Perinatal outcomes from preterm and early term births in a multicenter cohort of low risk nulliparous women

This chapter analyzes changes over time in early-term births. Labor induction rates have risen over time and many experts speculate that at least half of inductions are elective. Popular accounts suggest that pregnant women are driving this by requesting inductions. Healthcare providers are also part of the story because they can refuse women’s requests, but hospitals and OB/GYN practices benefit enormously from scheduling births even though they pose medical risks. Analyses of early-term births in low-risk pregnancies reveal that providers are more likely to take unnecessary risks in states with tort reforms that limit their liability risk. This effect was strongest during the period before 2009, when the strength of professional recommendations against early elective induction had eroded.

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Maternal Vascular Malperfusion and Adverse Perinatal Outcomes in Low-Risk Nulliparous Women

Obstetrics and Gynecology ◽

10.1097/aog.0000000000002264 ◽

2017 ◽

Vol 130 (5) ◽

pp. 1112-1120 ◽

Cited By ~ 33

Author(s):

Emily Wright ◽

Melanie C. Audette ◽

Xiang Y. Ye ◽

Sarah Keating ◽

Barry Hoffman ◽

...

Keyword(s):

Perinatal Outcomes ◽

Low Risk ◽

Nulliparous Women ◽

Adverse Perinatal Outcomes

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Do low-risk nulliparous women with abnormal uterine artery Doppler in the third trimester have poorer perinatal outcomes? A longitudinal prospective study on uterine artery Doppler in low-risk nulliparous women and correlation with pregnancy outcomes

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2016.1190822 ◽

2016 ◽

Vol 30 (7) ◽

pp. 877-880

Author(s):

M. Arrue ◽

M. García ◽

M. T. Rodriguez-Bengoa ◽

J. M. Landa ◽

L. Urbieta ◽

...

Keyword(s):

Prospective Study ◽

Pregnancy Outcomes ◽

Uterine Artery ◽

Perinatal Outcomes ◽

Low Risk ◽

Third Trimester ◽

Uterine Artery Doppler ◽

The Third ◽

Nulliparous Women

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Decision Aid to Assist Low-Risk Nulliparous Women Considering Induction of Labor At 39 Weeks

Case Medical Research ◽

10.31525/ct1-nct04052347 ◽

2019 ◽

Author(s):

Keyword(s):

Decision Aid ◽

Induction Of Labor ◽

Low Risk ◽

Nulliparous Women

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The effect of maternal position on fetal middle cerebral artery Doppler indices and its association with adverse perinatal outcomes: a pilot study

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0399 ◽

2020 ◽

Vol 48 (4) ◽

pp. 317-321

Author(s):

Rodney McLaren ◽

Bharati Kalgi ◽

Chima Ndubizu ◽

Peter Homel ◽

Shoshana Haberman ◽

...

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Repeated Measures ◽

Adverse Outcome ◽

Perinatal Outcomes ◽

Low Risk ◽

Doppler Velocity ◽

Chronic Hypertension ◽

Adverse Perinatal Outcomes

AbstractObjectiveThe aim of this study was to compare position-related changes in fetal middle cerebral artery (MCA) Doppler pulsatility indices (PI).MethodsA prospective study of 41 women with conditions associated with placental-pathology (chronic hypertension, pregestational diabetes, and abnormal analytes) and 34 women without those conditions was carried out. Fetal MCA Doppler velocity flow waveforms were obtained in maternal supine and left lateral decubitus positions. MCA PI Δ was calculated by subtracting the PI in the supine position from the PI in the left lateral position. Secondary outcomes included a composite of adverse perinatal outcomes (fetal growth restriction, oligohydramnios, and preeclampsia). χ2 and Student t-tests and repeated-measures analysis of variance were used.ResultsMCA PI Δ was significantly less for high-risk pregnant women ([P = 0.03]: high risk, left lateral PI, 1.90 ± 0.45 vs. supine PI, 1.88 ± 0.46 [Δ = 0.02]; low risk, left lateral PI, 1.90 ± 0.525 vs. supine PI, 1.68 ± 0.40 [Δ = 0.22]). MCA PI Δ was not significantly different between women who had a composite adverse outcome and women who did not have a composite adverse outcome (P = 0.843).ConclusionOur preliminary study highlights differences in position-related changes in fetal MCA PI between high-risk and low-risk pregnancies. These differences could reflect an attenuated ability of women with certain risk factors to respond to physiologic stress.

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Prolonged interpregnancy interval: how does it impact the length of second stage of labor?

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0171 ◽

2020 ◽

Vol 48 (8) ◽

pp. 811-818

Author(s):

Nicole B. Kurata ◽

Keith K. Ogasawara ◽

Kathryn L. Pedula ◽

William A. Goh

Keyword(s):

Perinatal Outcomes ◽

Kaiser Permanente ◽

Second Stage Of Labor ◽

Second Stage ◽

Labor Duration ◽

Nulliparous Women ◽

Multiparous Women ◽

Comparison Groups ◽

Maternal And Neonatal Outcomes ◽

Interpregnancy Intervals

AbstractObjectivesShort interpregnancy intervals (IPI) have been linked to multiple adverse maternal and neonatal outcomes, but less is known about prolonged IPI, including its relationship with labor progression. The objective of the study was to investigate whether prolonged IPIs are associated with longer second stages of labor.MethodsA perinatal database from Kaiser Permanente Hawaii was used to identify 442 women with a prolonged IPI ≥60 months. Four hundred forty two nulliparous and 442 multiparous women with an IPI 18–59 months were selected as comparison groups. The primary outcome was second stage of labor duration. Perinatal outcomes were compared between these groups.ResultsThe median (IQR) second stage of labor duration was 76 (38–141) min in nulliparous women, 15 (9–28) min in multiparous women, and 18 (10–38) min in women with a prolonged IPI (p<0.0001). Pairwise comparisons revealed significantly different second stage duration in the nulliparous group compared to both the multiparous and prolonged IPI groups, but no difference between the multiparous and prolonged IPI groups. There was a significant association with the length of the IPI; median duration 30 (12–61) min for IPI ≥120 months vs. 15 (9–27) min for IPI 18–59 months and 16 (9–31) min for IPI 60–119 months (p=0.0014).ConclusionsThe second stage of labor did not differ in women with a prolonged IPI compared to normal multiparous women. Women with an IPI ≥120 months had a significantly longer second stage vs. those with a shorter IPI. These findings provide a better understanding of labor progression in pregnancies with a prolonged IPI.

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