The Effect of a Multidisciplinary Obstetric Emergency Team Training Program, the in Time Course, on Breech Vaginal Delivery Management and Neonatal Outcomes Post Breech Delivery: A Retrospective Cohort Study

ObjectiveThis study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of umbilical cord prolapse in twin deliveries.DesignRetrospective cohort study.SettingSingle institution.ParticipantsThis study included 455 women pregnant with twins (307 dichorionic and 148 monochorionic) who attempted vaginal delivery from January 2009 to August 2018. The following criteria were considered for vaginal delivery: diamniotic twins, cephalic presentation of the first twin, no history of uterine scar, no other indications for caesarean delivery, no major structural abnormality in either twin and no fetal aneuploidy.ResultsThe rate of vaginal delivery of both twins was 89.5% (407 of 455), caesarean delivery of both twins was 7.7% (35 of 455) and caesarean delivery of only the second twin was 2.9% (13 of 455). The major reasons for unplanned caesarean delivery were arrest of labour and non-reassuring fetal heart rate pattern. The rate of umbilical cord prolapse in the second twin was 1.8% (8 of 455). Multivariate analysis revealed that abnormal umbilical cord insertion in the second twin (velamentous or marginal) was the only significant factor for umbilical cord prolapse in the second twin (OR, 5.05, 95% CI 1.139 to 22.472, p=0.033).ConclusionsAbnormal umbilical cord insertion in the second twin (velamentous or marginal) was a significant factor for umbilical cord prolapse during delivery. Antenatal assessment of the second twin’s umbilical cord insertion using ultrasonography would be beneficial.

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The epidemiology of Medical Emergency Team calls for orthopedic patients in a teaching hospital: A retrospective cohort study

Resuscitation ◽

10.1016/j.resuscitation.2020.12.006 ◽

2021 ◽

Vol 159 ◽

pp. 1-6

Author(s):

R. Zhang ◽

B. Maher ◽

J.R.R. Ramos ◽

A. Hardidge ◽

L. Olenko ◽

...

Keyword(s):

Cohort Study ◽

Teaching Hospital ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team ◽

Orthopedic Patients

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Predictive Factors for Successful Vaginal Delivery after a Trial of External Cephalic Version: A Retrospective Cohort Study of 946 Women

American Journal of Perinatology ◽

10.1055/s-0041-1739505 ◽

2021 ◽

Author(s):

Asaf Bilgory ◽

Olena Minich ◽

Maria Shvaikovsky ◽

Genady Gurevich ◽

Joseph B. Lessing ◽

...

Keyword(s):

Cohort Study ◽

Vaginal Delivery ◽

Predictive Factors ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Goodness Of Fit ◽

External Cephalic Version ◽

Nulliparous Women ◽

Tertiary Center ◽

Vertex Presentation

Objective Our aim was to find the factors which predict a vertex presentation of vaginal delivery (VD) in women who are admitted for a trial of external cephalic version (ECV). Study Design This is a retrospective cohort study of women who underwent a trial of ECV and delivered between November 2011 and December 2018 in a single tertiary center. The main outcome measure was successful VD of a fetus in the vertex presentation. Women who achieved VD in the vertex presentation or underwent cesarean delivery were compared on the basis of variety of predictive factors. Adverse neonatal and maternal outcomes were reported. Logistic regression was used for the multivariate analysis. Results A total of 946 women were included; 717 (75.8%) women had a successful ECV and 663 (70.1%) women had a VD in the vertex presentation. Parous women had 79.3% VD rate (570/719) and nulliparous women had 41.0% VD rate (93/227). Women with an amniotic fluid index (AFI) of 50 to 79, 80 to 200, and >200 mm had 34.8, 71.0, and 83.1% VD rate, respectively. Parous versus nulliparous women had an adjusted odds ratio (aOR) of 5.42 (95% confidence interval [CI] 3.90–7.52, p < 0.001), women with AFI 50 to 79 mm compared with AFI 80 to 200 mm had an aOR of 0.21 (95% CI 0.12–0.37, p < 0.001), and women with an AFI >200 mm compared with AFI 80 to 200 mm had an aOR of 1.74 (95% CI 1.03–2.92, p = 0.037) to achieve VD. The final prediction model for the chances of a VD based on data on admission for ECV was reported. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model (p = 0.836). Conclusion Being parous and having an AFI >200 mm are positive independent predictive factors for achieving VD of a vertex presenting fetus after ECV. Whereas AFI 50 to 79 mm is a negative independent predictive factor. Key Points

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Comparison of cesarean versus vaginal delivery of extremely preterm gestations in breech presentation: retrospective cohort study

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2017.1401997 ◽

2017 ◽

Vol 32 (7) ◽

pp. 1142-1147 ◽

Cited By ~ 1

Author(s):

Kirsten M. Niles ◽

Jon F. R. Barrett ◽

Noor Niyar N. Ladhani

Keyword(s):

Cohort Study ◽

Vaginal Delivery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Breech Presentation ◽

Extremely Preterm

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Comparison of Maternal and Neonatal Outcomes between Acute Fatty Liver of Pregnancy and Hemolysis, Elevated Liver Enzymes and Low Platelets Syndrome: A Retrospective Cohort Study

10.21203/rs.3.rs-111120/v1 ◽

2020 ◽

Author(s):

Sau Xiong Ang ◽

Chie-Pein Chen ◽

Fang-Ju Sun ◽

Chen-Yu Chen

Keyword(s):

Cohort Study ◽

Fatty Liver ◽

Retrospective Cohort Study ◽

Hellp Syndrome ◽

Retrospective Cohort ◽

Liver Enzymes ◽

Neonatal Outcomes ◽

Elevated Liver Enzymes ◽

Acute Fatty Liver ◽

Maternal And Neonatal Outcomes

Abstract Background: Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.Methods: This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were analyzed.Results: During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0% versus 23.8%) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7% versus 13.8%), acute kidney injury (61.9% versus 15.0%), disseminated intravascular coagulopathy (66.7% versus 8.8%), and sepsis (47.6% versus 10.0%) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1% versus 33.3%), neonatal respiratory distress syndrome (39.2% versus 8.3%) and neonatal sepsis (34.2% versus 12.5%) were noted in the HELLP syndrome group.Conclusions: AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

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Oxygen Saturation Index in Neonates with a Congenital Diaphragmatic Hernia: A Retrospective Cohort Study

Neonatology ◽

10.1159/000520883 ◽

2021 ◽

pp. 1-8

Author(s):

Emily J.J. Horn-Oudshoorn ◽

Marijn J. Vermeulen ◽

Kelly J. Crossley ◽

Suzan C.M. Cochius-den Otter ◽

J. Marco Schnater ◽

...

Keyword(s):

Cohort Study ◽

Oxygen Saturation ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Saturation Index ◽

Neonatal Outcomes ◽

Predictive Values ◽

Adverse Neonatal Outcomes

Introduction: The oxygenation index (OI) is a marker for respiratory disease severity and adverse neonatal outcomes. The oxygen saturation index (OSI) is an alternative that allows for continuous noninvasive monitoring, but evidence for clinical use in critically ill neonates is scarce. The aim of this study was to evaluate the OSI as compared to the OI in term neonates with a congenital diaphragmatic hernia (CDH). Methods: A single-center retrospective cohort study was conducted including all live-born infants with an isolated CDH between June 2017 and December 2020. Paired values of the OI and OSI in the first 24 h after birth were collected. The relation between OI and OSI measurements was assessed, taking into account arterial pH, body temperature, and preductal versus postductal location of oxygen saturation measurement or arterial blood sampling. The predictive values for pulmonary hypertension, need for extracorporeal membrane oxygenation therapy, and survival at discharge were evaluated. Results: Of 33 subjects included, 398 paired values of the OI (median 5.8 [3.3–17.2]) and OSI (median 7.3 [3.6–14.4]) were collected. The OI and OSI correlated strongly (r = 0.77, p < 0.001). The OSI values corresponding to the clinically relevant OI values (10, 15, 20, and 40) were 8.9, 10.9, 12.9, and 20.9, respectively. The predictive values of the OI and OSI were comparable for all adverse neonatal outcomes. No difference was found in the area under the receiver operating characteristic curves for the OI and the OSI for adverse neonatal outcomes. Conclusions: The OSI could replace the OI in clinical practice in infants with a CDH.

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