scholarly journals Retrospective study of maternal and neonatal outcomes after induction compared to spontaneous start of labour in women with one previous birth in uncomplicated pregnancies ≥ 41+3

2021 ◽  
Vol 49 (1) ◽  
pp. 23-29
Author(s):  
Lina Lindegren ◽  
Andrea Stuart ◽  
Marie Carlsson Fagerberg ◽  
Karin Källén
Keyword(s):  
Apgar Score ◽  
Neonatal Outcome ◽  
Labour Induction ◽  
Delivery Mode ◽  
Adjusted Risk ◽  
Medical Birth Register ◽  
Adjusted Risk Ratio ◽  
Increased Risk ◽  
Previous Birth ◽  
Swedish Medical

AbstractObjectivesTo study the association between induction and outcome among two-parous women in uncomplicated pregnancies ≥ 41+3, stratified by first labour delivery mode and conditions present at first delivery.MethodsThe Swedish Medical Birth Register was used to identify 58,964 uncomplicated singleton pregnancies among women with one previous birth between 1998 and 2014. Women with any registered pregnancy complications were excluded to minimise the risk for indication bias. The outcomes considered were emergency caesarean section (CS), and poor neonatal outcome (Apgar score <7 at 5 min, neonatal death, or meconium aspiration).ResultsWomen who were induced at their second labour had higher emergency CS rates compared to women in spontaneously started deliveries (adjusted risk ratio, ARR: 2.11; 95% CI: 2.00–2.23). Low Apgar score was more common after induction compared to spontaneously started labours (1.0 vs. 0.7%) (ARR: 1.44; 95% CI: 1.18–1.77). Increased CS rates were also found when comparing induction at 41 + 3 to 41 + 6 weeks to labour at 42 weeks or more, regardless of labour start (ARR 1.39; 95% CI: 1.26–1.52).ConclusionsWe found an increased risk of CS and poor neonatal outcome after second labour induction in prolonged pregnancies. The second labour vaginal success rate after induction was highly dependent, on first labour delivery mode, but also on diagnoses and conditions present at the first delivery.

Increased risk of acquisition and transmission of ESBL-producing Enterobacteriaceae in malnourished children exposed to amoxicillin

2019 ◽  
Vol 75 (3) ◽  
pp. 709-717 ◽  
Author(s):  
Naouale Maataoui ◽  
Céline Langendorf ◽  
Fatou Berthe ◽  
Jumamurat R Bayjanov ◽  
Willem van Schaik ◽  
...  
Keyword(s):  
Placebo Group ◽  
Severe Acute Malnutrition ◽  
Controlled Trial ◽  
Acute Malnutrition ◽  
Double Blind ◽  
Adjusted Risk ◽  
Malnourished Children ◽  
Nutritional Recovery ◽  
Adjusted Risk Ratio ◽  
Increased Risk

Abstract Objectives Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. Methods We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. Results Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. Conclusions Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.

scholarly journals Use of Antiasthmatic Drugs during Pregnancy after the First Trimester and Maternal and Neonatal Outcomes

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Bengt Källén ◽  
Birgitta Norstedt Wikner
Keyword(s):  
Preterm Births ◽  
First Trimester ◽  
Neonatal Hypoglycemia ◽  
Respiratory Problems ◽  
Medical Birth Register ◽  
Risk Increase ◽  
Increased Risk ◽  
Swedish Medical ◽  
Maternal And Neonatal Outcomes ◽  
Disease Effect

Background. Women with asthma using antiasthmatics during the later part of the pregnancy have an increased risk for obstetric complications and their infants of neonatal complications. Material and Methods. The study is based on a linkage between the Swedish Medical Birth Register and a register of prescribed drugs in Sweden for the years 2009–2011, identifying women who had filled prescriptions for antiasthmatics after the first trimester. Their characteristics, their obstetric history, and the neonatal conditions of their infants were compared with all other women who gave birth. Adjusted Mantel-Haenszel odds ratios were determined. Results. We found an increased risk for a number of maternal conditions but no risk increase for gestational diabetes (after adjustment for body mass index) or for premature rupture of membranes. There was an increase in preterm births for some drugs used at severe asthma and of low birth weight and small for gestational age for most drug combinations. An increased risk was seen for neonatal hypoglycemia, respiratory problems, and low Apgar score. Conclusions. There are many hazards associated with maternal asthma and use of antiasthmatic drugs. Most evidence suggests a disease effect. A careful control of the asthma during pregnancy is important.

scholarly journals Multi-Fetal Pregnancy, Preeclampsia, and Long-Term Cardiovascular Disease

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 167-175 ◽  
Author(s):  
Lina Bergman ◽  
Paliz Nordlöf-Callbo ◽  
Anna Karin Wikström ◽  
Jonathan M. Snowden ◽  
Susanne Hesselman ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Inflammatory Factors ◽  
Singleton Pregnancy ◽  
Medical Birth Register ◽  
Hazard Ratios ◽  
Increased Risk ◽  
National Patient ◽  
Swedish Medical ◽  
Cox Proportional Hazard Regression ◽  
Joint Contribution

This Swedish register-based cohort study determined the separate and joint contribution of preeclampsia and multi-fetal pregnancy on a woman’s risk of cardiovascular disease (CVD) later in life. The study included 892 425 first deliveries between 1973 and 2010 of women born 1950 until 1971, identified in the Swedish Medical Birth Register. A composite outcome of CVD was retrieved through linkage with the National Patient and Cause of Death Registers. Cox proportional hazard regression was used to assess the risk of CVD in women who had preeclampsia in a singleton or multi-fetal pregnancy, adjusting for potential confounders, and presented as adjusted hazard ratios. Compared with women who had a singleton pregnancy without preeclampsia (the referent group), women with preeclampsia in a singleton pregnancy had an increased risk of CVD (adjusted hazard ratio 1.75 [95% CI, 1.64–1.86]). Women who had a multi-fetal pregnancy without or with preeclampsia did not have an increased risk of future CVD (adjusted hazard ratios 0.94 [95% CI, 0.79–1.10] and 1.25 [95% CI, 0.83–1.86], respectively). As opposed to preeclampsia in a first singleton pregnancy, preeclampsia in a first multi-fetal pregnancy was not associated with increased risk of future CVD. This may support the theory that preeclampsia in multi-fetal pregnancies more often occurs as a result of the larger pregnancy-related burden on the maternal cardiovascular system and excessive placenta-shed inflammatory factors, rather than the woman’s underlying cardiovascular phenotype.

Idiopathic Polyhydramnios and Neonatal Morbidity at Term

2021 ◽  
Author(s):  
Brock Polnaszek ◽  
Brooke Liang ◽  
Fan Zhang ◽  
Alison G. Cahill ◽  
Nandini Raghuraman ◽  
...  
Keyword(s):  
Neonatal Morbidity ◽  
Supplemental Oxygen ◽  
Respiratory Morbidity ◽  
Amniotic Fluid Index ◽  
Adjusted Risk ◽  
Conflicting Evidence ◽  
Adjusted Risk Ratio ◽  
Increased Risk ◽  
Key Points ◽  
Primary Driver

Objective Idiopathic polyhydramnios is among the most common etiologies of polyhydramnios. However, conflicting evidence exists regarding the relationship between polyhydramnios and neonatal morbidity. We investigated the association between pregnancies with and without idiopathic polyhydramnios and neonatal morbidity at term. Study Design This is a retrospective cohort study of singleton, term (i.e., ≥370/7 weeks) pregnancies from 2014 to 2018. Pregnancies complicated by fetal anomalies, pregestational diabetes, and multifetal gestation were excluded. Pregnancies complicated by idiopathic polyhydramnios were defined by the deepest vertical pocket (DVP) ≥8 cm or amniotic fluid index (AFI) ≥24 cm after 20 weeks' gestation and were compared with women without polyhydramnios at time of delivery. These groups were matched 1:2 by gestational age within 7 days at delivery and maternal race. The primary outcome was a composite neonatal morbidity (neonatal death, respiratory morbidity, hypoxic–ischemic encephalopathy, therapeutic hypothermia, seizures, and umbilical artery pH < 7.10). Outcomes were compared between pregnancies with and without idiopathic polyhydramnios. Unadjusted and adjusted risk ratios were estimated using multivariable logistic regression. Results Idiopathic polyhydramnios was diagnosed in 192 pregnancies and were matched to 384 pregnancies without polyhydramnios. After adjustment for obesity, women with pregnancies complicated by idiopathic polyhydramnios had an increased risk of composite neonatal morbidity 21.4 versus 5.5% (adjusted risk ratio [aRR] = 4.0, 95% confidence interval [CI]: 2.3–6.7). Term neonatal respiratory morbidity was the primary driver 20.3 versus 4.2%, (aRR = 4.8, 95% CI: 2.7–8.7) and included higher use of continuous positive airway pressure 19.8 versus 3.4%, p <0.01 and the need for supplemental oxygen at >12 hours of newborn life 6.8 versus 1.8%, p <0.01. Conclusion Idiopathic polyhydramnios is associated with term neonatal respiratory morbidity at delivery and during the subsequent hours of newborn life, compared with pregnancies without idiopathic polyhydramnios. Further studies are needed to minimize neonatal morbidity at term. Key Points

scholarly journals A RANDOMIZED COMPARATIVE STUDY OF PROGRESS OF LABOUR AND FETAL OUTCOME OF DELIVERY AMONGST SPONTANEOUS VERSUS INDUCED LABOUR IN TERM PREGNANCY PRIMI GRAVIDA OF USING MODIFIED WHO PARTOGRAPH IN THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY SMS MEDICAL COLLEG

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Yeshwant Singh Chouhan ◽  
Anju Sharma ◽  
Megha Agrawal
Keyword(s):  
Apgar Score ◽  
Uterine Contraction ◽  
Neonatal Outcome ◽  
Perinatal Outcomes ◽  
Fetal Outcome ◽  
Labour Induction ◽  
Intrauterine Death ◽  
Cross Sectional ◽  
Weight Category ◽  
Significant Difference

Background: Childbirth is the period from the onset of regular uterine contraction until expulsion of placenta. The process by which this normally occurs is called labour. Induction of labour is the artificial initiation of uterine contraction prior to their spontaneous onset, leading to progressive dilatation and effacement of the cervix and delivery of the baby. Labour induction is indicated where the benefits to either the mother or the fetus outweighs the benefit of continuing pregnancy. Methods: Hospital based Prospective type of cross sectional study conducted at Department of Obstetrics and Gynaecology, S.M.S Medical College, Jaipur, Rajasthan. We assessed the following perinatal outcomes: at 1st and 5th minute APGAR score; birth weight; birth injuries; respiratory distress syndrome; admission to the  NICU; number of days in NICU; neonatal deaths taking place in hospital within the first week of life; stillbirth or intrauterine death. Results: The highest percentage of babies were in the weight category of 2500 to 3499 grams in both groups, 83.3% in spontaneous and 76.7% in induced group, followed by ≥3500 gram and <2500 gram  respectively. There is no statistical significant difference in weight of babies between the groups (P=0.64). In induced group ≤7 APGAR Score at 1 minute is 1.1%, and 7.8% in spontaneous group. There is statistically significant increase in Spontaneous group (P < 0.05). In induced group ≤7 Apgar score at 5 minutes is 0%, and 5.6% in spontaneous group. ≤7 APGAR score at 5minutes is significantly higher in Spontaneous group (P < 0.05). 3.3% of Induced group babies needed Admission to NICU compared to 2.2% in Spontaneous group, there is no statistically significant difference between groups (P = 0.684) Conclusion: We conclude from this study that though requirement of Augmentation for progress of Labour was more in induced group and Instrumentation rate of Caesarean section was also high in induced group. But the Neonatal outcome of Labour if monitored with modified WHO Partograph is less than Spontaneous group and also duration of labour is shorter in induced labour. Keywords: WHO Partograph, Induction, Neonatal outcome.

scholarly journals Tachysystole and risk of cesarean section after labor induction using misoprostol: a cohort study

2019 ◽  
Author(s):  
Joanna Sichitiu ◽  
Yvan Vial ◽  
Alice Panchaud ◽  
David Baud ◽  
David Desseauve
Keyword(s):  
Cohort Study ◽  
Cesarean Section ◽  
Risk Ratio ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Maternal Outcomes ◽  
Uterine Activity ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Increased Risk

Abstract Background In western countries, induction of labor is a common obstetrical intervention. Uterine tachysystole frequently manifests after cervical ripening by misoprostol vaginal inserts. Currently, there is insufficient evidence regarding the clinical impact of tachysystole during induction of labor. Therefore, the objective of the current study is to examine if tachysystole is associated with an increased risk of cesarean section following induction of labor by misoprostol vaginal inserts. Methods We conducted a retrospective cohort study of 446 women over 37 weeks of gestation admitted for labor induction by misoprostol vaginal inserts between May 2016 and May 2017. Fetal heart rate and uterine activity tracings were assessed for tachysystole, defined as ≥ 6 contractions per 10 minutes, averaged over a 30-minute window. Univariate analysis was performed by using t-test and Chi-square, comparing demographics, pregnancy characteristics, intrapartum monitoring, mode of delivery, neonatal outcomes (Apgar score < 7 at 5 minutes, umbilical cord artery pH < 7.10, neonatal intensive care unit admission) and maternal outcomes, with regard to the presence of tachysystole. The association between tachysystole and cesarean section was evaluated after adjusting for potential confounders by a modified Poisson regression model, expressed as an adjusted risk ratio and 95% confidence intervals. Results A total of 140 women (31.4%) presented with tachysystole. The median duration of tachysystole was 2 hours 12 minutes. The rate of cesarean section was 25.0% (N=35) among patients with tachysystole and 19.6% (N=60) for those without tachysystole. Presence of tachysystole during induction of labor with misoprostol vaginal inserts was not associated with cesarean section (adjusted risk ratio,1.0; 95% confidence interval, 0.7 to 1.4). Neonatal and maternal outcomes were similar between mothers who did and did not experience tachysystole. Conclusions This study illustrates that tachysystole is not associated with an increased risk of cesarean section after induction of labor by misoprostol vaginal inserts. The impact of excessive uterine activity on the fetal wellbeing defined by the frequency of uterine contraction alone is probably insufficient. Further research on the development of accurate measures of uterine contractility is necessary to better understand its effect on fetal well-being.

scholarly journals Ondansetron use in the first trimester of pregnancy and the risk of neonatal ventricular septal defect

2019 ◽  
Vol 49 (2) ◽  
pp. 648-656 ◽  
Author(s):  
Lara S Lemon ◽  
Lisa M Bodnar ◽  
William Garrard ◽  
Raman Venkataramanan ◽  
Robert W Platt ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Birth Defects ◽  
Septal Defect ◽  
Dose Range ◽  
First Trimester ◽  
Sensitivity Analyses ◽  
Full Cohort ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Increased Risk

Abstract Background Literature is divided regarding the risk of neonatal ventricular septal defect (VSD) associated with first trimester ondansetron use in pregnancy. Methods We evaluated the risk of VSD associated with first trimester exposure to intravenous or oral ondansetron in 33 677 deliveries at Magee–Womens Hospital in Pittsburgh, PA (2006–2014). Using log-binomial regression, we evaluated the risk: (1) in the full cohort, (2) using propensity score designs with both matching and inverse probability weighting and (3) utilizing clustered trajectory analysis evaluating the role of dose. Sensitivity analyses assessed the association between ondansetron and all recorded birth defects in aggregate. Results A total of 3733 (11%) pregnancies were exposed to ondansetron in the first trimester (dose range: 2.4–1008 mg). Ondansetron was associated with increased risk of VSD with risk ratios ranging from 1.7 [95% confidence interval (CI) 1.0–2.9] to 2.1 (95% CI 1.1–4.0) across methods. Risks correspond to one additional VSD for approximately every 330 pregnancies exposed in the first trimester. The association was dose-dependent with increased risk in women receiving highest cumulative doses compared with lowest doses [adjusted risk ratio: 3.2 (95% CI 1.0–9.9)]. The association between ondansetron and congenital malformations was diluted as the outcome included additional birth defects. Conclusions First trimester ondansetron use is associated with an increased risk of neonatal VSD potentially driven by higher doses. This risk should be viewed in the context of risks attributable to severe untreated nausea and vomiting of pregnancy.

scholarly journals Association between Dietary Salt Intake and Progression in the Gastric Precancerous Process

Cancers ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 467 ◽  
Author(s):  
Susan Thapa ◽  
Lori A. Fischbach ◽  
Robert Delongchamp ◽  
Mohammed F. Faramawi ◽  
Mohammed Orloff
Keyword(s):  
Gastric Cancer ◽  
Confidence Interval ◽  
Risk Ratio ◽  
Salt Intake ◽  
Precancerous Lesions ◽  
Urinary Sodium ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Increased Risk ◽  
H Pylori

Gastric cancer is the third leading cause of cancer mortality worldwide. Studies investigating the effect of salt on gastric cancer have mainly used self-reported measures, which are not as accurate as sodium/creatinine ratios because individuals may not know the amount of salt in their food. Using data from a prospective cohort study, we investigated the effect of salt intake on progression to gastric precancerous lesions. Salt intake was estimated by urinary sodium/creatinine ratios, self-reported frequencies of adding salt to food, and total added table salt. We repeated the analyses among groups with and without Helicobacter pylori infection. We did not observe a positive association between salt intake, measured by urinary sodium/creatinine ratio, and overall progression in the gastric precancerous process (adjusted risk ratio (RR): 0.94; 95% confidence interval (CI) 0.76–1.15). We did observe an association between salt intake and increased risk for progression to dysplasia or gastric cancer overall (adjusted risk ratio (RR): 1.32; 95% confidence interval (CI): 0.96–1.81), especially among those who continued to have H. pylori infection at the five-month follow-up (adjusted RR: 1.53; 95% CI: 1.12–2.09), and among those who had persistent H. pylori infection over 12 years (adjusted RR: 1.49; 95% CI: 1.09–2.05). Salt intake may increase the risk of gastric dysplasia or gastric cancer in individuals with H. pylori infection.

scholarly journals Risk of Congenital Malformations in Children Born Before Paternal Cancer

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Yahia Al-Jebari ◽  
Lars Rylander ◽  
Olof Ståhl ◽  
Aleksander Giwercman
Keyword(s):  
Cancer Diagnosis ◽  
Congenital Malformations ◽  
Cancer Therapies ◽  
Medical Birth Register ◽  
Increased Risk ◽  
Before And After ◽  
Swedish Medical ◽  
Central Nervous System Cancers ◽  
After Cancer ◽  
Mutagenic Effects

Abstract Background Increased risk of congenital malformations in children fathered by men treated for cancer might be due to mutagenicity of cancer therapies. Finding of increased malformation prevalence in offspring born before paternal cancer would indicate a treatment-independent mechanism. Methods Through national registries, we obtained data on singletons born in Sweden from 1994 to 2014 (n = 1 796 160) and their fathers and mothers (1 092 950/1 092 011). Men with cancer (n = 23 932) fathered 26 601 and 9926 children before and after cancer diagnosis, respectively. Associations between paternal cancer, diagnoses retrieved from the Swedish Cancer Register, and offspring malformations, based on Swedish Medical Birth Register data, were estimated by logistic regression. Results Children conceived before paternal cancer had a statistically significantly increased risk of all malformations (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.02 to 1.15, P = .016, 3.8% vs 3.4%) and major malformations (OR = 1.09, 95% CI = 1.01 to 1.18, P = .03, 2.4% vs 2.1%). Eye and central nervous system cancers were associated with the highest risk of all malformations (OR = 1.30, 95% CI = 1.04 to 1.61, P = .02, 4.5% vs 3.4%). A similar trend was seen for testicular cancer. The malformation rates among children conceived before and after paternal cancer diagnosis were similar. Conclusions The association between paternal cancer and risk of malformations in the offspring is not solely due to mutagenic effects of cancer therapy. The increase in prevalence of birth anomalies among children of fathers with malignancy might be due to cancer per se or a common underlying paternal factor, for example, genomic instability.

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