination therapy (proxy for moderate–severe asthma), exacerbators were at increased odds of elective (aOR 1.69, 95% CI 1.30–2.2) and emergency (aOR 1.62, 95% CI 1.26–2.08) caesarean section, and SGA (aOR 1.74, 95% CI 1.18–2.57) versus non-exacerbators.ConclusionMaternal asthma exacerbations increase the risk of SGA and caesarean sections, particularly in women with multiple exacerbations or moderate–severe asthma. Adequate antenatal asthma care is needed to reduce exacerbations and reduce risks of poor outcomes.

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301: The impact of mode of delivery on subsequent pregnancy outcomes after periviable birth

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.11.322 ◽

2019 ◽

Vol 220 (1) ◽

pp. S212-S213

Author(s):

Andrea Desai ◽

Nicole Krenitsky ◽

Audrey A. Merriam ◽

Katherine Kohari ◽

Christian Pettker ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Mode Of Delivery ◽

Subsequent Pregnancy ◽

The Impact

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Neonatal Immune System Ontogeny: The Role of Maternal Microbiota and Associated Factors. How Might the Non-Human Primate Model Enlighten the Path?

Vaccines ◽

10.3390/vaccines9060584 ◽

2021 ◽

Vol 9 (6) ◽

pp. 584

Author(s):

Natalia Nunez ◽

Louis Réot ◽

Elisabeth Menu

Keyword(s):

Immune System ◽

Mode Of Delivery ◽

Microbial Colonization ◽

Therapeutic Interventions ◽

Primate Model ◽

Neonatal Immune System ◽

Gastrointestinal Colonization ◽

The Impact ◽

Human Primate

Interactions between the immune system and the microbiome play a crucial role on the human health. These interactions start in the prenatal period and are critical for the maturation of the immune system in newborns and infants. Several factors influence the composition of the infant’s microbiota and subsequently the development of the immune system. They include maternal infection, antibiotic treatment, environmental exposure, mode of delivery, breastfeeding, and food introduction. In this review, we focus on the ontogeny of the immune system and its association to microbial colonization from conception to food diversification. In this context, we give an overview of the mother–fetus interactions during pregnancy, the impact of the time of birth and the mode of delivery, the neonate gastrointestinal colonization and the role of breastfeeding, weaning, and food diversification. We further review the impact of the vaccination on the infant’s microbiota and the reciprocal case. Finally, we discuss several potential therapeutic interventions that might help to improve the newborn and infant’s health and their responses to vaccination. Throughout the review, we underline the main scientific questions that are left to be answered and how the non-human primate model could help enlighten the path.

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A synbiotic intervention modulates meta-omics signatures of gut redox potential and acidity in elective caesarean born infants

BMC Microbiology ◽

10.1186/s12866-021-02230-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christophe Lay ◽

Collins Wenhan Chu ◽

Rikky Wenang Purbojati ◽

Enzo Acerbi ◽

Daniela I. Drautz-Moses ◽

...

Keyword(s):

Risk Factor ◽

Gut Microbiome ◽

Reference Group ◽

Mode Of Delivery ◽

Controlled Study ◽

Double Blind ◽

Lipopolysaccharide Biosynthesis ◽

Infant Gut Microbiome ◽

Stool Samples ◽

The Impact

Abstract Background The compromised gut microbiome that results from C-section birth has been hypothesized as a risk factor for the development of non-communicable diseases (NCD). In a double-blind randomized controlled study, 153 infants born by elective C-section received an infant formula supplemented with either synbiotic, prebiotics, or unsupplemented from birth until 4 months old. Vaginally born infants were included as a reference group. Stool samples were collected from day 3 till week 22. Multi-omics were deployed to investigate the impact of mode of delivery and nutrition on the development of the infant gut microbiome, and uncover putative biological mechanisms underlying the role of a compromised microbiome as a risk factor for NCD. Results As early as day 3, infants born vaginally presented a hypoxic and acidic gut environment characterized by an enrichment of strict anaerobes (Bifidobacteriaceae). Infants born by C-section presented the hallmark of a compromised microbiome driven by an enrichment of Enterobacteriaceae. This was associated with meta-omics signatures characteristic of a microbiome adapted to a more oxygen-rich gut environment, enriched with genes associated with reactive oxygen species metabolism and lipopolysaccharide biosynthesis, and depleted in genes involved in the metabolism of milk carbohydrates. The synbiotic formula modulated expression of microbial genes involved in (oligo)saccharide metabolism, which emulates the eco-physiological gut environment observed in vaginally born infants. The resulting hypoxic and acidic milieu prevented the establishment of a compromised microbiome. Conclusions This study deciphers the putative functional hallmarks of a compromised microbiome acquired during C-section birth, and the impact of nutrition that may counteract disturbed microbiome development. Trial registration The study was registered in the Dutch Trial Register (Number: 2838) on 4th April 2011.

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Adolescent, Pregnant, and HIV-Infected: Risk of Adverse Pregnancy and Perinatal Outcomes in Young Women from Southern Mozambique

Journal of Clinical Medicine ◽

10.3390/jcm10081564 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1564

Author(s):

Clara Pons-Duran ◽

Aina Casellas ◽

Azucena Bardají ◽

Anifa Valá ◽

Esperança Sevene ◽

...

Keyword(s):

Hiv Infection ◽

Maternal Morbidity ◽

Low Birthweight ◽

Negative Binomial ◽

Perinatal Outcomes ◽

Sub Saharan Africa ◽

P Value ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Impact

Sub-Saharan Africa concentrates the burden of HIV and the highest adolescent fertility rates. However, there is limited information about the impact of the interaction between adolescence and HIV infection on maternal health in the region. Data collected prospectively from three clinical trials conducted between 2003 and 2014 were analysed to evaluate the association between age, HIV infection, and their interaction, with the risk of maternal morbidity and adverse pregnancy and perinatal outcomes in women from southern Mozambique. Logistic regression and negative binomial models were used. A total of 2352 women were included in the analyses; 31% were adolescents (≤19 years) and 29% HIV-infected women. The effect of age on maternal morbidity and pregnancy and perinatal adverse outcomes was not modified by HIV status. Adolescence was associated with an increased incidence of hospital admissions (IRR 0.55, 95%CI 0.37–0.80 for women 20–24 years; IRR 0.60, 95%CI 0.42–0.85 for women >25 years compared to adolescents; p-value < 0.01) and outpatient visits (IRR 0.86, 95%CI 0.71–1.04; IRR 0.76, 95%CI 0.63–0.92; p-value = 0.02), and an increased likelihood of having a small-for-gestational age newborn (OR 0.50, 95%CI 0.38–0.65; OR 0.43, 95%CI 0.34–0.56; p-value < 0.001), a low birthweight (OR 0.40, 95%CI 0.27–0.59; OR 0.37, 95%CI 0.26–0.53; p-value <0.001) and a premature birth (OR 0.42, 95%CI 0.24–0.72; OR 0.51, 95%CI 0.32–0.82; p-value < 0.01). Adolescence was associated with an increased risk of poor morbidity, pregnancy and perinatal outcomes, irrespective of HIV infection. In addition to provision of a specific maternity care package for this vulnerable group interventions are imperative to prevent adolescent pregnancy.

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Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study

Scientific Reports ◽

10.1038/s41598-021-90240-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shigeki Koshida ◽

Shinsuke Tokoro ◽

Daisuke Katsura ◽

Shunichiro Tsuji ◽

Takashi Murakami ◽

...

Keyword(s):

Pregnant Women ◽

Maternal Behavior ◽

Multivariable Analysis ◽

Perinatal Outcomes ◽

Fetal Movement ◽

Post Intervention ◽

Fetal Movements ◽

Adverse Perinatal Outcomes ◽

The Impact ◽

Maternal Reaction

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.

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Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03884-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Clare Shakespeare ◽

Handsome Dube ◽

Sikhangezile Moyo ◽

Solwayo Ngwenya

Keyword(s):

Perinatal Outcomes ◽

Control Measures ◽

Central Hospital ◽

Cross Sectional ◽

Maternity Services ◽

Before And After ◽

The Mean ◽

Significant Change ◽

The Impact ◽

Mpilo Central Hospital

Abstract Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

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