1
|
Jayasundara DMCS, Jayawardane IA, Denuwara HMBH, Jayasingha TDKM. Membrane sweeping at term to promote spontaneous labor and reduce the likelihood of formal labor induction for prolonged pregnancy, in South Asia and the world: A meta-analysis. Int J Gynaecol Obstet 2024; 166:567-579. [PMID: 38247176 DOI: 10.1002/ijgo.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Membrane sweeping promotes the spontaneous onset of labor, reducing the need for formal labor induction. In addition to the safety profile, membrane sweep is a cost-effective measure in a low-resource setting like South Asia. OBJECTIVES To the best of our knowledge, previous reviews and meta-analyses have not explored the timing and frequency of membrane sweeping or its association with the period of gestation (POG) and parity. Additionally, the results should be interpreted with caution due to the inclusion of older studies and the analyses conducted regardless of ethnicity in previous literature. We addressed these gray areas in the current study to fill the research gap. SEARCH STRATEGY We searched PubMed, Google Scholar, Science Direct, and Cochrane Reviews. Study selection was performed using the semi-automated tool Rayyan. SELECTION CRITERIA The selection criteria for this study encompassed the inclusion of randomized controlled trials (RCTs) published in English between January 2010 and May 2023, with accessible full-text articles. The focus was on low-risk pregnant women carrying a single fetus in a cephalic presentation at term (37-42 weeks) gestation, confirmed by reliable methods. Essential data for relative risk (RR) and 95% confidence interval (CI) calculation must be present. DATA COLLECTION AND ANALYSIS The Cochrane risk-of-bias (RoB2) tool and funnel plots were used to assess bias. Review Manager (RevMan) 5.4 version was used for analysis. The Mantel-Haenszel statistics and random effects were used to calculate the overall effect of risk ratio with a 95% confidence interval. Study heterogeneity was calculated using the I2 statistic. Two subgroups were used in the analysis: South Asia and the rest of the world. MAIN RESULTS A total of 13 RCTs with 2599 participants were analyzed. Overall, membrane sweep effectively reduced formal IOL with an effect size of 2.43 (95% CI: 1.51-3.91). It also promoted spontaneous labor with an effect size of 1.71 (95% CI: 1.15-2.55). In the South Asian subgroup, membrane sweeping significantly promoted the spontaneous onset of labor with an overall effect of 1.85 (95% CI: 1.37-2.51), and in the rest of the world subgroup, membrane sweeping significantly reduced formal labor induction with an overall effect of 1.93 (95% CI: 1.33-2.82). The pooled effects were significant in mulipara with a POG ≥40 W in the South Asian subgroup. CONCLUSIONS Membrane sweeping effectively reduces the need for formal labor induction and promotes spontaneous labor. This may be particularly relevant in South Asian populations where a disproportionate ethnic contribution to stillbirth rates is noted. Due to the limited number of RCTs addressing the factors and study methodology heterogeneity, we had limited data in some subgroup analyses. Therefore, we encourage more RCTs and meta-analyses on POG, parity, timing and frequency of membrane sweeping, and ethnic differences.
Collapse
Affiliation(s)
- D M C S Jayasundara
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- De Soysa Maternity Hospital, Colombo, Sri Lanka
| | - I A Jayawardane
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- De Soysa Maternity Hospital, Colombo, Sri Lanka
| | - H M B H Denuwara
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - T D K M Jayasingha
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
2
|
Ehikioya E, Nwachukwu OB, Okobi OE. Effectiveness of Single Fetal Membrane Sweeping in Reducing Elective Labor Induction for Postdate Pregnancies (38+0 to 40+6 Weeks): A Randomized Controlled Trial. Cureus 2024; 16:e58030. [PMID: 38738107 PMCID: PMC11088221 DOI: 10.7759/cureus.58030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Postdate pregnancy is characterized by a heightened risk for both maternal and perinatal complications. Owing to the risks, clinicians frequently turn to elective labor induction as a management strategy for postdate pregnancies. However, patients are increasingly informed and apprehensive about this approach and its associated risks. This has prompted a search for alternative management methods that may encourage spontaneous labor in pregnant women. One such approach is the use of fetal membrane sweeping, a method known to increase the likelihood of spontaneous labor onset. Yet, it remains unclear whether a single fetal membrane sweeping procedure can effectively reduce the need for elective labor induction in postdate pregnancies while minimizing risks to both the mother and fetus. OBJECTIVES The primary objective of this study was to assess the efficacy of a single fetal membrane sweeping procedure conducted between 38+0 and 40+6 weeks of gestation in reducing the rate of elective labor induction among postdate pregnancies at Central Hospital Benin City, Nigeria. Secondary objectives included evaluating the impact of membrane sweeping on maternal and perinatal outcomes. METHODOLOGY This open-label superiority randomized controlled study was carried out from June 2020 to March 2021, following ethical approval from the Hospital Management Board (HMB). One hundred and forty eligible participants, without contraindications to vaginal delivery, were randomly assigned to one of two groups. The first group received a single fetal membrane sweeping procedure between 38+0 and 40+6 weeks of gestation, while the control group underwent vaginal examination only to assess the Bishop score. Participants were monitored until delivery. Data analysis was performed. Results were considered statistically significant at p < 0.05. RESULTS The implementation of a single fetal membrane sweeping procedure effectively reduced the incidence of elective labor induction. Specifically, the membrane sweep group exhibited a significantly lower rate of elective labor induction compared to the control group (9.0% vs. 27.1%; p=0.0083). Moreover, a substantial proportion of the treatment group (91.4%) experienced spontaneous labor, while the control group reported a rate of 72.9%. The difference was statistically significant (p=0.0054). Notably, the control group exhibited a significantly longer mean time interval from recruitment to delivery (10.67±3.51 days) than the membrane sweeping group (3.64±4.123 days; p<0.05). Also, postdate women in the membrane sweep group were less likely to require cervical ripening with Foley's catheter than those in the control group (33.3% vs. 100%; RR: 0.33 (0.11-1.03); p=0.0057). Still, maternal satisfaction was significantly higher in the membrane-sweeping group (p<0.01). No significant differences were noted across the groups in maternal and neonatal outcomes. CONCLUSION In low-risk term pregnancies, a single fetal membrane sweeping procedure is a superior alternative to no membrane sweeping in reducing the rate of elective labor induction for postdate pregnancies and in shortening the duration of term pregnancy.
Collapse
Affiliation(s)
| | - Onyinyechukwu B Nwachukwu
- Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Family Medicine, American International School of Medicine, Georgetown, GUY
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, Maryland, USA
- Family Medicine, Lakeside Medical center, Belle Glade, USA
| |
Collapse
|
3
|
Daalderop LA, Been JV, Steegers EAP, Bertens LCM. Impact of the EURO-PERISTAT Reports on obstetric management: a difference-in-regression-discontinuity analysis. Eur J Public Health 2023; 33:342-348. [PMID: 36807668 PMCID: PMC10066490 DOI: 10.1093/eurpub/ckad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Population health monitoring, such as perinatal mortality and morbidity rankings published by the European Perinatal Health (EURO-PERISTAT) reports may influence obstetric care providers' decision-making and professional behaviour. We investigated short-term changes in the obstetric management of singleton term deliveries in the Netherlands following publication of the EURO-PERISTAT reports in 2003, 2008 and 2013. METHODS We used a quasi-experimental difference-in-regression-discontinuity approach. National perinatal registry data (2001-15) was used to compare obstetric management at delivery in four time windows (1, 2, 3 and 5 months) surrounding publication of each EURO-PERISTAT report. RESULTS The 2003 EURO-PERISTAT report was associated with higher relative risks (RRs) for an assisted vaginal delivery across all time windows [RR (95% CI): 1 month: 1.23 (1.05-1.45), 2 months: 1.15 (1.02-1.30), 3 months: 1.21 (1.09-1.33) and 5 months: 1.21 (1.11-1.31)]. The 2008 report was associated with lower RRs for an assisted vaginal delivery at the 3- and 5-month time windows [0.86 (0.77-0.96) and 0.88 (0.81-0.96)]. Publication of the 2013 report was associated with higher RRs for a planned caesarean section across all time windows [1 month: 1.23 (1.00-1.52), 2 months: 1.26 (1.09-1.45), 3 months: 1.26 (1.12-1.42) and 5 months: 1.19(1.09-1.31)] and lower RRs for an assisted vaginal delivery at the 2-, 3- and 5-month time windows [0.85 (0.73-0.98), 0.83 (0.74-0.94) and 0.88 (0.80-0.97)]. CONCLUSIONS This study showed that quasi-experimental study designs, such as the difference-in-regression-discontinuity approach, are useful to unravel the impact of population health monitoring on decision-making and professional behaviour of healthcare providers. A better understanding of the contribution of health monitoring to the behaviour of healthcare providers can help guide improvements within the (perinatal) healthcare chain.
Collapse
Affiliation(s)
- Leonie A Daalderop
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Division of Neonatology, Department of Paediatrics, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Guideline No. 432a: Cervical Ripening and Induction of Labour - General Information. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:35-44.e1. [PMID: 36725128 DOI: 10.1016/j.jogc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This guideline presents evidence and recommendations for cervical ripening and induction of labour. It aims to provide information to birth attendants and pregnant individuals on optimal perinatal care while avoiding unnecessary obstetrical intervention. TARGET POPULATION All pregnant patients. BENEFITS, HARMS, AND COSTS Consistent interprofessional use of the guideline, appropriate equipment, and trained professional staff enhance safe intrapartum care. Pregnant individuals and their support person(s) should be informed of the benefits and risks of induction of labour. EVIDENCE Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane Library were used to search for systematic reviews, randomized controlled trials, and observational studies on cervical ripening and induction of labour. Grey (unpublished) literature was identified by searching the websites of health technology assessment and health technology related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All providers of obstetrical care. RECOMMANDATIONS
Collapse
|
5
|
Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Directive clinique n o 432a : Maturation cervicale et déclenchement artificiel du travail - Information générale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:45-55.e1. [PMID: 36725130 DOI: 10.1016/j.jogc.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIF Présenter des données probantes et des recommandations sur la maturation cervicale et le déclenchement artificiel du travail. Fournir de l'information aux professionnels accoucheurs et aux personnes enceintes sur les soins périnataux optimaux et la prévention des interventions obstétricales inutiles. POPULATION CIBLE Toutes les patientes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en application interprofessionnelle et cohérente de la présente directive, l'équipement adéquat et le personnel compétent améliorent la sécurité des soins per partum. Les personnes enceintes et leurs personnes de soutien doivent être informées des risques et bénéfices du déclenchement artificiel du travail. DONNéES PROBANTES: La littérature publiée jusqu'en mars 2022 a été passée en revue. Une recherche a été effectuée dans les bases de données PubMed, CINAHL et Cochrane Library pour répertorier des revues systématiques, des essais cliniques randomisés et des études observationnelles sur la maturation cervicale et le déclenchement artificiel du travail. La littérature grise (non publiée) a été obtenue à l'aide de recherches menées dans des sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, des registres d'essais cliniques et des sites Web de sociétés de spécialité médicale nationales et internationales. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins obstétricaux. RECOMMANDATIONS
Collapse
|
6
|
Klancic T, Black AM, Reimer RA. Influence of antibiotics given during labour and birth on body mass index z scores in children in the All Our Families pregnancy cohort. Pediatr Obes 2022; 17:e12847. [PMID: 34414675 DOI: 10.1111/ijpo.12847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Little is known about obesity risk associated with intrapartum antibiotic prophylaxis (IAP). Our objective was to determine if maternal antibiotic exposure during birth is associated with child body mass index (BMI) z scores in the first 3 years of life. METHODS In 2008 to 2010, 3388 pregnant women were recruited to the All Our Families study. Here, we included women with available data from obstetrical records on antibiotic use during birth (n = 1303) and children with at least one valid BMI z score (final sample n = 1262). The primary outcome was infant BMI z score at 1, 2 and 3 years of age. RESULTS IAP occurred in 432 of 1262 women. Children exposed to IAP had significantly higher mean [standard error (SE)] BMI z scores (1.071 [0.087] unit) at 1 year of age compared to non-exposed infants (0.744 [0.064] unit). Although the association was no longer significant after adjustment for confounding factors in the growth trajectory model, IAP resulted in a 0.255 unit increase in BMI z score at 1 year of age. Differences in BMI z score between exposed and non-exposed at baseline (year 1) only remained significant in sensitivity analysis. CONCLUSION The potential association between maternal IAP and increased infant BMI z score at 1 year of age should be confirmed in other cohorts and warrants investigation of interventions to mitigate this possible risk.
Collapse
Affiliation(s)
- Teja Klancic
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda M Black
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Raylene A Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
7
|
Maternal Prepregnancy Weight and Pregnancy Outcomes in Saudi Women: Subgroup Analysis from Riyadh Mother and Baby Cohort Study (RAHMA). BIOMED RESEARCH INTERNATIONAL 2021; 2021:6655942. [PMID: 33869631 PMCID: PMC8034996 DOI: 10.1155/2021/6655942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/07/2021] [Accepted: 03/13/2021] [Indexed: 01/22/2023]
Abstract
The objectives of this study were to estimate the prevalence of prepregnancy overweight/obesity and underweight among Saudi mothers and to determine the adverse pregnancy outcomes associated with them. Methods. This is a subgroup analysis from a Riyadh mother and baby cohort study. Participants were divided into four groups according to prepregnancy BMI. Participants with normal BMI were the reference group. Groups were compared in relation to pregnancy-related obstetric, as well as fetal and neonatal complications. A regression model was used to control for covariates, and adjusted odds ratios (AOR) with 95% Confidence Intervals (95% CI) were calculated. Results. A total of 7,029 women were included, 29.7% had normal BMI, 33.3% were overweight, 34.8% were obese, and 2.2% were underweight. Obesity was associated with increased odds of gestational diabetes (AOR 2.07, 95% CI 1.73-2.47), hypertensive events in pregnancy (AOR 2.33, 95% CI 1.19-3.91), induction of labour (IOL) (AOR 1.40, 95% CI, 1.19-1.65), failed IOL (AOR 2.13, 95% CI 1.40-3.25), and delivery by emergency caesarean section (CS) (AOR 1.67, 95% CI 1.39-2.01). Infants of obese women had increased odds of macrosomia (AOR 3.73, 95% CI 2.33-5.98). Overweight women had increased odds of CS delivery (AOR 1.25, 95% CI 1.03-1.5) and failed IOL (AOR 1.69, 95% CI 1.09-2.60). Underweight women had increased odds of delivering a low birth weight (LBW) infant (AOR 2.49, 95% CI, 1.58-3.92). Conclusion. The prevalence of prepregnancy overweight and obesity is very high in Saudi Arabia. Prepregnancy obesity is associated with GDM and hypertensive events inpregnancy, IOL, failed IOL, and CS delivery. Infants of obese mothers were at higher risk of macrosomia, while underweight women were at increased risk of delivering LBW infants.
Collapse
|
8
|
Wennerholm UB, Saltvedt S, Wessberg A, Alkmark M, Bergh C, Wendel SB, Fadl H, Jonsson M, Ladfors L, Sengpiel V, Wesström J, Wennergren G, Wikström AK, Elden H, Stephansson O, Hagberg H. Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial. BMJ 2019; 367:l6131. [PMID: 31748223 PMCID: PMC6939660 DOI: 10.1136/bmj.l6131] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks. DESIGN Multicentre, open label, randomised controlled superiority trial. SETTING 14 hospitals in Sweden, 2016-18. PARTICIPANTS 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group. INTERVENTIONS Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks. MAIN OUTCOME MEASURES The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat. RESULTS The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups. CONCLUSIONS This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths. TRIAL REGISTRATION Current Controlled Trials ISRCTN26113652.
Collapse
Affiliation(s)
- Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| | - Sissel Saltvedt
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Wessberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Mårten Alkmark
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| | - Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| | - Sophia Brismar Wendel
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lars Ladfors
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| | - Jan Wesström
- Center for Clinical Research Dalarna, Uppsala University, Sweden
| | - Göran Wennergren
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Hagberg
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| |
Collapse
|
9
|
Cannabis Use in Pregnancy in British Columbia and Selected Birth Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1311-1317. [DOI: 10.1016/j.jogc.2018.11.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/07/2018] [Indexed: 11/18/2022]
|
10
|
Kortekaas JC, Bruinsma A, Keulen JKJ, Vandenbussche FP, van Dillen J, de Miranda E. Management of late-term pregnancy in midwifery- and obstetrician-led care. BMC Pregnancy Childbirth 2019; 19:181. [PMID: 31117985 PMCID: PMC6532173 DOI: 10.1186/s12884-019-2294-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/12/2019] [Indexed: 11/24/2022] Open
Abstract
Management of late-term pregnancy in midwifery- and obstetrician-led care. BACKGROUND Since there is no consensus regarding the optimal management in late-term pregnancies (≥41.0 weeks), we explored the variety of management strategies in late-term pregnancy in the Netherlands to identify the magnitude of this variety and the attitude towards late-term pregnancy. METHODS Two nationwide surveys amongst all midwifery practices (midwifery-led care) and all hospitals with an obstetric unit (obstetrician-led care) were performed with questions on timing, frequency and content of consultations/surveillance in late-term pregnancy and on timing of induction. Propositions about late-term pregnancy were assessed using Likert scale questions. RESULTS The response rate was 40% (203/511) in midwifery-led care and 92% (80/87) in obstetrician-led care. All obstetric units made regional protocols with their collaborating midwifery practices about management in late-term pregnancy. Most midwifery-led care practices (93%) refer low-risk women at least once for consultation in obstetrician-led care in late-term pregnancy. The content of consultations varies among hospitals. Membrane sweeping is performed more in midwifery-led care compared to obstetrician-led care (90% vs 31%, p < 0.001). Consultation at 41 weeks should be standard care according to 47% of midwifery-led care practices and 83% of obstetrician-led care units (p < 0.001). Induction of labour at 41.0 weeks is offered less often to women in midwifery-led care in comparison to obstetrician-led care (3% vs 21%, p < 0.001). CONCLUSIONS Substantial practice variation exists within and between midwifery-and obstetrician-led care in the Netherlands regarding timing, frequency and content of antenatal monitoring in late-term pregnancy and timing of labour induction. An evidence based interdisciplinary guideline will contribute to a higher level of uniformity in the management in late- term pregnancies.
Collapse
Affiliation(s)
- Joep C. Kortekaas
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA Nijmegen, the Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Aafke Bruinsma
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Judit K. J. Keulen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Frank P.H.A. Vandenbussche
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA Nijmegen, the Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA Nijmegen, the Netherlands
| | - Esteriek de Miranda
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| |
Collapse
|
11
|
Rydahl E, Eriksen L, Juhl M. Effects of induction of labor prior to post-term in low-risk pregnancies: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:170-208. [PMID: 30299344 PMCID: PMC6382053 DOI: 10.11124/jbisrir-2017-003587] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this review was to identify, assess and synthesize the best available evidence on the effects of induction prior to post-term on the mother and fetus. Maternal and fetal outcomes after routine labor induction in low-risk pregnancies at 41+0 to 41+6 gestational weeks (prior to post-term) were compared to routine labor induction at 42+0 to 42+6 gestational weeks (post-term). INTRODUCTION Induction of labor when a pregnancy exceeds 14 days past the estimated due date has long been used as an intervention to prevent adverse fetal and maternal outcomes. Over the last decade, clinical procedures have changed in many countries towards earlier induction. A shift towards earlier inductions may lead to 15-20% more inductions. Given the fact that induction as an intervention can cause harm to both mother and child, it is essential to ensure that the benefits of the change in clinical practice outweigh the harms. INCLUSION CRITERIA This review included studies with participants with expected low-risk deliveries, where both fetus and mother were considered healthy at inclusion and with no known risks besides the potential risk of the ongoing pregnancy. Included studies evaluated induction at 41+1-6 gestational weeks compared to 42+1-6 gestational weeks. Randomized control trials (n = 2), quasi-experimental trials (n = 2), and cohort studies (n = 3) were included. The primary outcomes of interest were cesarean section, instrumental vaginal delivery, low Apgar score (≤ 7/5 min.), and low pH (< 7.10). Secondary outcomes included additional indicators of fetal or maternal wellbeing related to prolonged pregnancy or induction. METHODS The following information sources were searched for published and unpublished studies: PubMed, CINAHL, Embase, Scopus, Swemed+, POPLINE; Cochrane, TRIP; Current Controlled Trials; Web of Science, and, for gray literature: MedNar; Google Scholar, ProQuest Nursing & Allied Health Source, and guidelines from the Royal College of Obstetricians and Gynaecologists, and American College of Obstetricians and Gynecologists, according to the published protocol. In addition, OpenGrey and guidelines from the National Institute for Health and Care Excellence, World Health Organization, and Society of Obstetricians and Gynaecologists of Canada were sought. Included papers were assessed by all three reviewers independently using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). The standardized data extraction tool from JBI SUMARI was used. Data were pooled in a statistical meta-analysis model using RevMan 5, when the criteria for meta-analysis were met. Non-pooled results were presented separately. RESULTS Induction at 41+0-6 gestational weeks compared to 42+0-6 gestational weeks was found to be associated with an increased risk of overall cesarean section (relative risk [RR] = 1.11, 95% confidence interval [CI] 1.09-1.14), cesarean section due to failure to progress (RR = 1.43, 95% CI 1.01-2.01), chorioamnionitis (RR = 1.13, 95% CI 1.05-1.21), labor dystocia (RR = 1.29, 95% CI 1.22-1.37), precipitate labor (RR = 2.75, 95% CI 1.45-5.2), uterine rupture (RR = 1.97, 95% CI 1.54-2.52), pH < 7.10 (RR = 1.9, 95% CI 1.48-2.43), and a decreased risk of oligohydramnios (RR = 0.4, 95% CI 0.24-0.67) and meconium stained amniotic fluid (RR = 0.82, 95% CI 0.75-0.91). Data lacked statistical power to draw conclusions on perinatal death. No differences were seen for postpartum hemorrhage, shoulder dystocia, meconium aspiration, 5-minute Apgar score < 7, or admission to neonatal intensive care unit. A policy of awaiting spontaneous onset of labor until 42+0-6 gestational weeks showed, that approximately 70% went into spontaneous labor. CONCLUSIONS Induction prior to post-term was associated with few beneficial outcomes and several adverse outcomes. This draws attention to possible iatrogenic effects affecting large numbers of low-risk women in contemporary maternity care. According to the World Health Organization, expected benefits from a medical intervention must outweigh potential harms. Hence, our results do not support the widespread use of routine induction prior to post-term (41+0-6 gestational weeks).
Collapse
Affiliation(s)
- Eva Rydahl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Center of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark
| | - Lena Eriksen
- The Research Unit Women's and Children's Health, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Juhl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Prevalence of postterm births and associated maternal risk factors in China: data from over 6 million births at health facilities between 2012 and 2016. Sci Rep 2019; 9:273. [PMID: 30670707 PMCID: PMC6342977 DOI: 10.1038/s41598-018-36290-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/06/2018] [Indexed: 11/26/2022] Open
Abstract
Postterm births are associated with an increased risk of adverse perinatal outcomes, but few studies have investigated the epidemiological characteristics of postterm births. We aimed to estimate the prevalence of postterm births and examine the potential association between maternal sociodemographic and obstetric characteristics and postterm births. Data were collected from China’s National Maternal Near Miss Surveillance System, 2012–2016. A logistic regression was used to assess the association between sociodemographic and obstetric characteristics and postterm births. A Poisson regression was used to determine the crude and adjusted trends of postterm births over time across regions. Among the 6,240,830 singleton births with gestational periods of 37 weeks or longer, 1.16% were postterm. The prevalence of postterm births was significantly higher in the western region and among mothers who delivered at a level ≤2 hospital, had a lower education, or were younger. A reduced risk of postterm births was observed among primiparous women, mothers who previously had a caesarean section, mothers with pregnancy complications, and mothers with ten or more antenatal visits. The risk of postterm births decreased as the number of antenatal visits increased. The overall postterm birth rates significantly decreased from 1.49% in 2012 to 0.70% in 2016. The postterm birth rates were markedly reduced in the east, central, and west regions, and the rate of the decrease was greater in the east than in the west. Furthermore, substantial decreases were observed across regions in 2014 and 2016. In conclusion, multiple sociodemographic and obstetric factors are associated with the prevalence of postterm births. A significant decreasing trend in postterm birth rates was observed in China.
Collapse
|
13
|
Diguisto C, Gouge AL, Giraudeau B, Perrotin F. Mechanical cervicAl ripeninG for women with PrOlongedPregnancies (MAGPOP): protocol for a randomised controlled trial of a silicone double balloon catheter versus the Propess system for the slow release of dinoprostone for cervical ripening of prolonged pregnancies. BMJ Open 2017; 7:e016069. [PMID: 28912192 PMCID: PMC5640144 DOI: 10.1136/bmjopen-2017-016069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Induction of labour for prolonged pregnancies (PP) when the cervix is unfavourable is a challenging situation. Cervical ripening by pharmacological or mechanical techniques before oxytocin administration is used to increase the likelihood of vaginal delivery. Both techniques are equally effective in achieving vaginal delivery but excessive uterine activity, which induces fetal heart rate (FHR) anomalies, is more frequent after the pharmacological intervention. We hypothesised that mechanical cervical ripening could reduce the caesarean rate for non-reassuring FHR especially in PP where fetuses are already susceptible to this. METHODS AND ANALYSIS A multicentre, superiority, open-label, parallel-group, randomised controlled trial that aims to compare cervical ripening with a mechanical device (Cervical Ripening Balloon, Cook-Medical Europe, Ireland) inserted in standardised manner for 24 hours to pharmacological cervical ripening (Propess system for slow release system of 10 mg of dinoprostone, Ferring SAS, France) before oxytocin administration. Women (n=1220) will be randomised in a 1:1 ratio in 15 French units. Participants will be women with a singleton pregnancy, a vertex presentation, a term ≥41+0 and≤42+0 week's gestation, and for whom induction of labour is planned. Women with a Bishop score ≥6, a prior caesarean delivery, premature rupture of membranes or with any contraindication for vaginal delivery will be excluded. The primary endpoint is the caesarean rate for non-reassuring FHR. Secondary outcomes are related to delivery and perinatal morbidity. As study investigators and patients cannot be masked to treatment assignment, to compensate for the absence of blinding, an independent endpoint adjudication committee, blinded to group allocation, will determine whether the caesarean for non-reassuring FHR was justified. ETHICS AND DISSEMINATION Written informed consent will be obtained from all participants. The Tours Research ethics committee has approved this study (2016-R23, 29 November 2016). Study findings will be submitted for publication and presented at relevant conferences. TRIAL REGISTRATION NUMBER NCT02907060; pre-results.
Collapse
Affiliation(s)
- Caroline Diguisto
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Tonnellé, France
- Université François Rabelais Tours, Tonnellé, France
| | | | - Bruno Giraudeau
- Université François Rabelais Tours, Tonnellé, France
- INSERM CIC 1415, CHRU de Tours, Tours, France
| | - Franck Perrotin
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Tonnellé, France
- Université François Rabelais Tours, Tonnellé, France
| |
Collapse
|
14
|
Fayed AA, Wahabi H, Mamdouh H, Kotb R, Esmaeil S. Demographic profile and pregnancy outcomes of adolescents and older mothers in Saudi Arabia: analysis from Riyadh Mother (RAHMA) and Baby cohort study. BMJ Open 2017; 7:e016501. [PMID: 28893746 PMCID: PMC5595204 DOI: 10.1136/bmjopen-2017-016501] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/03/2017] [Accepted: 08/01/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To investigate the impact of maternal age on pregnancy outcomes with special emphasis on adolescents and older mothers and to investigate the differences in demographic profile between adolescents and older mothers. METHODS This study is a secondary analysis of pregnancy outcomes of women in Riyadh Mother and Baby cohort study according to maternal age. The study population was grouped according to maternal age into five subgroups; <20, 20-29, 30-34, 35-39 and 40+years. The age group 20-29 years was considered as a reference group. Investigation of maternal age impact on maternal and neonatal outcomes was conducted with adjustment of confounders using regression models. RESULTS All mothers were married when conceived with the index pregnancy. Young mothers were less likely to be illiterate, more likely to achieve higher education and be employed compared with mothers ≥ 40 years. Compared with the reference group, adolescents were more likely to have vaginal delivery (and least likely to deliver by caesarean section (CS); OR=0.6, 95% CI 0.4 to 0.9, while women ≥40 years, were more likely to deliver by CS; OR 2.9, 95% CI 2.3 to 3.7. Maternal age was a risk factor for gestational diabetes in women ≥40 years; OR 1.7, 95% CI 1.3 to 2.1. Adolescents had increased risk of preterm delivery; OR 1.5, 95% CI 1.1 to 2.1 and women ≥40 years had similar risk; OR, 1.3, 95% CI 1.1 to 1.6. CONCLUSION Adverse pregnancy outcomes show a continuum with the advancement of maternal age. Adolescents mother are more likely to have vaginal delivery; however, they are at increased risk of preterm delivery. Advanced maternal age is associated with increased risk of preterm delivery, gestational diabetes and CS.
Collapse
Affiliation(s)
- Amel A Fayed
- Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt
- College of Medicine, Clinical department, Princess Nourah Bint Abdulrahman University, Riyadh, Riyadh, Saudi Arabia
| | - Hayfaa Wahabi
- Chair of Evidence Based Health Care and Knowledge Translation, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Community and Family Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Heba Mamdouh
- Department of Family Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Reham Kotb
- Primary Health Care, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Samia Esmaeil
- Chair of Evidence Based Health Care and Knowledge Translation, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
15
|
Bisson M, Croteau J, Guinhouya BC, Bujold E, Audibert F, Fraser WD, Marc I. Physical activity during pregnancy and infant's birth weight: results from the 3D Birth Cohort. BMJ Open Sport Exerc Med 2017; 3:e000242. [PMID: 28761717 PMCID: PMC5530125 DOI: 10.1136/bmjsem-2017-000242] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 01/15/2023] Open
Abstract
Aim To evaluate the association between maternal physical activity and infant’s birth weight or risk of inappropriate weight for gestational age (GA), and whether this association differs by infant’s sex, maternal body mass index (BMI) or pregnancy complications in a prospective cohort study. Methods 1913 pregnant women from the 3D Birth Cohort (Québec, Canada) completed the Pregnancy Physical Activity Questionnaire at each trimester. Energy expenditure (metabolic equivalent of task (MET)*hours/week) for total activity, sports and exercise and vigorous intensity activities was calculated. The associations with birth weight and risk of inappropriate weight for GA were evaluated by regression modelling. Interactions were tested with infant’s sex, maternal prepregnancy BMI, gestational diabetes, hypertensive disorders and prematurity. Results Each 1 MET/hours/week increase in sports and exercise in the first trimester was associated with a 2.5 g reduction in infant’s birth weight (95% CI −4.8 to −0.3) but was not associated with the risk of small weight for GA. In contrast, although not significant, a 17% reduction in the risk of large weight for GA was observed with increasing sports and exercise. Furthermore, in women with subsequent pre-eclampsia (but not normotensive or hypertensive women), each 1 MET/hours/week increment spent in any vigorous exercise in the first trimester reduced the infant’s birth weight by 19.8 g (95% CI −35.2 to −4.3). Conclusions Pregnant women with higher sports and exercise levels in the first trimester delivered infants with a lower birth weight. The risk of reducing infant’s birth weight with vigorous exercise in women who develop pre-eclampsia later in pregnancy requires evaluation.
Collapse
Affiliation(s)
- Michèle Bisson
- Department of Pediatrics, CHU de Qubec, Québec City, Canada.,Department of Kinesiology, Université Laval, Québec City, Canada
| | - Jordie Croteau
- Laboratory of Biostatistics, Centre de recherche de l'Institut universitaire en sante mentale de Quebec, Quebec, Canada
| | | | - Emmanuel Bujold
- Department of Obstetrics and Gynecology, CHU de Québec, Québec City, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, Universite de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Marc
- Department of Pediatrics, CHU de Qubec, Québec City, Canada
| |
Collapse
|
16
|
Oros D, Garcia-Simon R, Clemente J, Fabre E, Romero MA, Montañes A. Predictors of perinatal outcomes and economic costs for late-term induction of labour. Taiwan J Obstet Gynecol 2017; 56:286-290. [PMID: 28600035 DOI: 10.1016/j.tjog.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE We aimed to predict the perinatal outcomes and costs of health services following labour induction for late-term pregnancies. MATERIALS AND METHODS We conducted a cohort study of 245 women who underwent labour induction during their 41st week of gestation. The cervical condition was assessed upon admission using the Bishop score and ultrasound cervical length measurements. We estimated the direct costs of labour induction, and a predictive model for perinatal outcomes was constructed using the decision tree analysis algorithm and a logit model. RESULTS A very unfavourable Bishop score at admission (Bishop score <2) (OR, 3.43 [95% CI, 1.77-6.59]), and a history of previous caesarean section (OR, 7.72 [95% CI, 2.43-24.43]) or previous vaginal delivery (OR, 0.24 [95% CI, 0.09-0.58]) were the only variables with predictive capacity for caesarean section in our model. The mean cost of labour induction was €3465.56 (95% confidence interval [CI], 3339.53-3591.58). Unfavourable Bishop scores upon admission and no history of previous deliveries significantly increased the cost of labour induction. Both of these criteria significantly predicted the likelihood of a caesarean section in the decision tree analysis. CONCLUSION The cost of labour induction mostly depends on the likelihood of successful trial of labour. Combined use of the Bishop score and previous vaginal or caesarean deliveries improves the ability to predict the likelihood of a caesarean section and the economic costs associated with labour induction for late-term pregnancies. This information is useful for patient counselling.
Collapse
Affiliation(s)
- Daniel Oros
- Instituto de Investigación Sanitaria de Aragón, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - Raquel Garcia-Simon
- Instituto de Investigación Sanitaria de Aragón, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Jesús Clemente
- Faculty of Economics and Business, University of Zaragoza, Spain
| | - Ernesto Fabre
- Instituto de Investigación Sanitaria de Aragón, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Manuel Angel Romero
- Instituto de Investigación Sanitaria de Aragón, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Antonio Montañes
- Faculty of Economics and Business, University of Zaragoza, Spain
| |
Collapse
|
17
|
Wessberg A, Lundgren I, Elden H. Being in limbo: Women's lived experiences of pregnancy at 41 weeks of gestation and beyond - A phenomenological study. BMC Pregnancy Childbirth 2017; 17:162. [PMID: 28578685 PMCID: PMC5457570 DOI: 10.1186/s12884-017-1342-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, the prevalence of post term pregnancy (PTP) is about 5-10%, but the rate varies considerably between and within countries. PTP is defined as a pregnancy ≥294 days, but the definition is arbitrary. Many studies focusing on the prevalence, risks and management of PTP include pregnancies ≥41 gestational weeks (GW). However, qualitative interview studies concerning women's experiences of PTP are lacking. Therefore, the aim of this study was to describe women's lived experiences of a pregnancy ≥41 GW. METHOD The study has a lifeworld research approach. Individual in-depth interviews were conducted from August 2013 to September 2014 with 10 healthy women with an expected normal pregnancy at GW 41 + 1-6 days in Gothenburg, Sweden. Interviews were conducted at the antenatal clinic or in the woman's home, depending on her preference. Data were analysed with a phenomenological reflective lifeworld approach. RESULT The essence of women's experiences of a pregnancy at GW ≥ 41 was described as being in limbo, a void characterised by contradictions related to time, giving birth and the condition. Exceeding the estimated date of childbirth implied a period of up to 2 weeks that was not expected. The contradictory aspect was the notion that time passed both slowly and quickly. Negative feelings dominated and increased over time. The women experienced difficulty due to not being in complete control, while at the same time finding it a beneficial experience. Health care professionals focused solely on the due date, while the women felt neither seen nor acknowledged. Lack of information led to searches in social media. Previously, they had trusted the body's ability to give birth, but this trust diminished after GW 41 + 0. In this state of limbo, the women became more easily influenced by people around them, while in turn influencing others. CONCLUSIONS Being in limbo represents a contradictory state related to time and process of giving birth, when women need to be listened to by healthcare professionals. An understanding of the importance of different information sources, such as family and friends, is necessary. It is vital that women are seen and acknowledged by midwives at the antenatal clinics. In addition, they should be asked how they experience waiting for the birth in order to create a sense of trust and confidence in the process.
Collapse
Affiliation(s)
- Anna Wessberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden. .,Sahlgrenska University Hospital, Diagnosvägen 15, SE-416 85, Gothenburg, Sweden.
| | - Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Sahlgrenska University Hospital, Diagnosvägen 15, SE-416 85, Gothenburg, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Sahlgrenska University Hospital, Diagnosvägen 15, SE-416 85, Gothenburg, Sweden
| |
Collapse
|
18
|
Post-term surveillance and birth outcomes in South Asian-born compared with Australian-born women. J Perinatol 2017; 37:139-143. [PMID: 27929532 DOI: 10.1038/jp.2016.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 09/01/2016] [Accepted: 09/09/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if apparently healthy post-term South Asian-born (SA) women were more likely to have abnormal post-term fetal surveillance than Australian- and New Zealand-born (AUS/NZ) women, whether those abnormalities were associated with increased rates of obstetric intervention and adverse perinatal outcomes, and whether SA women and their babies were at higher risk of adverse outcomes in the post-term period irrespective of their post-term surveillance outcomes. STUDY DESIGN Post-term surveillance and perinatal outcomes of 145 SA and 272 AUS/NZ nulliparous women with a singleton post-term pregnancy were compared in a retrospective multicentre cohort analysis. RESULTS Post-term SA women were not significantly more likely to have a low amniotic fluid index (AFI) than AUS/NZ women. However, they were nearly four times more likely (odds ratio 3.75; 95% CI 1.49-9.44) to have an abnormal CTG (P=0.005). Irrespective of maternal region of birth having an abnormal cardiotocography (CTG) or AFI was not associated with adverse intrapartum or perinatal outcomes. However, post-term SA women were significantly more likely than AUS/NZ women to have intrapartum fetal compromise (P=0.03) and an intrapartum cesarean section (P=0.002). Babies of SA women were more also significantly likely to be admitted to the Special Care Nursery or Neonatal Intensive Care Unit (P=0.02). CONCLUSION Post-term SA women experience higher rates of fetal compromise (antenatal and intrapartum) and obstetric intervention than AUS/NZ women. Irrespective of maternal region of birth an abnormal CTG or AFI was not predictive of adverse outcomes.
Collapse
|
19
|
Reddy M, Wallace EM, Mockler JC, Stewart L, Knight M, Hodges R, Skinner S, Davies-Tuck M. Maternal Asian ethnicity and obstetric intrapartum intervention: a retrospective cohort study. BMC Pregnancy Childbirth 2017; 17:3. [PMID: 28056853 PMCID: PMC5217270 DOI: 10.1186/s12884-016-1187-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal ethnicity is a recognized risk factor for stillbirth, such that South Asian women have higher rates than their Caucasian counterparts. However, whether maternal ethnicity is a risk factor for intrapartum outcomes is less clear. The aim of this study is to explore associations between maternal country of birth, operative vaginal delivery and emergency cesarean section, and to identify possible mechanisms underlying any such associations. METHODS We performed a retrospective cohort study of singleton term births among South Asian, South East/East Asian and Australian/New Zealand born women at an Australian tertiary hospital in 2009-2013. The association between maternal country of birth, operative vaginal birth and emergency cesarean was assessed using multivariate logistic regression. RESULTS Of the 31,932 births, 54% (17,149) were to Australian/New Zealand-born women, 25% (7874) to South Asian, and 22% (6879) to South East/East Asian born women. Compared to Australian/New Zealand women, South Asian and South East/East Asian women had an increased rate of both operative vaginal birth (OR 1.43 [1.30-1.57] and 1.22 [1.11-1.35] respectively, p < 0.001 for both) and emergency cesarean section (OR 1.67 [1.53-1.82] and 1.16 [1.04-1.26] respectively, p < 0.001 and p = 0.007 respectively). While prolonged labor was the predominant reason for cesarean section among Australian/New Zealand and South East/East Asian women, fetal compromise accounted for the majority of operative births in South Asian women. CONCLUSION South Asian and South East/East Asian women experience higher rates of both operative vaginal birth and cesarean section in comparison to Australian/New Zealand women, independent of other risk factors for intrapartum interventions.
Collapse
Affiliation(s)
- Maya Reddy
- Monash Health, Monash Medical Centre, Clayton, Australia. .,Department of Obstetrics and Gynecology, Monash University, Level 5, Monash Medical Centre, Clayton, VIC, 3168, Australia.
| | - Euan M Wallace
- Monash Health, Monash Medical Centre, Clayton, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia.,Department of Obstetrics and Gynecology, Monash University, Level 5, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Joanne C Mockler
- Monash Health, Monash Medical Centre, Clayton, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
| | - Lynne Stewart
- Monash Health, Monash Medical Centre, Clayton, Australia
| | | | - Ryan Hodges
- Monash Health, Monash Medical Centre, Clayton, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia.,Department of Obstetrics and Gynecology, Monash University, Level 5, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Sasha Skinner
- Monash Health, Monash Medical Centre, Clayton, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia.,Department of Obstetrics and Gynecology, Monash University, Level 5, Monash Medical Centre, Clayton, VIC, 3168, Australia
| |
Collapse
|
20
|
Duro Gómez J, Garrido Oyarzún MF, Rodríguez Marín AB, de la Torre González AJ, Arjona Berral JE, Castelo-Branco C. Vaginal misoprostol and cervical ripening balloon for induction of labor in late-term pregnancies. J Obstet Gynaecol Res 2016; 43:87-91. [DOI: 10.1111/jog.13193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Camil Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer; University of Barcelona; Barcelona Spain
| |
Collapse
|
21
|
Ying H, Tang YP, Bao YR, Su XJ, Cai X, Li YH, Wang DF. Maternal TSH level and TPOAb status in early pregnancy and their relationship to the risk of gestational diabetes mellitus. Endocrine 2016; 54:742-750. [PMID: 27423217 DOI: 10.1007/s12020-016-1022-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/13/2016] [Indexed: 01/13/2023]
Abstract
Subclinical hypothyroidism is common in pregnant women and often related to adverse pregnancy outcomes, but its relationship with gestational diabetes remains controversial. In particular, the impact of thyroperoxidase antibodies status on the relationship between subclinical hypothyroidism and gestational diabetes is not clear. We investigated the association between combined thyroid stimulating hormone (TSH) level and thyroperoxidase antibodies status in early pregnancy (<20 weeks of gestation) and gestational diabetes mellitus. A total of 7084 pregnant women met the inclusion criteria, which included thyroperoxidase antibodies-positive subclinical hypothyroidism [TSH(H)TPOAb(+)] (n = 78), thyroperoxidase antibodies-negative subclinical hypothyroidism [TSH(H)TPOAb(-)] (n = 281), thyroperoxidase antibodies-positive euthyroidism [TSH(N)TPOAb(+)] (n = 648), and thyroperoxidase antibodies-negative euthyroidism [TSH(N)TPOAb(-)] (n = 6077). Of the 7084 cases included in our study, 1141 cases were diagnosed with gestational diabetes mellitus at 24-28 weeks of pregnancy. The prevalence of gestational diabetes mellitus in TSH(N)TPOAb(-), TSH(H)TPOAb(-), TSH(N)TPOAb(+), and TSH(H)TPOAb(+) was 14.65, 19.57, 24.85, and 46.15 %, respectively. Compared with TSH(N)TPOAb(-) women, the risk of gestational diabetes mellitus was increased in all other groups of women in early pregnancy. After dividing early pregnancy into first and second trimesters, we found that TSH(H)TPOAb(-) women in the first trimester do not show this increase. Our study suggests that subclinical hypothyroidism and thyroperoxidase antibodies-positive euthyroidism in early pregnancy are associated with an increased risk of gestational diabetes mellitus.
Collapse
Affiliation(s)
- Hao Ying
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 Gaoke Road, Shanghai, 201204, China.
| | - Yu-Ping Tang
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 Gaoke Road, Shanghai, 201204, China
| | - Yi-Rong Bao
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 Gaoke Road, Shanghai, 201204, China
| | - Xiu-Juan Su
- Department of Women and Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 Gaoke Road, Shanghai, 201204, China
| | - XueYa Cai
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Saunders Research Building 4208, Rochester, NY, 14642, USA
| | - Yu-Hong Li
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 Gaoke Road, Shanghai, 201204, China
| | - De-Fen Wang
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 Gaoke Road, Shanghai, 201204, China
| |
Collapse
|
22
|
Frank R, Garfinkle J, Oskoui M, Shevell MI. Clinical profile of children with cerebral palsy born term compared with late- and post-term: a retrospective cohort study. BJOG 2016; 124:1738-1745. [DOI: 10.1111/1471-0528.14240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- R Frank
- Faculty of Medicine; McGill University; Montreal Quebec Canada
| | - J Garfinkle
- Department of Pediatrics; Faculty of Medicine, McGill University; Montreal Quebec Canada
| | - M Oskoui
- Department of Pediatrics; Faculty of Medicine, McGill University; Montreal Quebec Canada
- Department of Neurology & Neurosurgery; Faculty of Medicine, McGill University; Montreal Quebec Canada
| | - MI Shevell
- Department of Pediatrics; Faculty of Medicine, McGill University; Montreal Quebec Canada
- Department of Neurology & Neurosurgery; Faculty of Medicine, McGill University; Montreal Quebec Canada
| |
Collapse
|
23
|
Chauveau L, Di Bartolomeo A, Noblot E, Fanget C, Raia-Barjat T, Chauleur C. [Use of fetal movements counting for prolonged pregnancy: A comparative preliminary cohort study before and after implementation of an information brochure]. J Gynecol Obstet Hum Reprod 2016; 45:760-766. [PMID: 27006008 DOI: 10.1016/j.jgyn.2015.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/04/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Compare the number of consultations with the consultation's delay in relation with the sensation of decrease active fetal movements (AFM) in case of late pregnancy, according to the fact if the patients use or not the AFM's count. MATERIALS AND METHODS We have compared a "control" group made up of 160 patients who received a classic information and observation (from December 18th, 2013 to February 28th, 2014) versus an "educated" group made up of 160 patients who have been educated to the AFM count (from March 1st, 2014 to August 12th, 2014). RESULTS The consultations for AFM decrease, were significantly more frequent in the "control" group than in the "educated" group (36 versus 8, P=0.0009). Inducing labor due to AFM reduction was not statistically different between both groups (13 patients in the "educated group" versus 7 patients in the "control" group P=0.97). CONCLUSION Learning a count method seems to decrease the number of consultations for AFM reduction without increasing the perinatal morbidity but maybe at the cost of an increase of obstetric interventions.
Collapse
Affiliation(s)
- L Chauveau
- Département de gynécologie, obstétrique et médecine de la reproduction, CHU Saint-Étienne, université de Saint-Étienne-Jean-Monnet, 42055 Saint-Étienne cedex 2, France
| | - A Di Bartolomeo
- Département de gynécologie, obstétrique et médecine de la reproduction, CHU Saint-Étienne, université de Saint-Étienne-Jean-Monnet, 42055 Saint-Étienne cedex 2, France
| | - E Noblot
- Département de gynécologie, obstétrique et médecine de la reproduction, CHU Saint-Étienne, université de Saint-Étienne-Jean-Monnet, 42055 Saint-Étienne cedex 2, France
| | - C Fanget
- Département de gynécologie, obstétrique et médecine de la reproduction, CHU Saint-Étienne, université de Saint-Étienne-Jean-Monnet, 42055 Saint-Étienne cedex 2, France
| | - T Raia-Barjat
- Département de gynécologie, obstétrique et médecine de la reproduction, CHU Saint-Étienne, université de Saint-Étienne-Jean-Monnet, 42055 Saint-Étienne cedex 2, France; EA 3065, groupe de recherche sur la thrombose, université Jean-Monnet, 42100 Saint-Étienne, France.
| | - C Chauleur
- Département de gynécologie, obstétrique et médecine de la reproduction, CHU Saint-Étienne, université de Saint-Étienne-Jean-Monnet, 42055 Saint-Étienne cedex 2, France; EA 3065, groupe de recherche sur la thrombose, université Jean-Monnet, 42100 Saint-Étienne, France
| |
Collapse
|
24
|
Wahabi H, Fayed A, Esmaeil S, Alzeidan R, Elawad M, Tabassum R, Hansoti S, Magzoup ME, Al-Kadri H, Elsherif E, Al-Mandil H, Al-Shaikh G, Zakaria N. Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile. PLoS One 2016; 11:e0150297. [PMID: 26937965 PMCID: PMC4777404 DOI: 10.1371/journal.pone.0150297] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/11/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant. METHODS A multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated. FINDINGS The total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%. CONCLUSION Pregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world.
Collapse
Affiliation(s)
- Hayfaa Wahabi
- Chair of Evidence Based Health Care and Knowledge Translation, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Community and Family Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amel Fayed
- Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Samia Esmaeil
- Chair of Evidence Based Health Care and Knowledge Translation, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rasmieh Alzeidan
- Chair of Evidence Based Health Care and Knowledge Translation, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mamoun Elawad
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rabeena Tabassum
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shehnaz Hansoti
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohie Edein Magzoup
- Department of Medical Education, College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hanan Al-Kadri
- Department of Medical Education, College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Obstetrics and Gynecology, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
| | - Elham Elsherif
- Department of Obstetrics and Gynecology, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
| | - Hazim Al-Mandil
- Department of Obstetrics and Gynecology, King Khaled University Hospital, Riyadh, Saudi Arabia
| | - Ghadeer Al-Shaikh
- Department of Obstetrics and Gynecology, King Khaled University Hospital, Riyadh, Saudi Arabia
| | - Nasria Zakaria
- Department of Medical Informatics and E-Learning Unit, Medical Education Department, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
25
|
Riddell CA, Hutcheon JA, Dahlgren LS. Differences in obstetric care among nulliparous First Nations and non-First Nations women in British Columbia, Canada. CMAJ 2015; 188:E36-E43. [PMID: 26527824 DOI: 10.1503/cmaj.150223] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Canada's Aboriginal population faces significantly higher rates of stillbirth and neonatal and postnatal death than those seen in the general population. The objective of this study was to compare indicators of obstetric care quality and use of obstetric interventions between First Nations and non-First Nations mothers in British Columbia, Canada. METHODS We linked obstetrical medical records with the First Nations Client File for all nulliparous women who delivered single infants in British Columbia from 1999 to 2011. Using logistic regression models, we examined differences in the proportion of women who received services aligned with best practice guidelines, as well as the overall use of obstetric interventions among First Nations mothers compared with the general population, controlling for geographic barriers (distance to hospital) and other relevant confounders. RESULTS During the study period, 215,993 single births occurred in nulliparous women in British Columbia, 9152 of which were to members of our First Nations cohort. First Nations mothers were less likely to have early ultrasonography (adjusted risk difference = 10.2 fewer women per 100 deliveries [95% confidence interval {CI} -11.3 to -9.3]), to have at least 4 antenatal care visits (3.6 fewer women per 100 deliveries [95% CI -4.6 to -2.6]), and to undergo labour induction after prolonged (> 24 hours) prelabour rupture of membranes (-5.9 [95% CI -11.8 to 0.1]) or at post-dates gestation (-10.6 [95% CI -13.8 to -7.5]). Obstetric interventions including epidural, labour induction, instrumental delivery and cesarean delivery were used less often in First Nations mothers. INTERPRETATION We identified differences in the obstetric care received by First Nations mothers compared with the general population. Such differences warrant further investigation, given increases in perinatal mortality that are consistently shown and that may be a downstream consequence of differences in care.
Collapse
Affiliation(s)
- Corinne A Riddell
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
| | - Jennifer A Hutcheon
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
| | - Leanne S Dahlgren
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
| |
Collapse
|
26
|
Ramya V, Ghose S, Pallavee P. Membrane Sweeping for Vaginal Birth after Caesarean Section and its Outcome -A Comparative Study. J Clin Diagn Res 2015; 9:QC01-3. [PMID: 26435999 DOI: 10.7860/jcdr/2015/11161.6306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 05/08/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sweeping of membrane is a method of induction of labour. This is used to avoid prolonged labour. However, there is paucity of data about the use of this method for induction of labour and reducing prolonged labour in pregnancy with previous caesarean section. This study is an effort to find the effect of membrane sweeping in previous caesarean section. OBJECTIVE To initiate labour in previous LSCS patients by membrane sweeping and maternal outcome. STUDY SETTING This prospective randomised control study was conducted in Mahatma Gandhi Medical College and Research Institute, Puducherry between January 2011 to June 2012. MATERIALS AND METHODS Seventy five women were randomly assigned to membrane sweeping and seventy five to control. In study group serial membrane sweeping was done once weekly from 39 weeks of gestation until the onset of labour up to 41weeks of gestation. In control group, no intervention up to 41 weeks of gestation. All the cases were monitored by biophysical profile. OUTCOME MEASURES The primary outcomes measured were number of patients who had onset of labour. The secondary outcome included the successful vaginal delivery, number of membrane sweeping to initiate labour, sweeping to delivery interval and amount of oxytocin required. RESULTS The onset of labour in study group was 61.3% similar in control group 64% with p 0.736. The mean interval from sweeping to labour onset was 50.15±8 hours. The rate of VBAC was 17.3% in study group in compared to 18.7% in control group and LSCS was 82.7% in study group in compared to 81.3% in control group respectively. The mean gestation age at delivery 40±0.56 weeks for study group compared with 39.92±0.55 weeks for control group. CONCLUSION Although membrane sweeping is an easy way of inducing labour, present study failed to demonstrate its beneficial effect on obstetrical outcome.
Collapse
Affiliation(s)
- V Ramya
- Senior Resident, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute , Pillaiyarkuppam, Puducherry, India
| | - Seetesh Ghose
- Professor and Head, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute , Pillaiyarkuppam, Puducherry, India
| | - P Pallavee
- Associate Professor, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute , Pillaiyarkuppam, Puducherry, India
| |
Collapse
|
27
|
Roth DE, Gernand AD, Morris SK, Pezzack B, Islam MM, Dimitris MC, Shanta SS, Zlotkin SH, Willan AR, Ahmed T, Shah PS, Murphy KE, Weksberg R, Choufani S, Shah R, Al Mahmud A. Maternal vitamin D supplementation during pregnancy and lactation to promote infant growth in Dhaka, Bangladesh (MDIG trial): study protocol for a randomized controlled trial. Trials 2015; 16:300. [PMID: 26169781 PMCID: PMC4499946 DOI: 10.1186/s13063-015-0825-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/26/2015] [Indexed: 12/27/2022] Open
Abstract
Background Vitamin D regulates bone mineral metabolism and skeletal development. Some observational studies have suggested that prenatal vitamin D deficiency increases the risk of adverse pregnancy and/or birth outcomes; however, there is scant evidence from controlled trials, leading the World Health Organization to advise against routine vitamin D supplementation in pregnancy. Importantly, little is known about the effect of maternal vitamin D status on infant linear growth in communities in South Asia where stunting is highly prevalent and maternal-infant vitamin D status is commonly suboptimal. Methods/Design The Maternal Vitamin D for Infant Growth study is a randomized, placebo-controlled, dose-ranging trial of maternal vitamin D supplementation during pregnancy and lactation in Dhaka, Bangladesh. The primary aims are to estimate (1) the effect of maternal prenatal oral vitamin D3 supplementation (4200 IU/wk, 16,800 IU/wk, or 28,000 IU/wk, administered as weekly doses) versus placebo on infant length at 1 year of age and (2) the effect of maternal postpartum oral vitamin D3 supplementation (28,000 IU/wk) versus placebo on length at 1 year of age among infants born to women who received vitamin D 28,000 IU/wk during pregnancy. Generally healthy pregnant women (n = 1300) in the second trimester (17–24 weeks of gestation) are randomized to one of five parallel arms: placebo 4200 IU/wk, 16,800 IU/wk, or 28,000 IU/wk in the prenatal period and placebo in the postpartum period or 28,000 IU/wk in the prenatal period and 28,000 IU/wk in the postpartum period. Household- and clinic-based follow-up of mother-infant pairs is conducted weekly by trained personnel until 26 weeks postpartum and every 3 months thereafter. The primary trial outcome measure is length for age z-score at 1 year of age. Anthropometric measurements, clinical information, and biological specimens collected at scheduled intervals will enable the assessment of a range of maternal, perinatal, and infant outcomes. Discussion The role of vitamin D in maternal and infant health remains unresolved. This trial is expected to contribute unique insights into the effects of improving maternal-infant vitamin D status in a low-income setting where stunting and adverse perinatal outcomes represent significant public health burdens. Trial registration ClinicalTrials.gov identifier: NCT01924013. Registered on 13 August 2013 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0825-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Daniel E Roth
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Alison D Gernand
- Department of Nutritional Sciences, Penn State University, 110 Chandlee Laboratory, University Park, PA, USA.
| | - Shaun K Morris
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Brendon Pezzack
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - M Munirul Islam
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Michelle C Dimitris
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Shaila S Shanta
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Stanley H Zlotkin
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Andrew R Willan
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Prakesh S Shah
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Division of Neonatology, Mt. Sinai Hospital, 600 University Avenue, Toronto, ON, Canada.
| | - Kellie E Murphy
- Department of Obstetrics and Gynecology, University of Toronto and Mt. Sinai Hospital, 600 University Avenue, Toronto, ON, Canada.
| | - Rosanna Weksberg
- Department of Paediatrics, University of Toronto and the Centre for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Genetics and Genome Biology, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Sanaa Choufani
- Genetics and Genome Biology, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.
| | - Rashed Shah
- Department of Health and Nutrition, Save the Children USA, 2000 L Street NW, Suite 500, Washington, DC, USA.
| | - Abdullah Al Mahmud
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research (ICDDR,B), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| |
Collapse
|
28
|
Xu Y, Lek N, Cheung YB, Biswas A, Su LL, Kwek KYC, Yeo GSH, Soh SE, Saw SM, Gluckman PD, Chong YS. Unconditional and conditional standards for fetal abdominal circumference and estimated fetal weight in an ethnic Chinese population: a birth cohort study. BMC Pregnancy Childbirth 2015; 15:141. [PMID: 26108619 PMCID: PMC4480986 DOI: 10.1186/s12884-015-0569-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/27/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diagnosis of intrauterine fetal growth restriction and prediction of small-for-gestation age are often based on fetal abdominal circumference or estimated fetal weight (EFW). The present study aims to create unconditional (cross-sectional) and conditional (longitudinal) standards of fetal abdominal circumference and EFW for use in an ethnic Chinese population. METHODS In the Growing Up in Singapore Towards healthy Outcome (GUSTO) birth cohort study in Singapore, fetal biometric measurements were obtained at enrolment to antenatal care (11-12 weeks) and up to three more time points during pregnancy. Singleton pregnancies with a healthy profile defined by maternal, pregnancy and fetal characteristics and birth outcomes were selected for this analysis. The Hadlock algorithm was used to calculate EFW. Mixed effects model was used to establish unconditional and conditional standards in z-scores and percentiles for both genders pooled and for each gender separately. RESULTS A total of 313 women were included, of whom 294 had 3 and 19 had 2 ultrasound scans other than the gestational age dating scan. Fetal abdominal circumference showed a roughly linear trajectory from 18 to 36 weeks of gestation, while EFW showed an accelerating trajectory. Gender differences were more pronounced in the 10(th) percentile than the 50(th) or 90(th) percentiles. As compared to other published charts, this population showed growth trajectories that started low but caught up at later gestations. CONCLUSIONS Unconditional and conditional standards for monitoring fetal size and fetal growth in terms of abdominal circumference and EFW are available for this ethnic-Chinese population. Electronic spreadsheets are provided for their implementation.
Collapse
Affiliation(s)
- Ying Xu
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore.
| | - Ngee Lek
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore.
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Yin Bun Cheung
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore.
- Department of International Health, University of Tampere, Tampere, Finland.
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
| | - Kenneth Y C Kwek
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore.
| | - George S H Yeo
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Shu-E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore.
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Yap-Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore.
| |
Collapse
|
29
|
Hutcheon JA, Strumpf EC, Harper S, Giesbrecht E. Maternal and neonatal outcomes after implementation of a hospital policy to limit low-risk planned caesarean deliveries before 39 weeks of gestation: an interrupted time-series analysis. BJOG 2015; 122:1200-6. [PMID: 25851865 DOI: 10.1111/1471-0528.13396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the extent to which implementing a hospital policy to limit planned caesarean deliveries before 39 weeks of gestation improved neonatal health, maternal health, and healthcare costs. DESIGN Retrospective cohort study. SETTING British Columbia Women's Hospital, Vancouver, Canada, in the period 2005-2012. POPULATION Women with a low-risk planned repeat caesarean delivery. METHODS An interrupted time series design was used to evaluate the policy to limit planned caesarean deliveries before 39 weeks of gestation, introduced on 1 April 2008. MAIN OUTCOME MEASURES Composite adverse neonatal health outcome (respiratory morbidity, 5-minute Apgar score of <7, neonatal intensive care unit admission, mortality), postpartum haemorrhage, obstetrical wound infection, out-of-hour deliveries, length of stay, and healthcare costs. RESULTS Between 2005 and 2008, 60% (1204/2021) of low-risk planned caesarean deliveries were performed before 39 weeks of gestation. After the introduction of the policy, the proportion of planned caesareans dropped by 20 percentage points (adjusted risk difference of 20 fewer cases per 100 deliveries; 95% CI -25.8, -14.3) to 41% (1033/2518). The policy had no detectable impact on adverse neonatal outcomes (2.2 excess cases per 100; 95% CI -0.4, 4.8), maternal complications, or healthcare costs, but increased the risk of out-of-hours delivery from 16.2 to 21.1% (adjusted risk difference 6.3 per 100; 95% CI 1.6, 10.9). CONCLUSIONS We found little evidence that a hospital policy to limit planned caesareans before 39 weeks of gestation reduced adverse neonatal outcomes. Hospital administrators intending to introduce such policies should anticipate, and plan for, modest increases in out-of-hours and emergency-timing.
Collapse
Affiliation(s)
- J A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - E C Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, Montréal, QC, Canada.,Department Economics, McGill University, Montréal, QC, Canada
| | - S Harper
- Department of Epidemiology, Biostatistics and Occupational Health, Montréal, QC, Canada
| | - E Giesbrecht
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
30
|
Vinturache AE, McDonald S, Slater D, Tough S. Perinatal outcomes of maternal overweight and obesity in term infants: a population-based cohort study in Canada. Sci Rep 2015; 5:9334. [PMID: 25791339 PMCID: PMC4366803 DOI: 10.1038/srep09334] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/24/2015] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to assess the impact of increased pre-pregnancy maternal body mass index (BMI) on perinatal outcomes in term, singleton pregnancies who received prenatal care in community-based practices. The sample of 1996 infants included in the study was drawn from the All Our Babies Study, a prospective pregnancy cohort from Calgary. Multivariable logistic regression explored the relationship between the main outcomes, infant birth weight, Apgar score, admission to neonatal intensive care (NICU) and newborn duration of hospitalization, and BMI prior to pregnancy. Approximately 10% of the infants were macrosoms, 1.5% had a low Apgar score (<7 at 5 min), 6% were admitted to intensive care and 96% were discharged within 48 h after delivery. Although the infants of overweight and obese women were more likely to have increased birth weight as compared to infants of normal weight women, there were no differences in Apgar score, admission to NICU, or length of postnatal hospital stay among groups. This study suggests that in otherwise healthy term, singleton pregnancies, obesity does not seem to increase the risk of severe fetal impairment, neonatal admission to intensive care or duration of postnatal hospitalization.
Collapse
Affiliation(s)
- Angela Elena Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Sheila McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Donna Slater
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| |
Collapse
|
31
|
Kortekaas JC, Bruinsma A, Keulen JKJ, van Dillen J, Oudijk MA, Zwart JJ, Bakker JJH, de Bont D, Nieuwenhuijze M, Offerhaus PM, van Kaam AH, Vandenbussche F, Mol BWJ, de Miranda E. Effects of induction of labour versus expectant management in women with impending post-term pregnancies: the 41 week - 42 week dilemma. BMC Pregnancy Childbirth 2014; 14:350. [PMID: 25338555 PMCID: PMC4288619 DOI: 10.1186/1471-2393-14-350] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Post-term pregnancy, a pregnancy exceeding 294 days or 42 completed weeks, is associated with increased perinatal morbidity and mortality and is considered a high-risk condition which requires specialist surveillance and induction of labour. However, there is uncertainty on the policy concerning the timing of induction for post-term pregnancy or impending post-term pregnancy, leading to practice variation between caregivers. Previous studies on induction at or beyond 41 weeks versus expectant management showed different results on perinatal outcome though conclusions in meta-analyses show a preference for induction at 41 weeks. However, interpretation of the results is hampered by the limited sample size of most trials and the heterogeneity in design. Most control groups had a policy of awaiting spontaneous onset of labour that went far beyond 42 weeks, which does not reflect usual care in The Netherlands where induction of labour at 42 weeks is the regular policy. Thus leaving the question unanswered if induction at 41 weeks results in better perinatal outcomes than expectant management until 42 weeks. METHODS/DESIGN In this study we compare a policy of labour induction at 41 + 0/+1 weeks with a policy of expectant management until 42 weeks in obstetrical low risk women without contra-indications for expectant management until 42 weeks and a singleton pregnancy in cephalic position. We will perform a multicenter randomised controlled clinical trial. Our primary outcome will be a composite outcome of perinatal mortality and neonatal morbidity. Secondary outcomes will be maternal outcomes as mode of delivery (operative vaginal delivery and Caesarean section), need for analgesia and postpartum haemorrhage (≥1000 ml). Maternal preferences, satisfaction, wellbeing, pain and anxiety will be assessed alongside the trial. DISCUSSION This study will provide evidence for the management of pregnant women reaching a gestational age of 41 weeks. TRIAL REGISTRATION Dutch Trial Register (Nederlands Trial Register): NTR3431. Registered: 14 May 2012.
Collapse
Affiliation(s)
- Joep C Kortekaas
- />Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- />Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Aafke Bruinsma
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Judit KJ Keulen
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeroen van Dillen
- />Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martijn A Oudijk
- />Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, the Netherlands
| | - Joost J Zwart
- />Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - Jannet JH Bakker
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Dokie de Bont
- />Midwifery practice ‘het Verloskundig Huys’, Zwolle, the Netherlands
| | - Marianne Nieuwenhuijze
- />Research Center for Midwifery Science, Faculty Midwifery Education & Studies Maastricht, ZUYD University, Heerlen, the Netherlands
| | - Pien M Offerhaus
- />KNOV (Royal Dutch Organisation for Midwives), Utrecht, the Netherlands
| | - Anton H van Kaam
- />Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frank Vandenbussche
- />Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ben Willem J Mol
- />The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, 5000 SA Australia
| | - Esteriek de Miranda
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
32
|
Hutcheon JA, Joseph KS, Kinniburgh B, Lee L. Maternal, care provider, and institutional-level risk factors for early term elective repeat cesarean delivery: a population-based cohort study. Matern Child Health J 2014; 18:22-28. [PMID: 23400680 PMCID: PMC3889674 DOI: 10.1007/s10995-013-1229-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To identify maternal, care provider, and institutional-level risk factors for early term (37-38 weeks) elective repeat cesarean delivery in a population-based cohort. Retrospective cohort study of women in the British Columbia (BC) Perinatal Data Registry, BC, Canada, 2008-2011, with an elective repeat cesarean delivery at term. Absolute percent differences (risk differences) in early term delivery rates were calculated according to maternal characteristics, type of care provider, calendar time (day of the week, time of year), and annual institutional obstetrical volume. Of the 7,687 elective repeat cesareans at term in BC, 55 % occurred before 39 + 0 weeks. Early term delivery was significantly more common with multiple previous cesareans [8.2 percentage points (95 % CI 5.5, 10.9) for 2 previous cesareans, 11.3 (95 % CI 5.1, 17.4) for 3 or more previous cesareans], obesity [6.7 percentage points (95 % CI 1.6, 11.7)], and a hospital obstetrical volume <2,500 deliveries per year. Type of care provider and calendar time were not significant risk factors for early term delivery. Early term elective repeat cesarean was common across a wide range of maternal, care provider, and institutional characteristics, suggesting that most obstetrical care settings would benefit from quality-improvement programs to reduce elective repeat cesarean deliveries before 39 weeks. A better understanding of the risks and benefits of early term delivery among obese women and women with multiple previous cesareans is needed given the higher rates of early term delivery observed in these women.
Collapse
Affiliation(s)
- Jennifer A Hutcheon
- Department of Obstetrics & Gynaecology, BC Children's & Women's Hospital, University of British Columbia, Shaughnessy E421A, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada.
| | - K S Joseph
- Department of Obstetrics & Gynaecology, BC Children's & Women's Hospital, University of British Columbia, Shaughnessy E421A, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Brooke Kinniburgh
- Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Lily Lee
- Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada
| |
Collapse
|
33
|
Kiettisanpipop P, Phupong V. Intrapartum and neonatal outcome of screening non-stress test (NST) compared with no screening NST in healthy women at 40-40 (+6) weeks of gestation. J Obstet Gynaecol Res 2014; 41:50-4. [PMID: 25160054 DOI: 10.1111/jog.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 05/01/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to compare the intrapartum and neonatal outcome between screening non-stress test (NST) and no screening NST groups in healthy pregnant women at a gestational age of 40-40(+6) weeks. METHODS Healthy pregnant women, with a gestational age of 40-40(+6) weeks who had received antenatal care and delivered at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 1 July 2011 and 31 March 2013, were included in the study. The treatment group consisted of women who had had screening NST while no NST screening had been performed in the control group. The primary outcome was intrapartum and neonatal outcome, which included stillbirth, the incidence of non-reassuring fetal heart, neonatal morbidity (meconium aspiration, respiratory distress, neonatal asphyxia) and neonatal mortality. Secondary outcome was the cost-effectiveness of the NST screening. RESULTS A total of 460 healthy pregnant women with a gestational age of 40-40(+6) weeks were included in the study. There were 228 cases in the NST screening group and 232 cases in the no NST screening group. There was no significant difference in the incidence of stillbirth, non-reassuring fetal heart, neonatal morbidity (meconium aspiration, respiratory distress, neonatal asphyxia) and neonatal mortality. The cost of NST plus neonatal care was higher in the NST screening group than the no NST screening group. CONCLUSION Routine performing NST at the gestational age of 40-40(+6) weeks has no benefit in intrapartum and neonatal outcome.
Collapse
Affiliation(s)
- Patcharin Kiettisanpipop
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | |
Collapse
|
34
|
Hutcheon JA, Harper S, Strumpf EC, Lee L, Marquette G. Using inter-institutional practice variation to understand the risks and benefits of routine labour induction at 41(+0) weeks. BJOG 2014; 122:973-81. [PMID: 25041161 DOI: 10.1111/1471-0528.13007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the risks and benefits of routine labour induction at 41(+0) weeks' gestation for mother and newborn. DESIGN Population-based retrospective cohort study of inter-institutional variation in labour induction practices for women at or beyond 41(+0) weeks' gestation. POPULATION Women in British Columbia, Canada, who remained pregnant ≥41(+0) weeks and delivered at one of the province's 42 hospitals with >50 annual deliveries, 2008-2012 (n = 14,627). METHODS The proportion of women remaining pregnant a week or more past the expected delivery date who were induced at 41(+0) or 41(+1) weeks' gestation for an indication of 'post-dates' was calculated for each institution. We used instrumental variable analysis (using the institutional rate of labour induction at 41(+0) weeks as the instrument) to estimate the effect of labour induction on maternal and neonatal health outcomes. MAIN OUTCOME MEASURES Caesarean delivery, instrumental delivery, post-partum haemorrhage, 3rd or 4th degree lacerations, macrosomia, neonatal intensive care unit admission, and 5-minute Apgar score <7. RESULTS Institutional rates of labour induction at 41(+0) weeks ranged from 14.3 to 46%. Institutions with higher (≥30%) and average (20-29.9%) induction rates did not have significantly different rates of caesarean delivery, instrumental delivery, or other maternal or neonatal outcomes than institutions with lower induction rates (<20%). Instrumental variable analyses also demonstrated no significantly increased (or decreased) risk of caesarean delivery (0.69 excess cases per 100 pregnancies [95% CI -10.1, 11.5]), instrumental delivery (8.9 per 100 [95% CI -2.3, 20.2]), or other maternal or neonatal outcomes in women who were induced (versus not induced). CONCLUSIONS Within the current range of clinical practice, there was no evidence that differential use of routine induction at 41(+0) weeks affected maternal or neonatal health outcomes.
Collapse
Affiliation(s)
- J A Hutcheon
- Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada.,Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - E C Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Economics, McGill University, Montreal, Quebec, Canada
| | - L Lee
- Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - G Marquette
- Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada.,Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
35
|
Marquette GP, Hutcheon JA, Lee L. Predicting the spontaneous onset of labour in post-date pregnancies: a population-based retrospective cohort study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:391-399. [PMID: 24927290 DOI: 10.1016/s1701-2163(15)30584-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the probability of spontaneous onset of labour (SOL) among women with uncomplicated pregnancies who have reached 41+0 weeks and to examine the influence of maternal characteristics on this event. METHODS We conducted a population-based retrospective cohort study of women with uncomplicated singleton pregnancies in cephalic presentation between 41+0 and 42+0 weeks' gestation. Detailed clinical information was obtained from the British Columbia Perinatal Data Registry. We determined the time from 41+0 weeks to the exact day and time of SOL, pre-labour Caesarean section, or onset of labour following induction. A Kaplan-Meier curve was created to estimate the probability of SOL. A Cox regression model was used to assess the independent influence of maternal age, parity, BMI, and pregnancy weight gain on the SOL, and to assess the extent to which prediction of SOL could be individualized according to a woman's characteristics. RESULTS Among 15 253 women undelivered at 41+0 weeks, there was a 67.6% (95% CI 66.4% to 68.7%) chance of SOL by 41+6 weeks. Although SOL was statistically more likely in younger women, higher parity, lower BMI, and lower weight gain (P<0.01), the multivariable model's predictive ability was poor (c-statistic 0.56). CONCLUSION Maternal characteristics were not a strong determinant for successful individualized prediction of SOL in women with uncomplicated pregnancies reaching 41+0 weeks of gestation. Our population-based estimates of the daily occurrence of SOL can be used to inform discussions with women on when to offer induction of labour.
Collapse
Affiliation(s)
- Gerald P Marquette
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Perinatal Services British Columbia, Vancouver BC
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Perinatal Services British Columbia, Vancouver BC
| | - Lily Lee
- Perinatal Services British Columbia, Vancouver BC
| |
Collapse
|
36
|
McDonald SD, Machold CA, Marshall L, Kingston D. Documentation of guideline adherence in antenatal records across maternal weight categories: a chart review. BMC Pregnancy Childbirth 2014; 14:205. [PMID: 24927750 PMCID: PMC4065541 DOI: 10.1186/1471-2393-14-205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 05/28/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Documentation in medical records fulfills key functions, including management of care, communication, quality assurance and record keeping. We sought to describe: 1) rates of standard prenatal care as documented in medical charts, and given the higher risks with excess weight, whether this documentation varied among normal weight, overweight and obese women; and 2) adherence to obesity guidelines for obese women as documented in the chart. METHODS We conducted a chart review of 300 consecutive charts of women who delivered a live singleton at an academic tertiary centre from January to March 2012, computing Analysis of Variance and Chi Square tests. RESULTS The proportion of completed fields on the mandatory antenatal forms varied from 100% (maternal age) to 52.7% (pre-pregnancy body mass index). Generally, documentation of care was similar across all weight categories for maternal and prenatal genetic screening tests, ranging from 54.0% (documentation of gonorrhea/chlamydia tests) to 85.0% (documentation of anatomy scan). Documentation of education topics varied widely, from fetal movement in almost all charts across all weight categories but discussion of preterm labour in only 20.6%, 12.7% and 13.4% of normal weight, overweight and obese women's charts (p = 0.224). Across all weight categories, documentation of discussion of exercise, breastfeeding and pain management occurred in less than a fifth of charts. CONCLUSION Despite a predominance of excess weight in our region, as well as increasing perinatal risks with increasing maternal weight, weight-related issues and other elements of prenatal care were suboptimally documented across all maternal weight categories, despite an obesity guideline.
Collapse
Affiliation(s)
- Sarah D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics & Gynecology and Diagnostic Imaging and Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, HSC 3N52B, Hamilton, ON L8S4K1, Canada
| | - Clea A Machold
- Department of Obstetrics, Gynecology1280 Main St. West, HSC 3 N52, Hamilton, ON L8S4K1, Canada
| | - Laura Marshall
- Faculty of Health Sciences, Department of Obstetrics, Gynecology1280 Main St. West, HSC 3 N52, Hamilton, ON L8S4K1, Canada
| | - Dawn Kingston
- Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| |
Collapse
|
37
|
Abstract
OBJECTIVE To review the most current literature in order to provide evidence-based recommendations to obstetrical care providers on induction of labour. OPTIONS Intervention in a pregnancy with induction of labour. OUTCOMES Appropriate timing and method of induction, appropriate mode of delivery, and optimal maternal and perinatal outcomes. EVIDENCE Published literature was retrieved through searches of PubMed, CINAHL, and The Cochrane Library in 2010 using appropriate controlled vocabulary (e.g., labour, induced, labour induction, cervical ripening) and key words (e.g., induce, induction, augmentation). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to the end of 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The evidence in this document was rated using criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1). SUMMARY STATEMENTS: 1. Prostaglandins E(2) (cervical and vaginal) are effective agents of cervical ripening and induction of labour for an unfavourable cervix. (I) 2. Intravaginal prostaglandins E(2) are preferred to intracervical prostaglandins E(2) because they results in more timely vaginal deliveries. (I).
Collapse
|
38
|
Novembri R, Voltolini C, Torricelli M, Severi F, Marcolongo P, Benedetti A, Challis J, Petraglia F. Postdate pregnancy: Changes of placental/membranes 11β-hydroxysteroid dehydrogenase mRNA and activity. Placenta 2013; 34:1102-4. [DOI: 10.1016/j.placenta.2013.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/16/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
|
39
|
Liu S, Joseph K, Hutcheon JA, Bartholomew S, León JA, Walker M, Kramer MS, Liston RM. Gestational age-specific severe maternal morbidity associated with labor induction. Am J Obstet Gynecol 2013; 209:209.e1-8. [PMID: 23702296 DOI: 10.1016/j.ajog.2013.05.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/07/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the association between labor induction and gestational age-specific severe maternal morbidity. STUDY DESIGN Our study was restricted to women who delivered singletons at 37-42 weeks' gestation who had no pregnancy complications from 2003-2010 (n = 1,601,253) in Canada (excluding Quebec). Using a pregnancies-at-risk approach, the week-specific rates of specific morbidity after induction were contrasted with rates among ongoing pregnancies. Logistic regression was used to adjust for confounders. RESULTS Induction increased the rate of postpartum hemorrhage that required blood transfusion at 38 weeks' gestation (adjusted rate ratio, 1.28; 95% confidence interval, 1.11-1.49) and 39 weeks' gestation (adjusted rate ratio, 1.21; 95% confidence interval, 1.06-1.38). Induction was also associated with higher rates of pueperal sepsis at 38 and 39 weeks' gestation and venous thromboembolism at 38 weeks' gestation. The absolute increase in morbidity rates was small; the number needed to harm was large (eg, 1270 for postpartum hemorrhage with blood transfusion at 38 weeks' gestation). CONCLUSION Among women without pregnancy complications, induction at earlier term is associated with higher rates of specific severe maternal morbidity, although absolute risks are low.
Collapse
|
40
|
Assessing the impact of the SOGC recommendations to increase access to prenatal screening on overall use of health resources in pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:444-453. [PMID: 23756275 DOI: 10.1016/s1701-2163(15)30935-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The recommendation by the Society of Obstetricians and Gynaecologists of Canada that prenatal screening for fetal aneuploidy be offered to all pregnant women is an important change in clinical obstetrics. However, it is unknown how this recommendation might affect the use of other health resources during pregnancy. METHODS Twelve clinical and administrative databases were linked, and care paths outlining typical service use in pregnancy were created based on the type of prenatal screening accessed (first trimester screening [FTS], maternal serum screening [MSS], invasive testing only, or no screening and/or diagnosis). Logistic, Poisson, and negative binomial models were applied to the data to examine the association between use of prenatal screening/diagnosis and other health services during pregnancy. RESULTS Women who accessed prenatal screening/diagnosis were significantly more likely to have a consultation with a medical geneticist (FTS OR 2.42; 95% CI 1.75 to 3.33; MSS OR 4.84; 95% CI 2.92 to 8.03; and invasive testing OR 8.58; 95% CI 5.28 to 13.94), and women who accessed FTS had more prenatal visits (FTS incidence rate ratio 1.03; 95% CI 1.01 to 1.05) than women who did not access prenatal screening/diagnosis. Uptake of invasive tests did not differ between women who accessed FTS and those who accessed MSS. Use of prenatal screening/diagnosis was not significantly associated with use of most other health resources CONCLUSION In a publicly funded health care system, understanding the impact of recommendations to increase access to a specific service on other services is important. Recommendations to increase access to prenatal screening services may have some unanticipated downstream effects on the use of other services during pregnancy. However, most aspects of health resource use in pregnancy do not appear to be influenced by the use of prenatal screening services.
Collapse
|
41
|
Vayssière C, Haumonte JB, Chantry A, Coatleven F, Debord MP, Gomez C, Le Ray C, Lopez E, Salomon LJ, Senat MV, Sentilhes L, Serry A, Winer N, Grandjean H, Verspyck E, Subtil D. Prolonged and post-term pregnancies: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2013; 169:10-6. [PMID: 23434325 DOI: 10.1016/j.ejogrb.2013.01.026] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
Abstract
The duration of pregnancy varies between 40(+0) and 41(+3) weeks. Conventionally, and essentially arbitrarily, a pregnancy is considered to be "prolonged" after 41(+0) weeks, but the infant is not considered "post-term" until 42(+0) weeks (Professional consensus). A term birth thus occurs during the period from 37(+0) to 41(+6) weeks. In France, prolonged pregnancies (≥41(+0)weeks) involve 15-20% of pregnant women, and post-term pregnancies (≥42(+0) weeks) approximately 1%. The frequency of post-term pregnancies is very heterogeneous: in Europe and the United States, it ranges from 0.5% to 10% according to country. In prolonged pregnancies, the cesarean section rate-especially the emergency cesarean rate-is multiplied by approximately 1.5 (grade B). From 37(0-6) to 43(0-6) weeks, the risk of perinatal mortality increases regularly, from 0.7‰ to 5.8‰. Meconium aspiration syndrome is responsible for substantial morbidity and mortality, and its incidence increases regularly between 38(+0) and 42(+6) weeks, from 0.24‰ to 1.42‰ (grade B). Similarly, the risks of neonatal acidosis (grade B), 5-min Apgar scores less than 7 (grade B) and admissions to neonatal intensive care (grade B) increase progressively between 38(+0) and 42(+6) weeks. These risks appear to double for post-term growth-restricted newborns (grade C). Ultrasound dating of the pregnancy makes it possible to reduce the risk that it will be incorrectly considered prolonged and that labor will therefore be induced unnecessarily. To harmonize practices, if the crown-rump length (CRL) is correctly measured (this measurement should be taken between 11(+0) and 13(+6) weeks, when CRL should measure from 45 to 84mm), ultrasound dating based on it should be used to determine the official date pregnancy began, regardless of its difference from the date assumed by the patient or estimated based on the date of the last menstrual period. This rule does not apply to pregnancies by IVF, for which the date pregnancy began is defined by the date of oocyte retrieval (Professional consensus). From 37(0-6) to 43(0-6) weeks, the risk of perinatal mortality increases regularly and there is no threshold at which a clear increase in perinatal mortality becomes visible. Fetal monitoring by cardiotocography (CTG) that begins at 41(+0) weeks would cover approximately 20% of women and reduce perinatal morbidity compared with monitoring that begins at 42(+0) weeks (grade C). The frequency recommended for this monitoring ranges between two and three times a week (Professional consensus). For ultrasonography assessment, measurement of the largest fluid pocket is recommended, because measurement of the amniotic fluid index (that is, the sum of the four quadrants) is accompanied by more diagnoses of oligohydramnios, inductions of labor, and cesareans for fetal distress without any improvement in neonatal prognosis (grade A). The practice of assessing the Manning biophysical score increases the number of diagnoses of oligohydramnios and fetal heart rage (FHR) abnormalities and generates an increase in the rates of inductions and cesareans without improving neonatal prognosis. The use of this biophysical score in monitoring prolonged pregnancies is therefore not recommended (grade B). In the absence of a specific disorder, induction of labor can be proposed in patients between 41(+0) and 42(+6) weeks (grade B). Nonetheless, the choice of prolongation beyond above 42(+0) weeks appears to involve an increase in fetal risk, which must be explained to the patient and balanced against the potential disadvantages of induction (Professional consensus). Stripping the membranes can reduce the duration of pregnancy by increasing the number of patients going into labor spontaneously during the week afterward (grade B). Compared to an expectant approach, it does not increase the cesarean section rate (grade A). It reduces recourse to induction by 41% at 41(+0) weeks and by 72% at 42(+0) weeks (grade B), without increasing the risk of either membrane rupture or maternal or neonatal infection (grade B). Used as a tampon or vaginal gel, prostaglandins E2 (PGE2) are an effective method of inducing labor (grade A). They can be used to induce labor successfully, regardless of cervical ripeness (grade A). If misoprostol is chosen, the lowest dose is to be preferred, starting with a vaginal dose of 25μg every 3-6h (grade A). For misoprostol, more powerful studies remain necessary for better defining the doses, routes of administration, tolerance and indications. Misoprostol at any dose is contraindicated in women with uterine scars (grade B). Placement of an intracervical Foley catheter is an effective mechanical means of inducing labor, with less uterine hyperstimulation than prostaglandins and no increase in the cesarean section rate (grade A). Nonetheless, as the risk of infection might be increased, this technique requires more robust evaluation before entering general practice (grade B). In cases of meconium-stained amniotic fluid, pharyngeal aspiration before delivery of the shoulders is not recommended (grade A). The team managing a post-term newborn with meconium-stained amniotic fluid at birth must know how to perform intubation and, if the intubation is not helpful, endotracheal aspiration (grade C) and ventilation with a mask. Routine endotracheal intubation of a vigorous newborn is not recommended (grade A).
Collapse
Affiliation(s)
- Christophe Vayssière
- Service de Gynécologie-Obstétrique, Hôpital Paule de Viguier, CHU Toulouse, 31059 Toulouse, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Bogaerts A, Witters I, Van den Bergh BRH, Jans G, Devlieger R. Obesity in pregnancy: altered onset and progression of labour. Midwifery 2013; 29:1303-13. [PMID: 23427851 DOI: 10.1016/j.midw.2012.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/27/2012] [Accepted: 12/20/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND the incidence of obesity increases in all developed countries to frightful percentages, also in women of reproductive age. Maternal obesity is associated with important obstetrical complications; and this group also exhibits a higher incidence of prolonged pregnancies and labours. OBJECTIVE to review the literature on the pathophysiology of onset and progression of labour in obese woman and translate this knowledge into practical recommendations for clinical management. METHODS a literature review, in particular a critical summary of research, in order to determine associations, gaps or inconsistencies in this specific but limited body of research. FINDINGS the combination of a higher incidence of post-term childbirths and increased inadequate contraction pattern during the first stage of labour suggests an influence of obesity on myometrial activity. A pathophysiologic pathway for altered onset and progression of labour in obese pregnant women is proposed. CONCLUSIONS analysis of the literature shows that obesity is associated with an increased duration of pregnancy and prolonged duration of first stage of labour. IMPLICATIONS FOR PRACTICE an adapted clinical approach is suggested in these patients.
Collapse
Affiliation(s)
- Annick Bogaerts
- Limburg Catholic University College, PHL University College, Department of PHL-Healthcare Research, Oude Luikerbaan, 79, 3500 Hasselt, Belgium
| | | | | | | | | |
Collapse
|
43
|
Bat-Erdene U, Metcalfe A, McDonald SW, Tough SC. Validation of Canadian mothers' recall of events in labour and delivery with electronic health records. BMC Pregnancy Childbirth 2013; 13 Suppl 1:S3. [PMID: 23445768 PMCID: PMC3561172 DOI: 10.1186/1471-2393-13-s1-s3] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Maternal report of events that occur during labour and delivery are used extensively in epidemiological research; however, the validity of these data are rarely confirmed. This study aimed to validate maternal self-report of events that occurred in labour and delivery with data found in electronic health records in a Canadian setting. Methods Data from the All Our Babies study, a prospective community-based cohort of women’s experiences during pregnancy, were linked to electronic health records to assess the validity of maternal recall at four months post-partum of events that occurred during labour and delivery. Sensitivity, specificity and kappa scores were calculated. Results were stratified by maternal age, gravidity and educational attainment. Results Maternal recall at four months post-partum was excellent for infant characteristics (gender, birth weight, gestational age, multiple births) and variables related to labour and delivery (mode of delivery, epidural, labour induction) (sensitivity and specificity >85%). Women who had completed a university degree had significantly better recall of labour induction and use of an epidural. Conclusion Maternal recall of infant characteristics and events that occurred during labour and delivery is excellent at four months post-partum and is a valid source of information for research purposes.
Collapse
Affiliation(s)
- Uilst Bat-Erdene
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | | | | |
Collapse
|
44
|
Ray JG, Urquia ML. Risk of stillbirth at extremes of birth weight between 20 to 41 weeks gestation. J Perinatol 2012; 32:829-36. [PMID: 22595964 DOI: 10.1038/jp.2012.60] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the risk of stillbirth between 20 to 41 weeks gestation, at highly detailed weight percentiles, including extreme degrees of small (SGA) and large (LGA) for gestational age birth weight. STUDY DESIGN We completed a population-based study of all births in Ontario, Canada between 2002 and 2007. We included 767, 016 liveborn and 4,697 stillborn singletons delivered between 20 and 41 weeks gestation. Smoothed birthweight percentile curves were generated for males and females, combining livebirths and stillbirths. Quantile regression was used to calculate sex-specific absolute birthweight differences and 95% confidence intervals (CI) between stillborns vs liveborns at various gestational ages. Logistic regression was used to calculate the odds ratios (OR) for stillbirth at various sex-specific birthweight percentiles, including <1st and ≥ 99th percentile. OR were adjusted for maternal age and parity. RESULT At the 10th percentile, stillborns weighed significantly less than liveborns starting at 24 weeks gestation. By 32 weeks, this difference was 590 g (95% CI 430 to 750) for males and 551 g (95% CI 345 to 448) for females. A reverse J-shaped association was observed between birthweight percentile and risk of stillbirth across all gestational ages. Relative to the 40th to 60th percentile referent, the adjusted OR for stillbirth was 9.63 (95% CI 8.39 to 11.06) at a birth weight <1st percentile. At ≥ 99th percentile, the adjusted OR was 2.24 (95% CI 1.76 to 2.86). The risk of stillbirth at extreme birthweight percentiles was robustly observed across gestational ages. CONCLUSION Substantial birthweight differences exist between stillborns and newborns. As a possible hallmark of impending intrauterine death, severe SGA and LGA may each be potential targets for future stillbirth prevention initiatives.
Collapse
Affiliation(s)
- J G Ray
- Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | | |
Collapse
|
45
|
Allen VM, Stewart A, O'Connell CM, Baskett TF, Vincer M, Allen AC. The influence of changing post-term induction of labour patterns on severe neonatal morbidity. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:330-40. [PMID: 22472332 DOI: 10.1016/s1701-2163(16)35213-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To estimate the influence of changing practice patterns of post-term induction of labour on severe neonatal morbidity. METHODS This population-based cohort study used data from the Nova Scotia Atlee Perinatal Database to evaluate the effect of post-term induction of labour on stillbirth and neonatal mortality and severe neonatal morbidity in low-risk pregnancies. The study population included all pregnant women ≥ 40 weeks' gestation delivering in Nova Scotia from 1988 to 2008 who underwent induction of labour with a single fetus in cephalic presentation. Major congenital anomalies and pre-existing or severe gestational hypertension and diabetes were excluded. Women delivering post-term from 1994 to 2008 (after the Post-term Pregnancy Trial) were compared with women delivering from 1988 to 1992 to evaluate outcomes with changing maternal characteristics and obstetric practice patterns. RESULTS Evaluation and comparison of time epochs (1988 to 1992, 1994 to 1998, 1999 to 2003, and 2004 to 2008) demonstrated an increased risk for perinatal mortality or severe neonatal morbidity, especially low five-minute Apgar score, among both nulliparous and multiparous women. There were no significant differences in the risks for stillbirth or perinatal mortality over time. Comparable relationships were demonstrated in a subgroup of lower risk women. CONCLUSION The increase in post-term induction of labour with time is associated with a significant increase in severe neonatal morbidity, especially among infants born to multiparous women. Evaluation of the antepartum and intrapartum management of these low-risk pregnancies may provide additional information to reduce morbidity.
Collapse
Affiliation(s)
- Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
| | | | | | | | | | | |
Collapse
|
46
|
Burgos J, Rodríguez L, Otero B, Cobos P, Osuna C, Centeno MDM, Melchor JC, Fernández-Llebrez L, Martínez-Astorquiza T. Induction at 41 weeks increases the risk of caesarean section in a hospital with a low rate of caesarean sections. J Matern Fetal Neonatal Med 2012; 25:1716-8. [PMID: 22339273 DOI: 10.3109/14767058.2012.663018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To analyse the impact of a change in the management of prolonged pregnancies from inducing labour at 42(+0) to induction at 41(0-6). DESIGN Retrospective cohort study. METHODS Analysis of 3563 single pregnancies with cephalic presentation of ≥ 41 weeks of gestation delivered in Cruces University Hospital (Spain). Two cohorts were compared corresponding to before and after the change in the policy on induction. MAIN OUTCOME MEASURES Induction rate, vaginal delivery rate, newborn morbidity and mortality. RESULTS The overall rate of caesarean sections in the patients included in the study was 12.8% (19.5% among those induced and 8.4% among those in whom the onset of labour has been spontaneous). The caesarean section rate in cohorts 41(0-6) and 42(+0) were 14.1% and 11.4%, respectively (p=0.01). Though there were more newborns with umbilical cord blood ph<7.10 in cohort 41(0-6) than in the other group (8.7% versus 4.5%; p<0.01), no significant differences were found between cohorts in 5-min Apgar score < 7, number of admissions to the neonatal care unit or perinatal mortality. CONCLUSION The induction of labour during week 41 in prolonged pregnancies may increase the rate of caesarean sections in hospitals with low rates of caesarean sections.
Collapse
Affiliation(s)
- Jorge Burgos
- Department of Obstetrics and Gynecology, Cruces University Hospital, Biscay, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Allen V. Small packages. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:11-13. [PMID: 22260758 DOI: 10.1016/s1701-2163(16)35127-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
48
|
Allen V. Retard de croissance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012. [DOI: 10.1016/s1701-2163(16)35128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
49
|
Comment définir la date présumée de l’accouchement et le dépassement de terme ? ACTA ACUST UNITED AC 2011; 40:703-8. [DOI: 10.1016/j.jgyn.2011.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
50
|
Place du rythme cardiaque fœtal et de son analyse informatisée dans la surveillance de la grossesse prolongée. ACTA ACUST UNITED AC 2011; 40:774-84. [DOI: 10.1016/j.jgyn.2011.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|