scholarly journals Neonatal and Maternal Composite Adverse Outcomes Among Low-Risk Nulliparous Women Compared With Multiparous Women at 39–41 Weeks of Gestation

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Suneet P. Chauhan ◽  
Madeline Murguia Rice ◽  
William A. Grobman ◽  
Jennifer Bailit ◽  
Uma M. Reddy ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
Low Risk ◽  
Nulliparous Women ◽  
Multiparous Women

scholarly journals Obstetric and Neonatal Outcomes Related To Intrapartum Hydration Strategies in Low-Risk Deliveries: An Observational Study

2021 ◽  
Author(s):  
Ana B. Hernández-López ◽  
Cristina Muriel-Miguel ◽  
Tirso Pérez-Medina ◽  
Aurora Fernández-Cañadas Morillo ◽  
Carolina López-Lapeyrere ◽  
...  
Keyword(s):  
Weight Loss ◽  
Total Duration ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Nulliparous Women ◽  
Study Population ◽  
Maternal And Neonatal Outcomes ◽  
Prolonged Labor ◽  
Myometrial Contractility

Abstract Background Effective myometrial contractility is important for successful labor, although little attention has been paid to the effect of managing intrapartum fluid intake. Ineffective myometrial contractility leads to prolonged labor, thus increasing obstetric and neonatal adverse outcomes. The risk of prolonged labor can be reduced by increasing the total volume of fluids administered during labor. Objective To determine the hydration strategies applied in nulliparous women undergoing low risk labor and their association with obstetric and neonatal outcomes. Methods A prospective cohort study was conducted in a Universitary Hospital. The study population included nulliparous women who presented in active labor or induced labor. Sample size was 147. In order to stratify women based on the hydration received, we set as a cut-off point the mean total volume administered per hour (300 ml/h). This enabled to compare obstetric, clinical, and neonatal outcomes in women who had received ≥ 300 mL/h o < 300 mL/h. The primary outcome was total length of labor. Secondary outcomes included maternal and neonatal outcomes. Results The study population comprised 148 nulliparous women, mean (DS) age 32.2 (4.4) years, mean (DS) gestational age of 39.4 (1.41) weeks. At admission, median (IQR) dilation was 2 (1–3) cm. Labor was induced in 65.5% (n = 97). Obstetric and neonatal outcomes were more favorable in women who received a ≥ 300 mL/h volume, with statistically significant median differences in the duration total duration of labor (526 vs 735 min; p < 0.001). Clinically relevant differences were also observed with respect to cesarean delivery (14.3% vs 18.7%), fever (5.5% vs 7.7%), weight loss at 24 hours (–2.3% vs − 3%) and at 48 hours (–5.7% vs − 6.3 %), incidence of weight loss > 7% at 48 hours (28.6% vs 39.8%), breastfeeding (94.6% vs 82.4%). Conclusions Higher fluid volume administered to nulliparous women during low-risk labor is associated with improved obstetric and neonatal outcomes.

scholarly journals Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Vanessa L. Scarf ◽  
Rosalie Viney ◽  
Serena Yu ◽  
Maralyn Foureur ◽  
Chris Rossiter ◽  
...  
Keyword(s):  
New South ◽  
New South Wales ◽  
Home Birth ◽  
Vaginal Birth ◽  
Low Risk ◽  
Birth Centre ◽  
South Wales ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
At Home

Abstract Background In New South Wales (NSW) Australia, women at low risk of complications can choose from three birth settings: home, birth centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give birth in a birth centre (6%) or at home (0.4%) and 93.6% of women planned to birth in a hospital. A proportion of the woman in the home and birth centre groups transferred to hospital. However, their pathways or trajectories are largely unknown. Aim The aim was to map the trajectories and interventions experienced by women and their babies from births planned at home, in a birth centre or in a hospital over a 13-year period in NSW. Methods Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37–41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity. Results Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home birth were transferred to hospital. In the birth centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the planned hospital group for nulliparous women (10.1%), 7.1% for nulliparous women planning a birth centre birth and 5.1% of nulliparous women planning a homebirth. Multiparas had lower admissions to SCN/NICU for all thee settings (hospital 6.3%, BC 3.6%, home 1.6%, respectively). Conclusions Women who plan to give birth at home or in a birth centre have high rates of vaginal birth, even when transferred to hospital. Evidence on the trajectories of women who choose to give birth at home or in birth centres will assist the planning, costing and expansion of models of care in NSW.

scholarly journals Adverse Birth Outcomes among Nulliparous vs. Multiparous Women

2011 ◽  
Vol 126 (6) ◽  
pp. 797-805 ◽  
Author(s):  
Marie Lynn Miranda ◽  
Sharon E. Edwards ◽  
Evan R. Myers
Keyword(s):  
Birth Outcomes ◽  
Live Birth ◽  
Birth Outcome ◽  
Adverse Outcomes ◽  
Adverse Birth Outcomes ◽  
The North ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
The Difference ◽  
Age Adjusted Rates

Objectives. Previous studies indicate that nulliparous women (i.e., women having no previous births) are at higher risk for adverse birth outcomes than multiparous women (i.e., women having had at least one previous birth). We examined whether part of the difference in adverse outcome rates is attributable to nulliparous women with poor pregnancy outcomes being less likely (through choice or fecundity differences) to have a subsequent live birth within the same time period as nulliparous women without adverse outcomes. Methods. Using deterministic matching, we linked nulliparous women from the North Carolina Detailed Birth Record to subsequent births. We employed statistical and simulation-based analyses to estimate first birth outcome rate differences between nulliparous women who did have a subsequent live birth vs. those who did not. Our Markov simulations focused on preterm birth (PTB). Results. Among nulliparous women who were not linked to a second birth, maternal age-adjusted rates of multiple adverse outcomes were all statistically higher compared with rates for linked women. These results also held in race/ethnicity-specific analyses. Simulations found that the relative risk of PTB associated with a history of PTB was underestimated if some women who would have been at risk for PTB did not experience a second birth. Conclusions. The observed differences in rates of adverse outcomes between nulliparous and multiparous women are partly attributable to higher-risk women not having a subsequent live birth, either by choice or due to fecundity differences.

scholarly journals Association between Adherence with Recommended Antenatal Care in Low-Risk, Uncomplicated Pregnancy, and Maternal and Neonatal Adverse Outcomes: Evidence from Italy

2020 ◽  
Vol 18 (1) ◽  
pp. 173
Author(s):  
Giovanni Corrao ◽  
Anna Cantarutti ◽  
Anna Locatelli ◽  
Gloria Porcu ◽  
Luca Merlino ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Prevalence Ratio ◽  
Population Based ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Lombardy Region ◽  
Uncomplicated Pregnancy ◽  
Maternal And Neonatal Outcomes ◽  
Estimate Prevalence

Antenatal care (ANC) aims of monitoring wellbeing of mother and foetus during pregnancy. We validate a set of indicators aimed of measuring the quality of ANC of women on low-risk, uncomplicated pregnancy through their relationship with maternal and neonatal outcomes. We conducted a population-based cohort study including 122,563 deliveries that occurred between 2015 and 2017 in the Lombardy Region, Italy. Promptness and appropriateness of number and timing of gynaecological visits, ultrasounds and laboratory tests were evaluated. We assessed several maternal and neonatal outcomes. Log-binomial regression models were used to estimate prevalence ratio (PR), and corresponding 95% confidence interval (95% CI), for the exposure→outcome association. Compared with women who adhered with recommendations, those who were no adherent had a significant higher prevalence of maternal intensive care units admission (PR: 3.1, 95%CI: 1.2–7.9; and 2.7, 1.1–7.0 respectively for promptness of gynaecological visits, and appropriateness of ultrasound examinations), low Apgar score (1.6, 1.1–1.2; 1.9, 1.3–2.7; and 2.1, 1.5–2.8 respectively for appropriateness and promptness of gynaecological visits, and appropriateness of ultrasound examinations), and low birth weight (1.8, 1.5–2.3 for appropriateness of laboratory test examinations). Benefits for mothers and newborn are expected from improving adherence to guidelines-driven recommendations regarding antenatal care even for low-risk, uncomplicated pregnancies.

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

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.

Pilot Study of Physiologic Partograph Use Among Low-Risk, Nulliparous Women With Spontaneous Labor Onset

2016 ◽  
Vol 61 (2) ◽  
pp. 235-241 ◽  
Author(s):  
Jeremy L. Neal ◽  
Nancy K. Lowe ◽  
Amy S. Nacht ◽  
Kate Koschoreck ◽  
Jessica Anderson
Keyword(s):  
Pilot Study ◽  
Low Risk ◽  
Nulliparous Women ◽  
Labor Onset

The level of unpleasantness of pain influences the choice of home treatment during medical abortion

2011 ◽  
Vol 2 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Satu Suhonen ◽  
Marja Tikka ◽  
Seppo Kivinen ◽  
Timo Kauppila
Keyword(s):  
Medical Abortion ◽  
Nulliparous Women ◽  
Home Based ◽  
Vaginal Deliveries ◽  
Multiparous Women ◽  
Induced Abortions ◽  
Pain Drawings ◽  
Nonopioid Analgesics ◽  
Post Abortion ◽  
At Home

AbstractBackground and aimsMedical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure.MethodsWe studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3–6 weeks after abortion.ResultsEspecially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck’s Depression Index (BDI), Beck’s Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion.ConclusionsThe unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions.ImplicationsThese patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

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