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Bachar G, Shemesh D, Farago N, Siegler Y, Khatib N, Ginsberg Y, Beloosesky R, Weiner Z, Vitner D. The optimal induction timing in prelabor rupture of membranes: a retrospective study. J Matern Fetal Neonatal Med 2023; 36:2215997. [PMID: 37225389 DOI: 10.1080/14767058.2023.2215997] [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: 05/26/2022] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Term prelabour rupture of membrane (PROM) occurs in 8% of term deliveries, but it is unclear when to initiate induction. Our objective was to assess the optimal timing of oxytocin induction in the management of term PROM in terms of maternal and neonatal outcomes. METHODS A retrospective cohort study was performed at a single tertiary care center from 2010 to 2020. All singleton pregnancies with PROM beyond 37 weeks gestation, without regular uterine contractions, were included. Eligible women were divided into three groups according to the timing of oxytocin induction (≤12; 12-24; ≥24 h) following PROM. RESULTS Of 9,443 women presented with the term PROM, 1676 were included. They were classified according to the timing of oxytocin induction initiation following PROM: 1,127 within 12 h; 285 within 12-24 h; 264 after 24 h. There were no significant differences in baseline demographic characteristics between groups. Women who presented at our emergency department were induced earlier delivered significantly sooner than those who received oxytocin later (45 vs. 28.2 vs. 23.2 h, respectively, p < .001. Maternal infection rate was similar and unrelated to oxytocin starting time. Induction at <12 h from PROM was associated with reduced rate of antibiotic administration compared with other timings (26.8% vs. 38.6% vs. 33.33%, respectively; p < .001), and the same was found for neonatal composite adverse outcomes (RR = 1.27, p = .0307). CONCLUSION In term PROM, early induction (within 12 h of PROM) may be recommended to reduce the time-do-delivery interval and increase the delivery rate within 24 h. It may be of economic significance and improve women satisfaction. Furthermore, early induction may also improve neonatal outcomes, without worsening maternal outcomes.
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Affiliation(s)
- Gal Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Doron Shemesh
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Naama Farago
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yoav Siegler
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport, Technion-Israel Institute of Technology, Haifa, Israel
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Junior LCM, Pinto CN, Gerencer CS, Pro ECG, de Carvalho HB. Association of maternal, fetal and labor variables with a low Apgar score in the fifth minute in term pregnancy: a case-control study. Arch Gynecol Obstet 2023; 308:1473-1483. [PMID: 36374349 PMCID: PMC9662118 DOI: 10.1007/s00404-022-06832-6] [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: 02/14/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To search for maternal, labor-related and fetal variables associated with low Apgar in the fifth minute in term pregnancy. METHODS A retrospective case-control study with term births was conducted in a public teaching hospital from 2013 to 2020. Cases were term births with Apgar score less than 7 in the fifth minute, and controls, the next one or two births following a case, with Apgar of 7 or more. Non-cephalic presentations, multiples and malformations were excluded. We accessed 100 cases and 190 controls. We considered significant values of p < 0.05. RESULTS Were accessed 27 variables which could be risk factors, from which 12 were associated with the outcome. We found a protective effect of prelabor cesarean for the outcome, odds ratio (OR) 0.38, p = 0.013. Consequently, we conducted two sets of analyses: in the whole group and in the group of laboring women. The values of OR were in general greater in the group of laboring women, compared with the whole group. We conducted multivariate analysis within the group of women in labor. The variables which fitted best in the model were nulliparity, male sex of the fetus, less than six prenatal visits and abnormal cardiotocography; all remained significant. An association of rupture of membranes more than 360 min with the outcome, even after controlling fpr duration of labor, was found; adjusted OR 2.45, p = 0.023. CONCLUSION Twelve variables were associated with the outcome. Prelabor cesarean had a protective effect. The time of ruptured membranes was associated with low Apgar.
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Affiliation(s)
- Luís Carlos Machado Junior
- Universidade de São Paulo/Faculdade de Medicina/Centro de Saúde Escola Samuel Barnsley Pessoa, São Paulo, Brazil.
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil.
| | - Camila Nazareth Pinto
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil
| | - Caroline Sangalan Gerencer
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil
| | - Elisa Caroline Giacometti Pro
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil
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Abstract
The use of tobacco during pregnancy is the leading preventable cause of pregnancy complications and adverse birth outcomes. In high-income countries, around one in 10 pregnant women smokes tobacco, while smokeless tobacco is the primary form of tobacco used in many low- and middle-income countries. Although the risk of tobacco-related harms can be reduced substantially if mothers cease smoking in the first trimester of pregnancy, the proportion of women who successfully quit smoking during pregnancy remains modest. Psychosocial interventions are first-line treatment, with some high-quality evidence showing that counselling is effective in promoting smoking cessation among pregnant women. There is insufficient evidence regarding the efficacy and safety of smoking cessation pharmacotherapies when used during pregnancy, although in some countries nicotine replacement therapy is recommended for pregnant women who have been unable to quit without pharmacological assistance. E-cigarettes are increasingly being used as a smoking cessation aid in the general population of smokers, but more research is needed to determine if e-cigarettes are a safe and effective treatment option for pregnant women.
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Affiliation(s)
- Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Jonathan James Chandran
- CICADA Adolescent Drug and Alcohol Service, Department of Adolescent Medicine, Sydney Children's Hospital, Sydney, Australia
| | - Ju Lee Oei
- Department of Newborn Care, the Royal Hospital for Women, Randwick, Australia
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
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Analysis of Selected Risk Factors Depending on the Type of Cerebral Palsy. Brain Sci 2021; 11:brainsci11111448. [PMID: 34827447 PMCID: PMC8615573 DOI: 10.3390/brainsci11111448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Cerebral palsy (CP) is not a defined, separate disease classification, but a set of etiologically diverse symptoms that change with the child's age. According to the up-to-date definition, CP is a group of permanent but not unchanging disorders of movement and/or posture and motor function, which are due to a nonprogressive interference, lesion, or abnormality of the developing/immature brain. CP is one of the most frequent causes of motor disability in children. The aim of the present study was to analyze whether selected risk factors may vary depending on particular types of CP. Methods: 181 children with CP (aged 4-17 years), hospitalized at the Department of Pediatrics and Developmental Age Neurology in Katowice in the years 2008-2016 were retrospectively analyzed in the present study. The assumed risk factors of CP were divided into two groups: 1-pre-conception and prenatal (mother's age, family history of epilepsy, burdened obstetric history, mother's systemic diseases, pregnancy order, multiple pregnancy, duration of pregnancy, bleedings from the genital tract during gestation, arterial hypertension during pregnancy, infections during pregnancy, preterm contractions, maintained pregnancy, premature rupture of membranes, abruptio placentae, and others), 2-perinatal and postnatal (mode of delivery, birth weight, Apgar score at the first and fifth minute, neonatal convulsions, respiratory failure, infections in neonatal and infant period, and intraventricular bleeding). The division into particular CP types was based on Ingram's classification. Results: The following risk factors were the most frequent in the total group: respiratory failure, infections, intraventricular bleeding, and prematurity. Among the analyzed preconception and prenatal factors, the duration of pregnancy and preterm contractions during pregnancy significantly differentiated the subgroups of patients depending on the type of CP. The prevalence of almost all analyzed perinatal, neonatal, and infant-related risk factors (i.e., birth weight, Apgar score at the first and fifth minute, neonatal convulsions, respiratory failure, infections in neonatal and infant period, and intraventricular bleeding) significantly differed between CP types, apart from the mode of delivery. However, in multivariate regression, only intraventricular bleeding was an independent predictor for tetraplegic CP type when compared to joined extrapyramidal and ataxic types (OR = 2.801, p = 0.028). Conclusions: As CP is a syndrome of multifactorial etiology, the identification of CP risk factors entails the need for careful observation and comprehensive care of children in the risk group. The presence of certain risk factors may be a prognostic indicator for particular types of CP. The knowledge about the association between the risk factor(s) and the CP type could be a very useful tool for pediatricians looking after the child at risk of developmental disorders.
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Risk Factors for Cerebral Palsy in Moldova. ACTA ACUST UNITED AC 2021; 57:medicina57060540. [PMID: 34071238 PMCID: PMC8228264 DOI: 10.3390/medicina57060540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: This is the first study assessing risk factors for cerebral palsy (CP) among children born in Moldova. The aim of this study was to identify and describe risk factors for cerebral palsy (CP) among children born in Moldova, which is one of the low-middle income countries in Europe. Materials and Methods: We identified 351 children with CP born during 2009 and 2010 in Moldova. Detailed information on 417 children without CP served as a reference group. Logistic regression analyses were applied to the calculate crude and adjusted odds ratios (OR) for CP with 95% confidence intervals (CI) in addition to attributable fraction (AF). Results: Among children with CP (40.5% girls), 26% had spastic unilateral, 54% bilateral, 13% dyskinetic, 5% ataxic and 2% unclassified CP. Significant risk factors for CP included maternal alcohol consumption during pregnancy (OR 1.7, p = 0.002), maternal hypertension (OR 2.0, p < 0.001), children born to mothers from the rural areas (OR 1.6, p < 0.001), maternal age ≥35 years (OR 0.6, p = 0.018), maternal epilepsy (OR 4.3, p < 0.001), breech delivery (OR 3.1, p = 0.001), home births (OR 6.3, p = 0.001), umbilical cord around neck (OR 2.2, p < 0.001), AVD (OR 3.1, p < 0.001), male gender (OR 1.3, p < 0.001), SGA (OR 1.3, p = 0.027), multiple gestations (OR 1.7, p < 0.001) and hyperbilirubinemia (OR 4.5, p < 0.001). Multivariable analyses showed that the AF of CP was 64% for rural residence (OR 2.8, p = 0.002), 87% for home birth (7.6, p = 0.005), 79% for pre-labor rupture of membrane (OR 4.9, p = 0.001), 66% for breech delivery (OR 2.9, p = 0.002) and 81% for hyperbilirubinemia (OR 5.4, p < 0.001). Conclusions: A combination of factors related to the mother, the delivery and the child were risk factors for CP in Moldova, many of them possibly avoidable. Improved pregnancy and maternity care would potentially reduce the risk of CP. A national CP registry in Moldova is suggested as an opportunity to follow up on these findings.
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Han Y, Wang W, Wang X, Dong T, van Donkelaar A, Martin RV, Chen Y, Kan H, Xia Y. Prenatal exposure to fine particles, premature rupture of membranes and gestational age: A prospective cohort study. ENVIRONMENT INTERNATIONAL 2020; 145:106146. [PMID: 32987218 DOI: 10.1016/j.envint.2020.106146] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The associations between maternal exposure to fine particles with aerodynamic diameter ≤ 2.5 μm (PM2.5) and gestational age as well as premature rupture of membranes (PROM) remain unclear. Few studies have focused on preconception exposure and components of fine particles in China. METHODS A total of 1715 pregnant women were enrolled at hospitals affiliated with Nanjing Medical University from 2014 to 2015. Personal exposure to PM2.5 was estimated from preconception to the first trimester. Gestational age and PROM were investigated to explore their associations with PM2.5 and its components. RESULTS From 12 weeks before conception to the end of the first trimester, the gestational age was reduced by 0.89 days (95% CI: -1.37, -0.40) per 10 μg/m3 increment in PM2.5 exposure. After the exposure period was separated into two groups, PM2.5 exposure reduced the gestational age by 0.35 days (95% CI: -0.59, -0.11) in the 12 weeks before pregnancy. With maternal exposure to PM2.5 early in the first trimester, gestational age was reduced by 0.62 days (95% CI: -1.09, -0.14). After mediation analysis, we found that PROM mediated the association between PM2.5 and gestational age from preconception to the first trimester. Components analysis indicated that exposure to black carbon, organic matter, and nitrate increased the risk of PROM and decreased gestational age. CONCLUSION Exposure to PM2.5 as well as some components of PM2.5 before and during early pregnancy was associated with PROM and gestational age. PROM might be a potential mediator in associations between PM2.5 as well as various components and gestational age.
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Affiliation(s)
- Yingying Han
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, No. 321 Zhongshan Road, Nanjing, Jiangsu Province 210008, China; State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Weidong Wang
- Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xu Wang
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Tianyu Dong
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, N.S., Canada
| | - Randall V Martin
- Harvard-Smithsonian Center for Astrophysics, Cambridge, MA 02138, United States
| | - Ying Chen
- Central Lab, Wuxi Maternal and Child Health Hospital, Nanjing Medical University, 48 Huaishu Lane, Wuxi 214002, China
| | - Haidong Kan
- Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
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