scholarly journals Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth

2021 ◽  
Vol 9 ◽  
Author(s):  
María Luisa Mayol Pérez ◽  
José Manuel Hernández Garre ◽  
Paloma Echevarría Pérez
Keyword(s):  
Vaginal Delivery ◽  
Gestational Age ◽  
Umbilical Artery ◽  
Perinatal Asphyxia ◽  
Total Duration ◽  
Induction Of Labor ◽  
Induced Labor ◽  
Factors Associated ◽  
Labor Duration ◽  
Total Labor

Background: Perinatal asphyxia is a significant contributing factor for neonatal morbidity and mortality. The aim of this study was to investigate the clinical factors associated with umbilical artery pH variability and fetal acidosis at birth.Methods: This is a single center cross-sectional study in a public regional hospital in southeastern Spain from January to December 2019. The reference population was 1.655 newborns, final sample of 312 experimental units with validated values of umbilical cord blood pH.Results: Factors such as gestational age at term (X̄at-term: 7.26 ± 0.08-X̄no-at−term: 7.31 ± 0.05, p: 0.00), primiparity (X̄primiparity: 7.24 ± 0.078-X̄multiparity: 7.27 ± 0.08, p: 0.01), induced labor (X̄induced: 7.24 ± 0.07-X̄spontaneous: 7.26 ± 0.081, p: 0.02), vaginal delivery (X̄vaginal:7.25 ± 0.08-X̄cesarean:7.27 ± 0.07, p: 0.01), and prolonged dilation duration (X̄AboveAverage: 7.22 ± 0.07-X̄BelowAverage: 7.27 ± 0.08, p: 0.00), expulsion duration (X̄AboveAverage: 7.23 ± 0.07-X̄BelowAverage: 7.26 ± 0.08, p: 0.01), and total labor duration (X̄AboveAverage: 7.23 ± 0.07-X̄BelowAverage: 7.27 ± 0.08, p: 0.00) are associated with a decrease in umbilical artery pH at birth. However, only three factors are associated with acidosis pH (<7.20) of the umbilical artery at birth: the induction of labor [OR: 1.74 (95% CI: 0.98–3.10); p: 0.04], vaginal delivery [OR: 2.09 (95% CI: 0.95–4.61); p: 0.04], and total duration of labor [OR: 2.06 (95% CI: 1.18–3.57); p: 0.01].Conclusions: Although several factors may affect the variability of umbilical artery pH at birth by decreasing their mean values (gestational age, primiparity, induced labor, vaginal delivery and prolonged: dilation duration, expulsion duration and total labor duration), only induction of labor, vaginal delivery and total duration of labor are associated with an acidosis (<7.20) of same.

scholarly journals Persistent Fetal SVT in a COVID-19 Positive Pregnancy

2022 ◽  
Vol 2022 ◽  
pp. 1-4
Author(s):  
Gloria Wang ◽  
Eric Stapley ◽  
Sara Peterson ◽  
Jessica Parrott ◽  
Cecily Clark-Ganheart
Keyword(s):  
Vaginal Delivery ◽  
Vertical Transmission ◽  
Gestational Age ◽  
Induction Of Labor ◽  
Potential Complication ◽  
Third Trimester ◽  
Transplacental Therapy ◽  
New Onset

Background. Rapid introduction and spread of SARS-CoV-2 have posed unique challenges in understanding the disease, role in vertical transmission, and in developing management. We present a case of a patient with COVID-19 infection and fetus with new-onset fetal SVT. Case. A 26-year-old gravida 4 para 2012 with third trimester COVID-19 infection was diagnosed with new onset fetal SVT. Successful cardioversion was achieved with flecainide. The patient was followed outpatient until induction of labor at 39 and 3/7 weeks of gestational age resulting in an uncomplicated vaginal delivery. Postpartum course was uncomplicated. Conclusion. Fetal SVT is a potential complication of maternal COVID-19 infection. The use of transplacental therapy with flecainide is an appropriate alternative to digoxin in these cases.

scholarly journals Study of abnormal umbilical artery doppler and neonatal outcome

2019 ◽  
Vol 10 (5) ◽  
pp. 98-101
Author(s):  
Gyawali Merina ◽  
Poudel Ramesh
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Predictive Value ◽  
Umbilical Artery ◽  
Neonatal Outcome ◽  
Perinatal Asphyxia ◽  
Appropriate For Gestational Age ◽  
Umbilical Artery Doppler

Background: Doppler provides assessment of uteroplacental and fetoplacental circulation during pregnancy. It is a sensitive tool in early detection of fetal compromise and allows needful intervention. Aims and Objective: To study the role of umbilical artery doppler in clinically suspected IUGR and its implication on neonatal outcome. Materials and Methods: A total of 104 singleton pregnancies with gestational age of more than 34 weeks who had clinical suspicion of IUGR were evaluated using obstetric ultrasound and doppler. Umbilical arteryvelocimetry with S/D >3 and RI >0.7 were considered abnormal. Newborns were classified as either small for gestational age (SGA) ie, IUGR or appropriate for gestational age (AGA). Neonatal outcome were classified as either normal or adverse events that included still birth, NICU admissions, perinatal asphyxia and/or neonatal death. Results: Out of 104 clinically suspected IUGR, 55 were born with small for gestational age. Among these SGA neonates, 45 subjects had abnormal umbilical artery S/D and 42 had abnormal RI. Abnormal umbilicalartery S/D ratio had a sensitivity of 81.8 %, specificity of 59.2 %, the positive predictive value of 69.2 % and negative predictive value of 74.4 %. Abnormal Umbilical artery RI had a sensitivity of 76.4 %, specificity of 69.4 %, positive predictive value of 73.7 % and negative predictive value of 72.3 % in diagnosing IUGR. Abnormal umbilical artery velocimetry was associated with increased morbidity and mortality in IUGR neonates. Conclusions: Umbilical artery doppler plays an important role in diagnosing IUGR and predicting neonatal outcome.

scholarly journals Factors Associated with Intrapartum Cesarean Section in Women Submitted to Labor Induction

2019 ◽  
Vol 41 (06) ◽  
pp. 363-370
Author(s):  
Glaucia Regina Pfützenreuter ◽  
Juliana Coutinho Cavalieri ◽  
Ana Paula de Oliveira Fragoso ◽  
Karine Souza Da Corregio ◽  
Paulo Fontoura Freitas ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Gestational Age ◽  
Previous History ◽  
Labor Induction ◽  
Santa Catarina ◽  
Induced Labor ◽  
Factors Associated ◽  
History Of

Objective To evaluate the results of induced labor and to determine the main factors associated with intrapartum cesarean section after patients being submitted to this procedure at the Hospital Universitário of the Universidade Federal de Santa Catarina (HU/UFSC, in the Portuguese acronym), Florianópolis, state of Santa Catarina, Brazil. Methods A retrospective cross-sectional study that included all the pregnancies that resulted in single-fetus births, whose gestational-age was > 22 weeks and that had been submitted to labor induction at the HU/UFSC in the period from 2013 to 2016. Results During the proposed period, 1,491 pregnant women were submitted to the labor induction protocol. In 1,264 cases (84.8%), induction resulted in labor, with 830 (65.7%) progressing to vaginal delivery. Gestational age ≥ 41 + 0 weeks was the most common indication for induced labor (55.2%), and vaginal administration of misoprostol was the most commonly used method (72.0%). Among these pregnant women, the cesarean section rate was of 34.3%. Considering the cases of induction failure, the cesarean section rate rose to 44.3%. The factors associated with cesarean section were: previous history of cesarean delivery (PR [prevalence ratio] = 1.48; 95%CI [confidence interval]: 1.51–1.88), fetuses with intrauterine growth restriction (IUGR) (PR = 1.82; 95%CI: 1.32–2.19), Bishop score ≤ 6 (PR = 1.33; 95%CI: 1.01–1.82), and induction time either < 12 hours (PR = 1.44; 95%CI: 1.17–1.66) or > 36 hours (PR = 1.51; 95%CI 1.22–1.92) between the beginning of the induction and the birth. Conclusion Labor induction was successful in most patients. In the cases in which the final outcome was a cesarean section, the most strongly associated factors were: previous history of cesarean delivery, presence of fetuses with IUGR, and either excessively short or excessively long periods of induction.

Factors Predicting Successful Vaginal Delivery Following Induction of Labor in Term Pregnancy v1

2021 ◽  
Author(s):  
Wirada Hansahiranwadee ◽  
Threebhorn Kamlungkuea ◽  
Jittima Manonai Bartlett
Keyword(s):  
Prediction Model ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Fetal Weight ◽  
Term Pregnancy ◽  
Individual Probability ◽  
History Of ◽  
Estimated Fetal Weight

Objective This study was proposed to evaluatefactors predicting successful vaginal delivery following labor induction and develop induction prediction model in term pregnancy among Thai pregnant women. Method We conducted a retrospective cohort study using electronic medical recordsof 23,833 deliveries from April 2010 - July 2021 at tertiary-level hospital in Bangkok, Thailand. Univariate regression was performed to identify association of individual parameters to successful vaginal delivery. Multiple logistic regression analysis of all possible variables from univariate analysis was performed to develop prediction model with statistically significant of p value < 0.05. Results Of thetotal 809 labor-induced pregnancies, the vaginal delivery rate was 56.6%. Among predicting variables, history of previous vaginal delivery (aOR 5.75, 95%CI3.701-8.961), maternal delivery BMI < 25 kg/m2 (aOR 2.010, 95%CI1.303-3.286), estimated fetal weight < 3500 g (aOR 2.193, 95%CI1.246-3.860), and gestational age ≤ 39 weeks (aOR 1.501, 95%CI1.038-2.173) significantly increased the probability of successful vaginal delivery following labor induction. The final prediction model has been internally validated. Model calibration and discrimination were satisfactory with Hosmer-Lemeshow test P= 0.21 and with AUC of 0.732 (95% CI 0.692-0.772). Conclusions This study determined the pragmatic predictors for successful vaginal delivery following labor induction comprised of history of previous vaginal delivery, maternal delivery BMI < 25 kg/m2, estimated fetal weight < 3500 g, and gestational age ≤ 39 weeks. The final induction prediction model was well-performing internally validated prediction model to estimate individual probability when undergoing induction of labor. Despite of restricted population, the predicting factors and model could be useful for further prospective study and clinical practice to improve induction outcomes.

Factors associated with delayed onset of active labor following administration of vaginal Misoprostol among women at Mbarara Regional referral hospital, Uganda: A prospective cohort study

2019 ◽  
Author(s):  
Rogers Kajabwangu ◽  
Francis Bajunirwe ◽  
Henry Lukabwe ◽  
Esther Atukunda ◽  
Baraka Munyanderu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Labor Induction ◽  
Induction Of Labor ◽  
P Value ◽  
Regional Referral Hospital ◽  
Factors Associated ◽  
Delayed Onset ◽  
Active Labor ◽  
Vaginal Misoprostol

Abstract Background Vaginal misoprostol has been recommended by the World Health Organization as one of the effective methods for induction of labor. Globally 9.6% of all deliveries follow induction of labor. Although the goal of labor induction is to initiate active labor with subsequent vaginal delivery, some mothers undergoing labor induction delay to get into active labor and some fail completely. The factors associated with delayed onset of active labor following labor induction with vaginal misoprostol have not been sufficiently explored in resource limited settings.Methods We conducted a prospective cohort study over a period of 6 months on the antenatal ward and labor suit of Mbarara Regional Referral Hospital, southwestern Uganda. We enrolled mothers of gestational age at least 28 weeks, with indication for labor induction. They received 50 micrograms of vaginal misoprostol every 6 hours with a maximum of 4 doses and were followed up until onset of active labor. Onset of active labor was considered delayed if it occurred at more than 12 hours after administration of the first dose of vaginal misoprostol. Bivariate and multivariate analysis was done to determine the factors associated with delayed onset of active labor.Results Eighty-eight mothers underwent induction of labor, 22.7% had delayed onset of active labor. After adjusting for potential confounders, low/no parity (Relative Risk or RR 2.67, p-value=0.01), low gestational age (RR 3.1, p-value=0.006) and higher BMI (RR 0.36, p-value=0.005), were associated with delayed onset of active labor following vaginal misoprostol administration.Conclusion Nulliparity, gestational age less than 37weeks are associated with delayed onset of active labor following labor induction with vaginal misoprostol while BMI of 26 and above is protective from delayed onset of labor.

scholarly journals Perinatal Asphyxia Among Neonates Admitted Jimma Medical Center, Jimma, Ethiopia

2020 ◽  
Vol 7 ◽  
pp. 2333794X2098130
Author(s):  
Ebissa Bayana Kebede ◽  
Adugna Olani Akuma ◽  
Yonas Biratu Tarfa
Keyword(s):  
Gestational Age ◽  
Medical Center ◽  
Perinatal Asphyxia ◽  
Mode Of Delivery ◽  
Large For Gestational Age ◽  
Systematic Sampling ◽  
P Value ◽  
Health Extension Workers ◽  
Severe Problem ◽  
Prolonged Labor

Background: Perinatal asphyxia is a severe problem which causes serious problem in neonates in developing countries. This study is aimed to determine magnitude of perinatal asphyxia and its associated factors. Methods: A cross-sectional study design was conducted among neonates admitted over a period of 4 years on 740 samples. Systematic sampling method was employed to get required samples from log book. Epi-data 3.1 is used for data entry and the entered data was exported to SPSS Version 23 for analysis. Bivariable and multiple variable logistic regressions analysis were applied to see the association between dependent and independent variables. Finally, P-value <.05 at 95% CI was declared statistically significant. Results: The main significant factor associated to perinatal asphyxia were prolonged labor ( P = .04, AOR = 1.68 95%CI: [1.00, 2.80]), being primipara ( P = .003, AOR = 2.06, 95%CI: [1.28, 3.30]), Small for Gestational Age (SGA) ( P = .001, AOR = 4.35, 95%CI: [1.85, 10.19]), Large for Gestational Age ( P = .001, AOR = 16.75, 95%CI: [3.82, 73.33]) and mode of delivery. Conclusion: The magnitude of perinatal asphyxia was 18%. Prolonged labor, parity, birth size, mode of delivery, and APGAR score at 1st minute were significantly associated with perinatal asphyxia. So, Nurses, Midwives, Medical Doctors, and health extension workers have to engage and contribute to on how to decrease the magnitude of perinatal asphyxia.

147 To pull or not to pull: clinical factors associated with failed operative vaginal delivery

2021 ◽  
Vol 224 (2) ◽  
pp. S101
Author(s):  
Danielle M. Panelli ◽  
Stephanie A. Leonard ◽  
Noor Joudi ◽  
Anna Girsen ◽  
Amy Judy ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Clinical Factors ◽  
Factors Associated ◽  
Operative Vaginal Delivery

scholarly journals Factors associated with small- and large-for-gestational-age in socioeconomically vulnerable individuals in the 100 Million Brazilian Cohort

2021 ◽  
Author(s):  
Ila R Falcão ◽  
Rita de Cássia Ribeiro-Silva ◽  
Marcia Furquim de Almeida ◽  
Rosemeire L Fiaccone ◽  
Natanael J Silva ◽  
...  
Keyword(s):  
Gestational Age ◽  
Multinomial Logistic Regression ◽  
Mixed Race ◽  
Sociodemographic Factors ◽  
Reproductive Age ◽  
Large For Gestational Age ◽  
Maternal Characteristics ◽  
Factors Associated ◽  
Study Population ◽  
Brazilian Populations

ABSTRACT Background Evidence points to diverse risk factors associated with small- (SGA) and large-for-gestational-age (LGA) births. A more comprehensive understanding of these factors is imperative, especially in vulnerable populations. Objectives To estimate the occurrence of and sociodemographic factors associated with SGA and LGA births in poor and extremely poor populations of Brazil. Methods The study population consisted of women of reproductive age (14–49 y), whose last child was born between 2012 and 2015. INTERGROWTH 21st consortium criteria were used to classify weight for gestational age according to sex. Multinomial logistic regression modeling was performed to investigate associations of interest. Results Of 5,521,517 live births analyzed, SGA and LGA corresponded to 7.8% and 17.1%, respectively. Multivariate analysis revealed greater odds of SGA in children born to women who self-reported as black (OR: 1.21; 95% CI: 1.19, 1.22), mixed-race (parda) (OR: 1.08; 95% CI: 1.07, 1.09), or indigenous (OR: 1.11; 95% CI: 1.06, 1.15), were unmarried (OR: 1.08; 95% CI: 1.07, 1.08), illiterate (OR: 1.47; 95% CI: 1.42, 1.52), did not receive prenatal care (OR: 1.57; 95% CI: 1.53, 1.60), or were aged 14–20 y (OR: 1.21; 95% CI: 1.20, 1.22) or 35–49 y (OR: 1.12; 95% CI: 1.10, 1.13). Considering LGA children, higher odds were found in infants born to women living in households with ≥3 inadequate housing conditions (OR: 1.11; 95% CI: 1.10, 1.12), in indigenous women (OR: 1.22; 95% CI: 1.19, 1.25), those who had 1–3 y of schooling (OR: 1.18; 95% CI: 1.17, 1.19), 1–3 prenatal visits (OR: 1.16; CI 95%: 1.14, 1.17), or were older (OR: 1.26; 95% CI: 1.25, 1.27). Conclusions In poorer Brazilian populations, socioeconomic, racial, and maternal characteristics are consistently associated with the occurrence of SGA births, but remain less clearly linked to the occurrence of LGA births.

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