In water or on land? Evaluation of perinatal and neonatal outcomes of water births in low-risk women

2021 ◽  
Vol 86 (5) ◽  
pp. 311-317
Author(s):  
Lenka Kubeczková ◽  
◽  
Jana Daňková Kučerová ◽  
Pavla Prašivková ◽  
Michaela Gelnar ◽  
...  
Keyword(s):  
Low Risk ◽  
Land Evaluation ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Index Number ◽  
Eye Drops ◽  
Umbilical Blood ◽  
Water Births ◽  
Water Birth ◽  
Low Risk Women

Objective: Evaluate perinatal and neonatal outcomes comparing a water birth to regular childbirth in low-risk women. File and methods: Retrospective analysis of a set of childbirths that took place over a given period of time in the hospital and health center of Havířov. We compared a set of low-risk women that had given a water birth to a selected control group of low-risk women that had given regular childbirth. We evaluated statistical comparability, as well as perinatal and neonatal outcomes in both sets. Results: From 1. 1. 2020 to 28. 2. 2021, 1,083 women gave birth in the delivery department of Havířov hospital; from this set 122 were water births (11.3%). In our study, we only included 101 water deliveries (we designed our study to monitor low-risk births in order to be able to statistically correlate our fi ndings; 21 water deliveries were excluded from our study due to perinatal risk factors – gestational diabetes and induced deliveries). We selected 60 low-risk women for our control group. Both sets of women were compared and we ruled out any statistically signifi cant diff erences in age, education, body mass index, number of births given, gestation week at time of labor, number of smokers, premature rupture of membranes, women with previous history of one cesarean section, becoming pregnant by in vitro fertilization, presence of streptokoka skupiny B, and fetal weight. Water birth does not aff ect the Apgar score, neonatal adaptation to extra-uterine life, umbilical blood pH decrease, complications of infection, need of intensive care, and neonatal mortality. In the water birth set, we found increased occurrence of non-infectious conjunctivitis, treatable by regular eye drops without antibio tics. We have not observed the eff ect of water birth on duration of the fi rst and second stage of labor, total amount of uterotonics used, blood loss determined by the obstetrician, and uterine hypotonia. In the water birth group, we observed a prolonged third stage of delivery, lesser need for pharmacological stimulation (augmentation) of labor, notably lower use of analgesics, lower occurrence of birth injuries, shorter in-patient time, and more frequent bonding. Conclusions: We discovered that water birth does not increase the risk for mother and neonate in low-risk women. Despite initial concerns, our outcomes and mother satisfaction have clearly shown that water births are not only a temporary whim, but probably a new integral part of our obstetric care. Key words: water birth – analgesia with water – childbirth – perinatal and neonatal outcomes

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.

scholarly journals Maternal and neonatal outcome of births in alongside midwifery units: A cohort study from a tertiary center in Germany

2019 ◽  
Author(s):  
Waltraut Maria Merz ◽  
Laura Tascon-Padron ◽  
Marie-Therese Puth ◽  
Andrea Heep ◽  
Sophia L. Tietjen ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Neonatal Outcome ◽  
Obstetric Care ◽  
Models Of Care ◽  
Low Risk ◽  
Control Group ◽  
Study Group ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Low Risk Women

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate without compromising the maternal or health of the neonate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of all births in the AMU at our hospital from 2010 to 2017 with a matched group of low-risk women who gave birth during the same period of time in standard obstetric care. Methods We used a retrospective cohort study design. The study group consists of all women admitted to labor ward who had registered for birth in AMU. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth, postpartum hemorrhage, and obstetric injury was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.20 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural analgesia, duration of the second stage of labor, and episiotomy rate. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI; birthweight was on average 95 g higher. Except for birth injuries, non-inferiority could be established for the primary outcomes. Secondary outcomes occurred less common in the study group, including a shorter duration of the second stage of labor. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Our investigation confirms comparable maternal and neonatal outcome with less interventions for women giving birth in AMU at our institution. Currently, obstetric services in Germany are almost exclusively provided by consultant-led units. Our results support the integration of AMU as complementary models of care for low-risk women.

scholarly journals Neonatal outcomes associated with obstetric interventions performed during labor in nulliparous women

Rev Rene ◽  
2021 ◽  
Vol 22 ◽  
pp. e67921
Author(s):  
Paloma Gabrielly Amorim Monteiro ◽  
Tatiane da Silva Coelho ◽  
Adriana Moreno de Lima ◽  
Uly Reis Ferreira ◽  
Maria Salete Barbosa Monteiro ◽  
...  
Keyword(s):  
Positive Pressure Ventilation ◽  
Valsalva Maneuver ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Positive Pressure ◽  
Cross Sectional ◽  
Skin Contact ◽  
Nulliparous Women ◽  
Skin To Skin ◽  
Low Risk Women

Objective: to analyze neonatal outcomes associated with obstetric interventions performed during labor in low-risk nulliparous women. Methods: a cross-sectional observational study of 534 low-risk nulliparous women. Results: interruption of skin-to-skin contact after delivery was shown to be associated with obstetric interventions such as cardiotocography at admission, oxytocin in labor, amniotomy, and episiotomy. The need for positive pressure ventilation and oxygen therapy was associated with the encouragement of the Valsalva maneuver; the performance of this maneuver was also associated with interventions such as amniotomy, episiotomy and directed pulling. Conclusion: the study showed that the use of obstetric interventions during labor in low-risk women is associated with unfavorable neonatal outcomes that lead to the need for further interventions after delivery.

Adverse maternal and neonatal outcomes among low-risk women with obesity at 37-41 weeks gestation

2020 ◽  
Vol 254 ◽  
pp. 141-146
Author(s):  
Matthew J. Bicocca ◽  
Megha Gupta ◽  
Stephen M. Wagner ◽  
Hector Mendez-Figueroa ◽  
Suneet P. Chauhan
Keyword(s):  
Low Risk ◽  
Neonatal Outcomes ◽  
Maternal And Neonatal Outcomes ◽  
Low Risk Women

scholarly journals Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes

2021 ◽  
Vol 18 (8) ◽  
pp. 4375
Author(s):  
Xavier Espada-Trespalacios ◽  
Felipe Ojeda ◽  
Mercedes Perez-Botella ◽  
Raimon Milà Villarroel ◽  
Montserrat Bach Martinez ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Birth Outcomes ◽  
Neonatal Intensive Care ◽  
Neonatal Resuscitation ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Risk Pregnancy ◽  
Increased Risk ◽  
Umbilical Arterial Ph ◽  
Low Risk Women

Background: In recent years, higher than the recommended rate of oxytocin use has been observed among low-risk women. This study examines the relationship between oxytocin administration and birth outcomes in women and neonates. Methods: A retrospective analysis of birth and neonatal outcomes for women who received oxytocin versus those who did not. The sample included 322 women with a low-risk pregnancy. Results: Oxytocin administration was associated with cesarean section (aOR 4.81, 95% CI: 1.80–12.81), instrumental birth (aOR 3.34, 95% CI: 1.45–7.67), episiotomy (aOR 3.79, 95% CI: 2.20–6.52) and length of the second stage (aOR 00:18, 95% CI: 00:04–00:31). In neonatal outcomes, oxytocin in labor was associated with umbilical artery pH ≤ 7.20 (OR 3.29, 95% CI: 1.33–8.14). Admission to neonatal intensive care unit (OR 0.56, 95% CI: 0.22–1.42), neonatal resuscitation (OR 1.04, 95% CI: 0.22–1.42), and Apgar score <7 (OR 0.48, 95% CI: 0.17–1.33) were not associated with oxytocin administration during labor. Conclusions: Oxytocin administration during labor for low-risk women may lead to worse birth outcomes with an increased risk of instrumental birth and cesarean, episiotomy and the use of epidural analgesia for pain relief. Neonatal results may be also worse with an increased proportion of neonates displaying an umbilical arterial pH ≤ 7.20.

scholarly journals Maternal and neonatal outcome of births planned in alongside midwifery units: A cohort study from a tertiary center in Germany

2020 ◽  
Author(s):  
Waltraut Maria Merz ◽  
Laura Tascon-Padron ◽  
Marie-Therese Puth ◽  
Andrea Heep ◽  
Sophia L. Tietjen ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cohort Study ◽  
Primary Outcome ◽  
Obstetric Care ◽  
Low Risk ◽  
Control Group ◽  
Study Group ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Low Risk Women

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of women registered for planned birth in the AMU at our hospital with a matched group of low-risk women who gave birth in standard obstetric care during the same period of time. Methods We used a retrospective cohort study design. The study group consisted of all women admitted to labor ward who had registered for birth in AMU from 2010 to 2017. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.10 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural anesthesia, duration of the second stage of labor, episiotomy, obstetric injury, and postpartum hemorrhage. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI; birthweight was on average 95 g higher. Non-inferiority could be established for the primary outcome parameters. Epidural anesthesia and episiotomy rates were lower, and the mean duration of the second stage of labor was shorter in the study group; second-degree perineal tears were less common, higher-order obstetric lacerations occurred more frequently. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Compared to births in our consultant-led obstetric unit, the outcome of births planned in the AMU was not inferior, and intervention rates were lower. Our results support the integration of AMU as a complementary model of care for low-risk women.

scholarly journals Frequency of meconium stained liquor in low risk laboring women and its effect on perinatal outcome in a tertiary care hospital.

2021 ◽  
Vol 28 (7) ◽  
pp. 936-943
Author(s):  
Abeera Choudry ◽  
◽  
Maria Habib ◽  
Zaineb Shamim ◽  
Syeda Zubda Batool ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Military Hospital ◽  
Care Hospital ◽  
Positive Correlation ◽  
Adverse Neonatal Outcomes ◽  
Low Risk Women

Objective: To evaluate the frequency of meconium stained liquor (MSL) in low risk women and its effect on perinatal outcomes. Study Design: Prospective Case Control study. Setting: Department of Obstetrics and Gynecology Military Hospital, Rawalpindi. Period: January to August 2017. Material & Methods: Distribution of MSL was studied according to its grade. Data included demographic profile, mode of delivery, intrapartum factors and neonatal outcomes. Descriptive statistics and chi-square were used for analysis. Results: Frequency of MSL was 376 (3.65%) among 10,281 deliveries during study period. A total of 752 women were included in the study which were divided into cases and controls. Nulliparity and advanced gestational age were significantly associated with MSL. Distribution of grade of meconium was 20.5%, 56.4% and 23.1% for grade I, II and III MSL. Breech presentation, fetal heart rate abnormalities and cesarean section were significantly associated with MSL. Low apgar score at 1 and 5 minutes, Neonatal intensive unit care admissions and fetal complications had positive correlation with MSL. Frequency of meconium aspiration syndrome (MAS) was 16.4%, birth asphyxia 5.31% and respiratory distress syndrome (RDS) 1.32% amongst all the cases of MSL. However, frequency of MAS, birth asphyxia and RDS was 0.6%, 0.19%, 0.02% in general obstetric population. Neonatal mortality was 29% in MAS, 3.4% in MSL and 0.12% in general population. Adverse neonatal outcomes had positive correlation with increasing grade of meconium. Conclusion: There is a significant frequency of meconium stained liquor even in low risk women. MSL is significantly associated with increased cesarean section rates and adverse neonatal outcomes.

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.

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