scholarly journals Unattended Home Labor until Complete Cervical Dilatation Ending with Hospital Delivery: Analysis of 238 Pregnancies

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Ozlem Gun Eryilmaz ◽  
Nasuh Utku Dogan ◽  
Cavidan Gulerman ◽  
Leyla Mollamahmutoglu ◽  
Nedim Cicek ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Hospital Setting ◽  
Current Data ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Study Group ◽  
Hospital Delivery ◽  
Active Labor ◽  
Maternal And Neonatal Outcomes ◽  
At Home

Objectives. Hospital fear and avoidance of the routine hospital obstetrical interventions cause some women with low-risk pregnancies to spend most of the active labor period at home, and subsequently they present to the hospital for delivery. Our aim was to analyze the maternal and neonatal outcomes of pregnancies with a planned hospital birth, yet spending the first stage of labor at home without a health provider and completing the delivery in the hospital setting.Methods. We retrospectively compared 238 pregnancies having home labor plus hospital delivery (study group) with 476 pregnancies that had spent the whole labor in the hospital setting, considering various maternal and neonatal outcomes.Results. Cesarean and episiotomy rates were lower (P<0.0001andP<0.001, resp.), but neonatal intensive care unit admissions of the infants were more prevalent (P<0.01) in the study group. Other maternal and neonatal outcomes including neonatal mortality were comparable.Conclusion. Although our preliminary data generally do support the safety of home active labor plus hospital delivery for low-risk pregnancies, the clinical implications of current data warrant further prospective trials.

scholarly journals Effects of the Timing of Labour Induction on Maternal and Neonatal Outcomes in Low-risk Nulliparous Chinese Women

2020 ◽  
Author(s):  
Qiang WEI ◽  
Qin-yan CAO ◽  
Li ZHANG ◽  
Yi XU ◽  
Mei-fan DUAN
Keyword(s):  
Neonatal Intensive Care ◽  
Chinese Women ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Labour Induction ◽  
Control Group ◽  
Study Group ◽  
Retrospective Case ◽  
Maternal And Neonatal Outcomes ◽  
Control Study

Abstract Backgroud: When labour induction should be offered to women at or beyond term is unclear. This work aimed to investigate the effects of the timing of labour induction on maternal and neonatal outcomes in low-risk pregnancies. Methods: This retrospective case-control study involved low-risk primigravid pregnant mothers in whom labour was induced at 40-41+6 weeks at our two hospitals between January and December 2017. According to the gestational age at labour induction, participants were categorized into the study group (40-40+6 weeks, n=284) or to the control group (41-41+6 weeks, n=172), and maternal and neonatal outcomes were compared.Results: The study group showed significantly shorter labour in the first stage (391.8±225.7 vs. 472.0±268.9 min, P=0.006), second stage (65.41±38.66 vs. 53.73±31.58 min, P= 0.008) and total stage (453.0±235.8 vs. 535.7±259.8 min, P=0.005). The two groups showed no significant differences in the methods of labour induction or in the rates of failure of labour induction, of caesarean delivery, of postpartum haemorrhage, or of admission to the neonatal intensive care unit.Conclusions: Our retrospective study suggests that inducing labour at 40-40+6 weeks does not increase the risk of adverse maternal or foetal outcomes, and that it shortens labour. These results suggest that labor induction at 40-40+6 weeks was feasible for low-risk primiparas.Trial registration: The research has been approved by the Ethics Committee of West China Second Hospital of Sichuan University and Chengdu Women and Children's Central Hospital, China. Patients gave written informed consent for their anonymized medical data to be analyzed and published for research purposes.

Twin pregnancy in women above the age of 45 years: maternal and neonatal outcomes

2017 ◽  
Vol 45 (7) ◽  
Author(s):  
Tomer Avnon ◽  
Alon Haham ◽  
Ariel Many
Keyword(s):  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Admission Rate ◽  
Neonatal Outcomes ◽  
Study Group ◽  
Perinatal Complications ◽  
Childbearing Age ◽  
Younger Women ◽  
Maternal And Neonatal Outcomes ◽  
Twin Pregnancies

AbstractChildbearing age continues to rise and, with the increasing implementation of assisted reproductive technology (ART), the number of multiple pregnancies has also risen. This is a retrospective cohort study on maternal and neonatal outcomes of the twin pregnancies of 57 women aged ≥45 years compared to 114 younger women who gave birth in our institution between January 2011 and August 2015. Data were extracted from the real-time computerized database. The rates of hypertensive complications and pre-eclampsia (PE) were much higher in the study group compared to the controls (24/57 vs. 19/114, P=0.000 and 15/57 vs. 13/114, P=0.013, respectively). The respective incidence of very low birth weight (VLBW) was also significantly higher (14/114 vs. 12/228, P=0.021). Infants in the study group required four times more intubation and had a higher admission rate to the neonatal intensive care unit (NICU) compared to control infants (14/114 vs. 6/228 P=0.000 and 42/114 vs. 57/228, P=0.023, respectively). We conclude that women older than 45 years with twin pregnancies have higher maternal and perinatal complications with worse outcomes in comparison with younger women. When pregnancy is attempted via ART, embryo transfer of only one embryo should be considered in this age group.

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.

scholarly journals Maternal and Neonatal Outcomes Associated with Psychostimulant Use in Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ximena Camacho ◽  
Alys Havard ◽  
Helga Zoega ◽  
Margaret Wilson ◽  
Tara Gomes ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Cohort Analysis ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
The Usa ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes. Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers. ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)). Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.

Nonmedically Indicated Induction of Labor Compared with Expectant Management in Nulliparous Women Aged 35 Years or Older

2018 ◽  
Vol 36 (01) ◽  
pp. 045-052 ◽  
Author(s):  
Katherine Bowers ◽  
Jane Khoury ◽  
Tetsuya Kawakita
Keyword(s):  
Intensive Care Unit ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Expectant Management ◽  
Induction Of Labor ◽  
Neonatal Outcomes ◽  
Nulliparous Women ◽  
Maternal And Neonatal Outcomes ◽  
Nicu Admission

Objective This article compares maternal and neonatal outcomes in women aged ≥ 35 years who experienced nonmedically indicated induction of labor (NMII) versus expectant management. Study Design This was a retrospective cohort study of nulliparas aged ≥ 35 years with a singleton and cephalic presentation who delivered at term. Outcomes were compared between women who underwent NMII at 37, 38, 39, and 40 weeks' gestation and those with expectant management that week. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for predefined covariates. Results Of 3,819 nulliparas aged ≥ 35 years, 1,409 (36.9%) women underwent NMII. Overall at 39 weeks' gestation or later, maternal and neonatal outcomes were similar or improved with NMII. At 37, 38, and 39 weeks' gestation, NMII compared with expectant management was associated with decreased odds of cesarean delivery at 37, 38, and 39 weeks' gestation. At 40 weeks' gestation, NMII compared with expectant management was associated with an increased odds of operative vaginal delivery and a decreased odds of neonatal intensive care unit (NICU) admission. Conclusion In nulliparous women aged ≥ 35 years, NMII was associated with decreased odds of cesarean delivery at 37 to 39 weeks' gestation and decreased odds of NICU admission at 40 weeks' gestation compared with expectant management.

scholarly journals Does an increased number of cesarean sections result in greater risk for mother and baby in low-risk, late preterm and term deliveries?

2019 ◽  
Vol 35 (1) ◽  
Author(s):  
Necati Hancerliogullari ◽  
Selen Yaman ◽  
Rifat Taner Aksoy ◽  
Aytekin Tokmak
Keyword(s):  
Placenta Previa ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Late Preterm ◽  
Cesarean Sections ◽  
Intraperitoneal Adhesions ◽  
Group I ◽  
Significant Difference ◽  
Maternal And Neonatal Outcomes ◽  
Group Ii

Objective: To compare surgical complications and maternal and neonatal outcomes of low-risk, late preterm and term pregnant women who have had one or two previous cesarean sections (CSs) with those who have had three or more CSs. Methods: We conducted a retrospective study of 850 patients undergoing repeat CS at a tertiary level maternity hospital in Ankara, Turkey. Of those, 380 had previously undergone one or two CSs (Group-I: second or third CS) and 470 had previously undergone three or four CSs (Group-II: fourth or fifth CS). Outcomes and complications were compared between the groups. Results: The two groups were statistically significantly different in terms of maternal age, parity, body mass index, maternal weight gain during pregnancy, and length of hospital stay (all p<0.001). Although the prevalence of intraperitoneal adhesions and placenta previa was higher in Group-II than in Group-I (p<0.001), there was no statistically significant difference in terms of cesarean hysterectomy and adjacent organ injuries (p>0.05). There were also no significant differences between the groups in terms of neonatal outcomes (p>0.05). Conclusion: Although the increase in the number of CSs appears to be associated with intraperitoneal adhesions and placenta previa, adverse maternal and neonatal outcomes were not observed in those women with low-risk pregnancies who underwent CS for the fourth or fifth time. Therefore, fourth and fifth CSs may be considered relatively safe surgical procedures in this cohort. How to cite this:Hancerliogullari N, Yaman S, Aksoy RT, Tokmak A. Does an increased number of cesarean sections result in greater risk for mother and baby in low-risk, late preterm and term deliveries? Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.364 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial

2017 ◽  
Vol 35 (07) ◽  
pp. 624-631 ◽  
Author(s):  
Lindsay Doherty ◽  
Jim Roberts ◽  
Leslie Myatt ◽  
Kenneth Leveno ◽  
Michael Varner ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Neonatal Intensive Care ◽  
Secondary Analysis ◽  
Preterm Births ◽  
Neonatal Outcomes ◽  
Composite Outcome ◽  
Spontaneous Preterm Birth ◽  
Membrane Rupture ◽  
Nulliparous Women ◽  
Maternal And Neonatal Outcomes

Objective To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB). Methods A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity. Results Of 9,867 women, 10.4% (N = 1,038) were PTBs; 32.7% (n = 340) IPTBs and 67.3% (n = 698) SPTBs. Compared with SPTB, the composite maternal outcome was more frequent in IPTB—4.4% versus 0.9% (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4–11.8), as were blood transfusion and prolonged hospital stay (3.2 and 3.7 times, respectively). The frequency of composite neonatal outcome was higher in IPTBs (aOR, 1.8; 95% CI, 1.1–3.0), as were RDS (1.7 times), small for gestational age (SGA) < 5th percentile (7.9 times), and neonatal intensive care unit (NICU) admission (1.8 times). Conclusion Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB.

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.

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