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Botelho A, Invitti AL, Mattar R, Pares DBDS, Salmeron CP, Caldas JVJ, Mello N, Peixoto AB, Araujo Júnior E, Sun SY. Risk factors for postpartum hemorrhage according to the Robson classification in a low-risk maternity hospital. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo53. [PMID: 38994464 PMCID: PMC11239210 DOI: 10.61622/rbgo/2024rbgo53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/20/2024] [Indexed: 07/13/2024] Open
Abstract
Objective To evaluate the risk factors for postpartum hemorrhage (PPH) according to the Robson Classification in a low-risk maternity hospital. Methods We conducted retrospective cohort study by analyzing the medical records of pregnant women attended in a low-risk maternity hospital, during from November 2019 to November 2021. Variables analyzed were: maternal age, type of delivery, birth weight, parity, Robson Classification, and causes of PPH. We compared the occurrence of PPH between pregnant women with spontaneous (Groups 1 and 3) and with induction of labor (2a and 4a). Chi-square and Student t-tests were performed. Variables were compared using binary logistic regression. Results There were 11,935 deliveries during the study period. According to Robson's Classification, 48.2% were classified as 1 and 3 (Group I: 5,750/11,935) and 26.1% as 2a and 4a (Group II: 3,124/11,935). Group II had higher prevalence of PPH than Group I (3.5 vs. 2.7%, p=0.028). Labor induction increased the occurrence of PPH by 18.8% (RR: 1.188, 95% CI: 1.02-1.36, p=0.030). Model including forceps delivery [x2(3)=10.6, OR: 7.26, 95%CI: 3.32-15.84, R2 Nagelkerke: 0.011, p<0.001] and birth weight [x2(4)=59.0, OR: 1.001, 95%CI:1.001-1.001, R2 Nagelkerke: 0.033, p<0.001] was the best for predicting PPH in patients classified as Robson 1, 3, 2a, and 4a. Birth weight was poor predictor of PPH (area under ROC curve: 0.612, p<0.001, 95%CI: 0.572-0.653). Conclusion Robson Classification 2a and 4a showed the highest rates of postpartum hemorrhage. The model including forceps delivery and birth weight was the best predictor for postpartum hemorrhage in Robson Classification 1, 3, 2a, and 4a.
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Affiliation(s)
- Amanda Botelho
- Department of ObstetricsEscola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilDepartment of Obstetrics, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo, SP,
Brazil.
| | - Adriana Luckow Invitti
- Department of GynecologyEscola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilDepartment of Gynecology, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo, SP,
Brazil.
- Beneficent Association of Blood
CollectionSão PauloSPBrazilBeneficent Association of Blood Collection, São
Paulo, SP, Brazil.
| | - Rosiane Mattar
- Department of ObstetricsEscola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilDepartment of Obstetrics, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo, SP,
Brazil.
- Hospital Amparo MaternalSão PauloSPBrazilHospital Amparo Maternal, São Paulo, SP,
Brazil.
| | - David Baptista da Silva Pares
- Department of ObstetricsEscola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilDepartment of Obstetrics, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo, SP,
Brazil.
- Hospital Amparo MaternalSão PauloSPBrazilHospital Amparo Maternal, São Paulo, SP,
Brazil.
| | | | - João Victor Jacomele Caldas
- Department of ObstetricsEscola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilDepartment of Obstetrics, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo, SP,
Brazil.
| | - Nathalia Mello
- Hospital Amparo MaternalSão PauloSPBrazilHospital Amparo Maternal, São Paulo, SP,
Brazil.
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics ServiceHospital Universitário Mário
PalmérioUniversidade de UberabaUberabaMGBrazilGynecology and Obstetrics Service, Hospital
Universitário Mário Palmério, Universidade de Uberaba, Uberaba, MG,
Brazil.
- Department of Obstetrics and
GynecologyUniversidade Federal do Triângulo
MineiroUberabaMGBrazilDepartment of Obstetrics and Gynecology,
Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.
| | - Edward Araujo Júnior
- Department of ObstetricsEscola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilDepartment of Obstetrics, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo, SP,
Brazil.
| | - Sue Yazaki Sun
- Department of ObstetricsEscola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrazilDepartment of Obstetrics, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo, SP,
Brazil.
- Hospital Amparo MaternalSão PauloSPBrazilHospital Amparo Maternal, São Paulo, SP,
Brazil.
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Cheng TS, Zahir F, Carolin SV, Verma A, Rao S, Choudhury SS, Deka G, Mahanta P, Kakoty S, Medhi R, Chhabra S, Rani A, Bora A, Roy I, Minz B, Bharti OK, Deka R, Opondo C, Churchill D, Knight M, Kurinczuk JJ, Nair M. Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100417. [PMID: 38757059 PMCID: PMC11097080 DOI: 10.1016/j.lansea.2024.100417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
Background Guidelines for labour induction/augmentation involve evaluating maternal and fetal complications, and allowing informed decisions from pregnant women. This study aimed to comprehensively explore clinical and non-clinical factors influencing labour induction and augmentation in an Indian population. Methods A prospective cohort study included 9305 pregnant women from 13 hospitals across India. Self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records were obtained at recruitment (≥28 weeks of gestation), and women were followed up within 48 h after childbirth. Maternal and fetal clinical information were classified based on guidelines into four groups of clinical factors: (i) ≥2 indications, (ii) one indication, (iii) no indication and (iv) contraindication. Associations of clinical and non-clinical factors (socio-demographic, healthcare utilisation and lifestyle related) with labour induction and augmentation were investigated using multivariable logistic regression analyses. Findings Over two-fifths (n = 3936, 42.3%, 95% confidence interval [CI] 41.3-43.3%) of the study population experienced labour induction and more than a quarter (n = 2537, 27.3%, 95% CI 26.4-28.2%) experienced augmentation. Compared with women with ≥2 indications, those with one (adjusted odds ratio [aOR] 0.50, 95% CI 0.42-0.58) or no indication (aOR 0.24, 95% CI 0.20-0.28) or with contraindications (aOR 0.12, 95% CI 0.07-0.20) were less likely to be induced, adjusting for non-clinical characteristics. These associations were similar for labour augmentation. Notably, 34% of women who were induced or augmented did not have any clinical indication. Several maternal demographic (age at labour, parity and body mass index in early pregnancy), healthcare utilization (number of antenatal check-ups, duration of iron-folic acid supplementation and individuals managing childbirth) and socio-economic factors (religion, living below poverty line, maternal education and partner's occupation) were independently associated with labour induction and augmentation. Interpretation Although decisions about induction and augmentation of labour in our study population in India were largely guided by clinical recommendations, we cannot ignore that more than a third of the women did not have an indication. Decisions could also be influenced by non-clinical factors which need further research. Funding The MaatHRI platform is funded by a Medical Research Council Career Development Award (Grant Ref: MR/P022030/1) and a Transition Support Award (Grant Ref: MR/W029294/1).
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Affiliation(s)
- Tuck Seng Cheng
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Farzana Zahir
- Department of Obstetrics and Gynaecology, Assam Medical College, Dibrugarh, Assam, India
| | - Solomi V. Carolin
- Department of Obstetrics and Gynaecology, Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India
| | - Ashok Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad, Government Medical College, Kangra, Tanda, Himachal Pradesh, India
| | - Sereesha Rao
- Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Saswati Sanyal Choudhury
- Department of Obstetrics and Gynaecology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Gitanjali Deka
- Department of Obstetrics and Gynaecology, Tezpur Medical College, Tezpur, India
| | - Pranabika Mahanta
- Department of Obstetrics and Gynaecology, Jorhat Medical College and Hospital, Jorhat, Assam, India
| | - Swapna Kakoty
- Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Robin Medhi
- Department of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Shakuntala Chhabra
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Anjali Rani
- Department of Obstetrics and Gynaecology, Banaras Hindu University Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Amrit Bora
- Department of Obstetrics and Gynaecology, Sonapur District Hospital, Assam, India
| | - Indrani Roy
- Department of Obstetrics and Gynaecology, Nazareth Hospital, Shillong, Meghalaya, India
| | - Bina Minz
- Department of Obstetrics and Gynaecology, Sewa Bhawan Hospital Society, Chattisgarh, India
| | - Omesh Kumar Bharti
- State Institute of Health and Family Welfare, Department of Health & Family Welfare, Government of Himachal Pradesh, India
| | - Rupanjali Deka
- MaatHRI Project, Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - David Churchill
- Department of Obstetrics and Gynaecology, The Royal Wolverhampton NHS Trust, UK
- Research Institute for Healthcare Science, University of Wolverhampton, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
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Sileo FG, Tramontano AL, Sponzilli A, Facchinetti F. Prelabour rupture of the membranes at term: antibiotic overuse in Italy. Minerva Obstet Gynecol 2024; 76:135-141. [PMID: 35829626 DOI: 10.23736/s2724-606x.22.05145-4] [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: 06/15/2023]
Abstract
BACKGROUND The proper management of women with premature rupture of membrane (PROM) and not spontaneously entering in labour remains controversial. The aim of this study was to identify the current management for women with PROM at term according to the Group B Streptococcus (GBS) status across different Italian hospitals. METHODS Anonymous online survey evaluating: the current practice of women with PROM in terms of management (expectant management vs. induction of labour) and antibiotic prophylaxis according to GBS status. RESULTS In case of negative GBS status, the 82.4% of respondents wait until 24 hours before labour induction. Antibiotics are administered for prophylaxis in 35.3%, 27.5% and 2% at 18, 12 and 24 hours respectively. The remaining 35.3% of respondents are divided between those using antibiotics only with signs of infections or according to different risk factors (i.e. meconium-stained amniotic fluid or suspected infection). Neonates born from a mother with negative GBS status almost never (90.2%) receive prophylactic antibiotics. In case of positive GBS status, induction is started as soon as possible by 49.1% of respondents; the remnants choose to wait 6 (15.7%), 12 (17.6%), 18 (3.9%) and 24 (13.7%) hours. Antibiotics are administered as soon as possible by 78.4% of clinicians. In the neonates, 51% of neonatologist administer antibiotics upon clinical indications (suspected sepsis); 15.7% use antibiotics routinely or with a short interval between maternal antibiotics and delivery (17.6%). CONCLUSIONS The management after PROM is highly heterogeneous with an inappropriate extension of antibiotic prophylaxis in cases with negative GBS status.
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Affiliation(s)
- Filomena G Sileo
- Unit Prenatal Medicine, Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna L Tramontano
- Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Sponzilli
- Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy -
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Braund S, Deneux-Tharaux C, Sentilhes L, Seco A, Rozenberg P, Goffinet F. Induction of labor and risk of postpartum hemorrhage in women with vaginal delivery: A propensity score analysis. Int J Gynaecol Obstet 2024; 164:732-740. [PMID: 37568268 DOI: 10.1002/ijgo.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE To explore the association between induction of labor (IOL) and postpartum hemorrhage (PPH) after vaginal delivery. METHODS We included women from the merged database of three randomized prospective trials (TRACOR, CYTOCINON, and TRAAP) that measured postpartum blood loss precisely, with standardized methods. IOL was considered overall and according to its method. The association between IOL and PPH was tested by multivariate logistic regression modeling, adjusted for confounders, and by propensity score matching. The role of potential intermediate factors, i.e. estimated quantity of oxytocin administered during labor and operative vaginal delivery, was assessed with structural equation modeling. RESULTS Labor was induced for 1809 of the 9209 (19.6%) women. IOL was associated with a significantly higher risk of PPH of 500 mL or more (adjusted odds ratio 1.56, 95% confidence interval 1.42-1.70) and PPH of 1000 mL or more (adjusted odds ratio 1.51, 95% confidence interval 1.16-1.96). The risk of PPH increased similarly regardless of the method of induction. The results were similar after propensity score matching (odds ratio for PPH ≥500 mL 1.57, 95% confidence interval 1.33-1.87, odds ratio for PPH ≥1000 mL 1.57, 95% confidence interval 1.06-2.07). Structural equation modeling showed that 34% of this association was mediated by the quantity of oxytocin administered during labor and 1.3% by women who underwent operative vaginal delivery. CONCLUSION Among women with vaginal delivery, the risk of PPH is higher in those with IOL, regardless of its method, and after accounting for indication bias. The quantity of oxytocin administered during labor may explain one third of this association.
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Affiliation(s)
- Sophia Braund
- Université Paris Cité, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
- Department of Obstetrics and Gynecology, Charles Nicolle University Hospital, Rouen, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Pellegrin University Hospital, Bordeaux, France
| | - Aurélien Seco
- Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Paris, France
| | | | - François Goffinet
- Université Paris Cité, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
- Department of Obstetrics and Gynecology, Cochin Port-Royal Hospital, APHP, Paris, France
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Alexander MV, Wang MJ, Srivastava A, Tummala S, Abbas D, Young S, Claus L, Yarrington C, Comfort A. Association between duration of intrapartum oxytocin exposure and obstetric hemorrhage. Arch Gynecol Obstet 2024; 309:491-501. [PMID: 36781431 DOI: 10.1007/s00404-022-06901-w] [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: 08/21/2022] [Accepted: 12/18/2022] [Indexed: 02/15/2023]
Abstract
PURPOSE Prolonged duration of intrapartum oxytocin exposure is included as a risk factor within widely adopted obstetric hemorrhage risk stratification tools. However, the duration of exposure that confers increased risk is poorly understood. This study aimed to assess the association between duration of intrapartum oxytocin exposure and obstetric blood loss, as measured by quantitative blood loss, and hemorrhage-related maternal morbidity. METHODS This was a retrospective cohort study of all deliveries from 2018 to 2019 at a single medical center. We included patients who had received any intrapartum oxytocin, and we categorized them into 1 of 5 groups: > 0-2, ≥ 2-4, ≥ 4-6, ≥ 6-12, and ≥ 12 h of intrapartum oxytocin exposure. The primary outcomes were mean quantitative blood loss, proportion with obstetric hemorrhage (defined as quantitative blood loss ≥ 1000 mL), and proportion with obstetric hemorrhage-related morbidity, a composite of hemorrhage-related morbidity outcomes. Secondary outcomes were hemorrhage-related pharmacologic and procedural interventions. A stratified analysis was also conducted to examine primary and secondary outcomes by delivery mode. RESULTS Of 5332 deliveries between January 1, 2018 and December 31, 2019 at our institution, 2232 (41.9%) utilized oxytocin for induction or augmentation. 326 (14.6%) had exposure of > 0-2 h, 295 (13.2%) ≥ 2-4 h, 298 (13.4%) ≥ 4-6 h, 562 (25.2%) ≥ 6-12 h, and 751 (33.6%) ≥ 12 h. Across all deliveries, there was higher mean quantitative blood loss (p < 0.01) as well as increased odds of obstetric hemorrhage (adjusted odds ratio [aOR] 1.52, 95% confidence interval [CI] 1.21-1.91) for those with ≥ 12 h of oxytocin compared to all groups between > 0-12 h of exposure. In our stratified analysis, ≥ 12 h of oxytocin exposure was associated with higher mean quantitative blood loss (p = 0.04) and odds of obstetric hemorrhage in vaginal deliveries (aOR 1.47, 95% CI: 1.03-2.11), though not in cesarean deliveries (aOR 1.16, 95% CI 0.82-1.62). There were no differences in proportion with obstetric hemorrhage-related morbidity across all deliveries (p = 0.40) or in the stratified analysis. CONCLUSION Intrapartum oxytocin exposure of ≥ 12 h was associated with increased quantitative blood loss and odds of obstetric hemorrhage in vaginal, but not cesarean, deliveries.
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Affiliation(s)
- Megan V Alexander
- Boston University School of Medicine, Boston, MA, USA.
- Department of Obstetrics and Gynecology, Boston Medical Center, 770 Albany Street, Dowling 4, Boston, MA, 02118, USA.
| | - Michelle J Wang
- Department of Obstetrics and Gynecology, Boston Medical Center, 770 Albany Street, Dowling 4, Boston, MA, 02118, USA
| | | | | | - Diana Abbas
- Boston University School of Medicine, Boston, MA, USA
| | - Sara Young
- Boston University School of Medicine, Boston, MA, USA
| | - Lindsey Claus
- Boston University School of Medicine, Boston, MA, USA
| | - Christina Yarrington
- Boston University School of Medicine, Boston, MA, USA
- Department of Obstetrics and Gynecology, Boston Medical Center, 770 Albany Street, Dowling 4, Boston, MA, 02118, USA
| | - Ashley Comfort
- Boston University School of Medicine, Boston, MA, USA
- Department of Obstetrics and Gynecology, Boston Medical Center, 770 Albany Street, Dowling 4, Boston, MA, 02118, USA
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Ghosh R, Owa O, Santos N, Butrick E, Piaggio G, Widmer M, Althabe F, Qureshi Z, Lumbiganon P, Katageri G, Walker D. Heat stable carbetocin or oxytocin for prevention of postpartum hemorrhage among women at risk: A secondary analysis of the CHAMPION trial. Int J Gynaecol Obstet 2024; 164:124-130. [PMID: 37357606 DOI: 10.1002/ijgo.14938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To examine whether the observed non-inferiority of heat-stable carbetocin (HSC), compared with oxytocin, was influenced by biologic (macrosomia, parity 3 or more, or history of postpartum hemorrhage [PPH]) and/or pharmacologic (induction or augmentation) risk factors for PPH. METHODS The present study is a secondary analysis of the CHAMPION non-inferiority randomized trial-a two-arm, double-blind, active-controlled study conducted at 23 hospitals in 10 countries, between July 2015 and January 2018. Women with singleton pregnancies, expected to deliver vaginally with cervical dilatation up to 6 cm were eligible. Randomization was stratified by country, with 1:1 assignment. Women in the intervention and control groups received a single intramuscular injection of 100 μg of HSC or 10 IU of oxytocin, respectively. The drugs were administered immediately after birth, and the third stage of labor was managed according to the WHO guidelines. Blood was collected using a plastic drape. For this analysis, we defined a woman as being at risk if she had any one or more of the biologic or pharmacologic risk factor(s). RESULTS The HSC and oxytocin arms contained 14 770 and 14 768 women, respectively. The risk ratios (RR) for PPH were 1.29 (95% confidence interval [CI] 1.08-1.53) or 1.73 (95% CI 1.51-1.98) for those with only biologic (macrosomia, parity 3 or more, and PPH in the previous pregnancy) or only pharmacologic (induced or augmented) risk factors, respectively, compared with those with neither risk factors. CONCLUSIONS Findings reinforce previous evidence that macrosomia, high parity, history of PPH, and induction/augmentation are risk factors for PPH. We did not find a difference in effects between HSC and oxytocin for PPH among women who were neither induced nor augmented or among those who were induced or augmented.
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Affiliation(s)
- Rakesh Ghosh
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Olorunfemi Owa
- Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure, Nigeria
| | - Nicole Santos
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Elizabeth Butrick
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | | | - Mariana Widmer
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Fernando Althabe
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Zahaida Qureshi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Khon Kaen University, Bangkok, Thailand
| | | | - Dilys Walker
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
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Kartal YA, Kaya L, Yazıcı S. Effects of oxytocin induction on early postpartum hemorrhage, perineal integrity, and breastfeeding: a case-control study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 70:e20231002. [PMID: 38126414 PMCID: PMC10740191 DOI: 10.1590/1806-9282.20231002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the postpartum hemorrhage, perineal integrity, and breastfeeding results of mothers who underwent oxytocin induction in the first stage of labor in the early postpartum period. METHODS This single-center observational case-control study was conducted in the obstetric unit of a public hospital in Istanbul. The study sampling included 44 pregnant women who received oxytocin induction (case group) and 44 pregnant women who did not receive oxytocin (control group). The Personal Information Form, LATCH Breastfeeding Assessment Tool, Breastfeeding Self-Efficacy Scale, Redness, Edema, Ecchymosis, Discharge, and Approximation Scale, and Postpartum Hemorrhage Collection Bag were used in data collection, and pad follow-up was carried out. RESULTS The amount of hemorrhage in the first 24 h of the postpartum period and the mean Redness, Edema, Ecchymosis, Discharge, and Approximation Scale score were significantly higher in the case group. While 47.7% of the oxytocin-induced women had 1st or 2nd, and 11.4% had 3rd or 4th degrees of lacerations, 20.5% of the control group had 1st or 2nd, and 2.3% had 3rd or 4th degrees of lacerations. There was no significant difference between the mean scores of the Breastfeeding Self-Efficacy Scale and LATCH Breastfeeding Assessment Tool in both groups. CONCLUSION According to the study findings, it was determined that oxytocin induction administered in the first stage of labor increased hemorrhage and perineal trauma in the early postpartum period but did not affect the results of breastfeeding. CLINICAL TRIAL REGISTRATION NUMBER NCT04441125.
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Affiliation(s)
- Yasemin Aydın Kartal
- University of Health Sciences, Faculty of Health Sciences, Department of Midwifery – İstanbul, Turkey
| | - Leyla Kaya
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Department of Obstetrics and Gynaecology – İstanbul, Turkey
| | - Saadet Yazıcı
- Istanbul Health and Technology University, Faculty of Health Sciences, Department of Nursing – İstanbul, Turkey
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Ammam A, Zemour H, Kaid M, Villemin D, Soufan W, Belhouadjeb FA. Assessment of the anti-inflammatory and analgesic effects of Opuntia ficus indica L. Cladodes extract. Libyan J Med 2023; 18:2275417. [PMID: 37905304 PMCID: PMC11018314 DOI: 10.1080/19932820.2023.2275417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
This study aimed to evaluate the anti-inflammatory and analgesic properties of the methanolic extract of Opuntia ficus indica L. in small animal (rats and mice model). The current treatment for febrile conditions often involves the use of non-steroidal anti-inflammatory drugs (NSAIDs), which can have adverse effects, particularly gastrointestinal ulcers. Therefore, there is a growing need to explore natural alternatives with fewer side effects. The study utilized various experimental models to assess the effects of the extract. The results demonstrated a significant analgesic effect of the extract, as evidenced by a reduction in pain induced by acetic acid and hot plate tests. Additionally, the extract exhibited anti-inflammatory effects, as indicated by a decrease in carrageenan-induced paw edema and dextran-induced inflammation. To gain insights into the chemical composition of the extract, HPLC analysis was conducted. The analysis successfully identified and quantified 20 compounds, including luteolin, galangin, catechin, thymol, methylated quercetin, quercetin, rutin, acacetin, hesperidin, apigenin, kaempferol, pinocembrin, chrysin, gallic acid, caffeic acid, ascorbic acid, ferulic acid, m-coumaric acid, rosmarinic acid, and trans-cinnamic acid.The findings suggest that Opuntia ficus indica L. extract holds promise as an effective and reasonably priced natural remedy for pain and inflammation in rats and mice model. The comprehensive chemical composition analysis provided valuable insights into the presence of various bioactive compounds, which may contribute to the observed therapeutic effects. Further research and exploration of the extract's mechanisms of action are warranted to fully understand its potential in small animal healthcare.
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Affiliation(s)
- Abdelkader Ammam
- Departement of biology, University Dr Moulay Tahar Saida city AADL Saida N 40, Algeria
| | - Hafidh Zemour
- Faculty of Natural and Life Sciences, Ibn Khaldoun University, Tiaret, BP, Algeria
| | - M’hamed Kaid
- Laboratoire des études physico-chimiques. Faculté des sciences.Université de Saïda, BP, Algeria
| | | | - Walid Soufan
- Plant Production Department, College of Food and Agriculture Sciences, King Saud University, Riyadh, Saudi Arabia
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9
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Kananen A, Bernhardsen GP, Lehto SM, Huuskonen P, Kokki H, Keski-Nisula L. Quetiapine and other antipsychotic medications during pregnancy: a 15-year follow-up of a university hospital birth register. Nord J Psychiatry 2023; 77:651-660. [PMID: 37149788 DOI: 10.1080/08039488.2023.2205852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/15/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To survey trends of antipsychotic use during pregnancy and examine the associations between the use of quetiapine or any antipsychotic and adverse obstetric and neonatal outcomes. METHODS Birth register study of 36,083 women who gave birth at Kuopio University Hospital, Finland, between 2002 and 2016. Obstetric and neonatal outcomes between women using quetiapine (N = 152) or any antipsychotic (N = 227) were compared to controls (N = 35,133). RESULTS Altogether 246 (0.7%) women used antipsychotic medications during pregnancy and 153 (62,2%) of these women used quetiapine. Antipsychotic usage increased from 0.4% to 1.0% during the 15-year follow-up. Women using antipsychotics were more likely to smoke, drink alcohol, use illicit drugs, use other psychotropic medications, and have higher pre-pregnancy body mass index. Quetiapine use was associated with higher risk of increased postpartum bleeding in vaginal delivery (aOR 1.65; 95%CI 1.13-2.42), prolonged neonatal hospitalization (≥5 days) (aOR 1.54; 95%CI 1.10-2.15), and higher placental to birth weight ratio (PBW ratio) (aB 0.009; 95%CI 0.002-0.016). Use of any antipsychotic was associated with a higher risk of gestational diabetes mellitus (aOR 1.64; 95%CI 1.19-2.27), increased postpartum bleeding in vaginal delivery (aOR 1.50; 95%CI 1.09-2.07), prolonged neonatal hospitalization (≥5 days) (aOR 2.07; 95%CI 1.57-2.73), and higher PBW ratio (aB 0.007; 95%CI 0.001-0.012). CONCLUSION The use of antipsychotic medications increased among Finnish pregnant women from 2002 to 2016. Pregnant women using antipsychotics appear to have a higher risk for some adverse pregnancy and birth outcomes and may benefit from more frequent maternity care follow-ups.
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Affiliation(s)
- Anniina Kananen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Guro Pauck Bernhardsen
- R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Soili Marianne Lehto
- R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Pasi Huuskonen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Finnish Institute of Occupational Health, Kuopio, Finland
| | - Hannu Kokki
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
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10
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Hong J, Atkinson J, Roddy Mitchell A, Tong S, Walker SP, Middleton A, Lindquist A, Hastie R. Comparison of Maternal Labor-Related Complications and Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks of Gestation vs Expectant Management: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2313162. [PMID: 37171818 PMCID: PMC10182428 DOI: 10.1001/jamanetworkopen.2023.13162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Elective induction of labor at 39 weeks of gestation is common. Thus, there is a need to assess maternal labor-related complications and neonatal outcomes associated with elective induction of labor. Objective To examine maternal labor-related complications and neonatal outcomes following elective induction of labor at 39 weeks compared with expectant management. Data Sources A systematic review of the literature was conducted using the MEDLINE (Ovid), Embase (Ovid), Cochrane Central Library, World Health Organization, and ClinicalTrials.gov databases and registries to search for articles published between database inception and December 8, 2022. Study Selection This systematic review and meta-analysis included randomized clinical trials, cohort studies, and cross-sectional studies reporting perinatal outcomes following induction of labor at 39 weeks vs expectant management. Data Extraction and Synthesis Two reviewers independently assessed study eligibility, extracted data, and assessed studies for bias. Pooled odds ratios (ORs) and 95% CIs were calculated using a random-effects model. This study is reported per the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline, and the protocol was prospectively registered with PROSPERO. Main Outcomes and Measures Maternal outcomes of interest included emergency cesarean section, perineal injury, postpartum hemorrhage, and operative vaginal birth. Neonatal outcomes of interest included admission to the neonatal intensive care unit, low 5-minute Apgar score (<7) after birth, macrosomia, and shoulder dystocia. Results Of the 5827 records identified in the search, 14 studies were eligible for inclusion in this review. These studies reported outcomes for 1 625 899 women birthing a singleton pregnancy. Induction of labor at 39 weeks of gestation was associated with a 37% reduced likelihood of third- or fourth-degree perineal injury (OR, 0.63 [95% CI, 0.49-0.81]), in addition to reductions in operative vaginal birth (OR, 0.87 [95% CI, 0.79-0.97]), macrosomia (OR, 0.66 [95% CI, 0.48-0.91]), and low 5-minute Apgar score (OR, 0.62 [95% CI, 0.40-0.96]). Results were similar when confined to multiparous women only, with the addition of a substantial reduction in the likelihood of emergency cesarean section (OR, 0.61 [95% CI, 0.38-0.98]) and no difference in operative vaginal birth (OR, 1.01 [95% CI, 0.84-1.21]). However, among nulliparous women only, induction of labor was associated with an increased likelihood of shoulder dystocia (OR, 1.22 [95% CI, 1.02-1.46]) compared with expectant management. Conclusions and Relevance In this study, induction of labor at 39 weeks was associated with improved maternal labor-related and neonatal outcomes. However, among nulliparous women, induction of labor was associated with shoulder dystocia. These results suggest that elective induction of labor at 39 weeks may be safe and beneficial for some women; however, potential risks should be discussed with nulliparous women.
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Affiliation(s)
- James Hong
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
| | - Jessica Atkinson
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Alexandra Roddy Mitchell
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anna Middleton
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anthea Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Evaluation of the effect of dinoprostone vaginal ovule for cervical maturation and labor induction in term pregnancies on the duration of the third stage of labor and amount of postpartum bleeding. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Background/Aim: Postpartum bleeding is a leading preventable cause of maternal death. Prolonged 3rd stage duration of labor and induction agents can increase postpartum bleeding. This study evaluated the effect of using a dinoprostone (PGE2) vaginal insert, a cervical ripening and labor induction agent, on the 3rd stage duration of labor and the amount of postpartum bleeding.
Methods: This prospective cross-sectional study involved 301 patients with vaginal delivery between 01.10.2020 and 30.06.2021. Patients were separated into two groups: PGE2+oxytocin (Group A) and only oxytocin (Group B). They were compared in terms of prepartum and postpartum data, 3rd stage duration of labor, and the amount of blood loss in the first 18 h postpartum.
Results: The median 3rd stage duration of labor was 8 min in Group A and 7 min in Group B (P=0.009). No significant differences were found between the groups in the amount of postpartum blood loss, percentage changes in hemoglobin and hematocrit values, or when patients were analyzed based on 3rd stage duration of labor (≤10 vs. >10 min). Severe postpartum hemorrhage (≥1000 ml) was associated with decreased gravida, increased body mass index, longer oxytocin use, and prolonged 3rd stage duration of labor in all patients. In Group A, severe postpartum hemorrhage was associated with decreased gravida, increased body mass index, and longer duration of PGE2 use.
Conclusion: PGE2 prolonged the 3rd stage duration of labor, but this did not increase postpartum bleeding compared to oxytocin. However, an increase in the duration of PGE2 use was associated with postpartum hemorrhage. Therefore, shortening the duration may be considered in patients with additional risk for postpartum hemorrhage.
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Buckley S, Uvnäs-Moberg K, Pajalic Z, Luegmair K, Ekström-Bergström A, Dencker A, Massarotti C, Kotlowska A, Callaway L, Morano S, Olza I, Magistretti CM. Maternal and newborn plasma oxytocin levels in response to maternal synthetic oxytocin administration during labour, birth and postpartum - a systematic review with implications for the function of the oxytocinergic system. BMC Pregnancy Childbirth 2023; 23:137. [PMID: 36864410 PMCID: PMC9979579 DOI: 10.1186/s12884-022-05221-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/15/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The reproductive hormone oxytocin facilitates labour, birth and postpartum adaptations for women and newborns. Synthetic oxytocin is commonly given to induce or augment labour and to decrease postpartum bleeding. AIM To systematically review studies measuring plasma oxytocin levels in women and newborns following maternal administration of synthetic oxytocin during labour, birth and/or postpartum and to consider possible impacts on endogenous oxytocin and related systems. METHODS Systematic searches of PubMed, CINAHL, PsycInfo and Scopus databases followed PRISMA guidelines, including all peer-reviewed studies in languages understood by the authors. Thirty-five publications met inclusion criteria, including 1373 women and 148 newborns. Studies varied substantially in design and methodology, so classical meta-analysis was not possible. Therefore, results were categorized, analysed and summarised in text and tables. RESULTS Infusions of synthetic oxytocin increased maternal plasma oxytocin levels dose-dependently; doubling the infusion rate approximately doubled oxytocin levels. Infusions below 10 milliunits per minute (mU/min) did not raise maternal oxytocin above the range observed in physiological labour. At high intrapartum infusion rates (up to 32 mU/min) maternal plasma oxytocin reached 2-3 times physiological levels. Postpartum synthetic oxytocin regimens used comparatively higher doses with shorter duration compared to labour, giving greater but transient maternal oxytocin elevations. Total postpartum dose was comparable to total intrapartum dose following vaginal birth, but post-caesarean dosages were higher. Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus. CONCLUSIONS Synthetic oxytocin infusion during labour increased maternal plasma oxytocin levels 2-3-fold at the highest doses and was not associated with neonatal plasma oxytocin elevations. Therefore, direct effects from synthetic oxytocin transfer to maternal brain or fetus are unlikely. However, infusions of synthetic oxytocin in labour change uterine contraction patterns. This may influence uterine blood flow and maternal autonomic nervous system activity, potentially harming the fetus and increasing maternal pain and stress.
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Affiliation(s)
- Sarah Buckley
- grid.1003.20000 0000 9320 7537Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Zada Pajalic
- grid.463529.f0000 0004 0610 6148Faculty for Health Sciences, VID Specialized University, Oslo, Norway
| | - Karolina Luegmair
- grid.9018.00000 0001 0679 2801Institute for Health Care and Nursing Studies, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Anette Ekström-Bergström
- grid.412716.70000 0000 8970 3706Department of Health Sciences, University West, Trollhättan, Sweden
| | - Anna Dencker
- grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Claudia Massarotti
- grid.5606.50000 0001 2151 3065Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alicja Kotlowska
- grid.11451.300000 0001 0531 3426Department of Clinical and Experimental Endocrinology, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | - Leonie Callaway
- grid.1003.20000 0000 9320 7537Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sandra Morano
- grid.5606.50000 0001 2151 3065Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Ibone Olza
- European Institute of Perinatal Mental Health, Madrid, Spain
| | - Claudia Meier Magistretti
- grid.425064.10000 0001 2191 8943Institute for Health Policies, Prevention and Health Promotion, Lucerne University of Applied Sciences and Arts, Luzern, Switzerland
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Wesselius SM, Hammiche F, Ravelli AC, Pajkrt E, Kamphuis EI, de Groot CJ. Decrease in perinatal mortality after closure of obstetric services in a community hospital in Amsterdam, The Netherlands. A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 284:189-199. [PMID: 37028203 DOI: 10.1016/j.ejogrb.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To assess differences in adverse maternal and neonatal outcomes before and after closure of a secondary obstetric care unit of a community hospital in an urban district. STUDY DESIGN Retrospective cohort study using aggregated data from National Perinatal Registry of the Netherlands (PERINED) in the very urban region of Amsterdam, consisting of data of five secondary and two tertiary hospitals. We assessed maternal and neonatal outcomes in singleton hospital births between 24+0 weeks of gestational age (GA) up to 42+6 weeks. Data of 78.613 births were stratified in two groups: before closure (years 2012-2015) and after closure (2016-2019). RESULTS Perinatal mortality decreased significantly from 0.84 % to 0.63 % (p = 0.0009). The adjusted odds ratio (aOR) of the closure on perinatal mortality was 0.73 (95 % CI 0.62-0.87). Both antepartum death (0.46 % vs 0.36 %, p = 0.02) and early neonatal death (0.38 % vs 0.28 %, p = 0.015) declined after closure of the hospital. The number of preterm births decreased significantly (8.7 % vs 8.1 %, p=<0.007) as well as number of neonates with congenital abnormalities (3.2 % vs2.2 %, p=<0.0001). APGAR < 7 after 5 min increased (2.3 % vs 2.5 %, p = 0.04). There was no significant difference in SGA or NICU admission. Postpartum hemorrhage increased significantly from 7.7 % to 8.2 % (p=<0.003). Perinatal mortality from 32 weeks onwards was not significantly different after closure 0.29 % to 0.27 %. CONCLUSIONS After closure of an obstetric unit in a community hospital in Amsterdam, there was a significant decrease in perinatal, intrapartum and early neonatal mortality in neonates born from 24+0 onwards. The mortality decrease coincides with a reduction of preterm deliveries. The increasing trend in asphyxia and postpartum hemorrhage is of concern.. Centralization of care and increasing birth volume per hospital may lead to improvement of quality of care. A broad integrated, multidisciplinary maternity healthcare system linked with the social domain can achieve health gains in maternity care for all women.
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14
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Corbett GA, Dicker P, Daly S. Onset and outcomes of spontaneous labour in low risk nulliparous women. Eur J Obstet Gynecol Reprod Biol 2022; 274:142-147. [PMID: 35640443 DOI: 10.1016/j.ejogrb.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of this study was to: 1. Establish the median gestational age of spontaneous labour for low-risk nulliparas. 2. Examine the variation in mode of delivery and short-term neonatal outcomes with gestation at onset of spontaneous labour. STUDY DESIGN This is a retrospective observational cohort study conducted at a tertiary obstetric unit. The study population was 12, 323 low risk nulliparous women with singleton pregnancies who experienced spontaneous onset of labour. The study period was over seven years, from Jan 1st 2011 to 31st Dec 2017. Exclusion criteria were multiparity, multi-fetal pregnancy, booking after 14 weeks gestation, antepartum or intrapartum death, or any obstetric or fetal indication for delivery with the exception of post-maturity. Gestation of onset of spontaneous labour, demographic variables and maternal and neonatal outcomes were collected. The primary outcome was median gestational age at onset of spontaneous labour and its distribution at term. Secondary outcomes were mode of delivery and neonatal outcomes including low-apgar score and NICU admission. RESULTS 12, 323 patients were eligible for inclusion. Median gestation for onset of labour was 40.1 weeks gestation, with 80.5% of spontaneous labour occurs by 41 + 0 weeks gestation. The risk of assisted delivery (RR 1.32, 95% CI 1.23 - 1.42), caesarean section (RR 2.17, 95% CI 1.88-2.51) and low-apgar scores (RR 3.13 95% CI 1.50-6.55) increased significantly with spontaneous labour after 41 weeks' gestation. CONCLUSIONS Nulliparous women with low-risk pregnancies are most likely to experience spontaneous labour between 40 + 0 and 40 + 6. 80.5% of spontaneous labour occurred by 41 + 0 weeks gestation. Assisted vaginal delivery, caesarean section and low-apgar scores were significantly more likely with spontaneous labour after 41 weeks' gestation.
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Affiliation(s)
- Gillian A Corbett
- Department of Obstetrics and Gynaecology, The Coombe Women and Infants' University Hospital, Dublin, Ireland.
| | - Patrick Dicker
- Departments of Epidemiology and Public Health Medicine and Obstetrics and Gynaecology, Royal College of Surgeons, Ireland
| | - Sean Daly
- Department of Obstetrics and Gynaecology, The Coombe Women and Infants' University Hospital, Dublin, Ireland
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Kumar B, Kumari S, Hughes S, Savill S. Prospective cohort study of induction of labor: Indications, outcome and postpartum hemorrhage. Eur J Midwifery 2021; 5:53. [PMID: 34825132 PMCID: PMC8582328 DOI: 10.18332/ejm/142782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study was undertaken because of the increasing rate of induction of labor (IOL) in our hospital and its associated higher caesarean section (CS) rates. The objective was to ascertain the incidence, indications, methods, outcome, and complications of IOL, in particular postpartum hemorrhage. METHODS This was a prospective observational cohort study of women who underwent IOL in a medium-sized district general hospital. Blood loss was measured by the gravimetric method and correlated to postpartum hemoglobin level within 48 hours of birth. RESULTS A total of 445 women needed IOL (incidence 33%). Common indications were: small for gestational age (SGA) or fetal growth restriction (FGR) (18%), spontaneous rupture of membrane (17%), reduced fetal movement (16%), prolonged pregnancy (15%), and diabetes (13%). In all, 67% women achieved spontaneous vaginal delivery and 18% underwent caesarean section. With regard to blood loss, 62 women (14%) had postpartum hemorrhage (PPH) of >1000 mL and 22 women (4.9%) had a blood loss >1500 mL. The caesarean section rate was higher than the overall emergency caesarean section rate in that year. Incidence of PPH in this cohort was higher than the normal incidence. CONCLUSIONS Increasing trend of induction of labor (IOL) is due to the changing clinical policy on management of small for gestational age babies, spontaneous rupture of membrane, reduced fetal movement and other complications of pregnancy. There is conflicting evidence on the effect of IOL on caesarean section rates. IOL is a risk factor for PPH. Accurate measurement of blood loss is essential in detecting a fall in hemoglobin which in turn helps in the appropriate management of PPH.
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Affiliation(s)
- Bid Kumar
- Department of Obstetrics and Gynaecology, Wrexham Maelor, Hospital, Wrexham, United Kingdom
| | - Sujatha Kumari
- Department of Obstetrics and Gynaecology, Ysbyty Gwynedd Hospital, Bangor, United Kingdom
| | - Stephen Hughes
- North Wales Clinical Research Centre, Wrexham Technology Park, Wrexham, United Kingdom
| | - Stuart Savill
- North Wales Clinical Research Centre, Wrexham Technology Park, Wrexham, United Kingdom
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Association of Gestational Age with Postpartum Hemorrhage: An International Cohort Study. Anesthesiology 2021; 134:874-886. [PMID: 33760074 DOI: 10.1097/aln.0000000000003730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Risk factors for postpartum hemorrhage, such as chorioamnionitis and multiple gestation, have been identified in previous epidemiologic studies. However, existing data describing the association between gestational age at delivery and postpartum hemorrhage are conflicting. The aim of this study was to assess the association between gestational age at delivery and postpartum hemorrhage. METHODS The authors conducted a population-based retrospective cohort study of women who underwent live birth delivery in Sweden between 2014 and 2017 and in California between 2011 and 2015. The primary exposure was gestational age at delivery. The primary outcome was postpartum hemorrhage, classified using International Classification of Diseases, Ninth Revision-Clinical Modification codes for California births and a blood loss greater than 1,000 ml for Swedish births. The authors accounted for demographic and obstetric factors as potential confounders in the analyses. RESULTS The incidences of postpartum hemorrhage in Sweden (23,323/328,729; 7.1%) and in California (66,583/2,079,637; 3.2%) were not comparable. In Sweden and California, the incidence of postpartum hemorrhage was highest for deliveries between 41 and 42 weeks' gestation (7,186/75,539 [9.5%] and 8,921/160,267 [5.6%], respectively). Compared to deliveries between 37 and 38 weeks, deliveries between 41 and 42 weeks had the highest adjusted odds of postpartum hemorrhage (1.62 [95% CI, 1.56 to 1.69] in Sweden and 2.04 [95% CI, 1.98 to 2.09] in California). In both cohorts, the authors observed a nonlinear (J-shaped) association between gestational age and postpartum hemorrhage risk, with 39 weeks as the nadir. In the sensitivity analyses, similar findings were observed among cesarean deliveries only, when postpartum hemorrhage was classified only by International Classification of Diseases, Tenth Revision-Clinical Modification codes, and after excluding women with abnormal placentation disorders. CONCLUSIONS The postpartum hemorrhage incidence in Sweden and California was not comparable. When assessing a woman's risk for postpartum hemorrhage, clinicians should be aware of the heightened odds in women who deliver between 41 and 42 weeks' gestation. EDITOR’S PERSPECTIVE
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Ejigu AG, Lambyo SH. Predicting factors of failed induction of labor in three hospitals of Southwest Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:387. [PMID: 34011318 PMCID: PMC8132374 DOI: 10.1186/s12884-021-03862-x] [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: 02/09/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Failed induction of labor affects maternal and neonatal outcomes as well as the cost of healthcare, especially in low-resource setting regions in which the prevalence of failed induction is higher despite the incidence of labor induction is low. This study aimed to assess the prevalence of failed induction of labor in southwest Ethiopia. Method A hospital-based cross-sectional study was conducted among 441 induced women from March 1 to August 30, 2018. A systematic random sampling technique was used to select study participants. Data were collected using a pretested and structured questionnaire. Bivariable and multivariable logistic regression models were done and fitted to identify predictors of failed induction. An adjusted odds ratio with 95% confidence interval (CI) was calculated to determine the level of significance. Result Premature rupture of membrane was the most common cause of labor induction and the commonly used method of labor induction were oxytocin infusion. Cesarean section was done for 28.1% of induced women. Failed induction of labor was found to be 21%. Primiparous [AOR = 2.35 (1.35–4.09)], analgesia/anesthesia [AOR = 4.37 (1.31–14.59)], poor Bishop Score [AOR = 2.37 (1.16–4.84)], Birth weight ≥ 4 k grams [AOR = 2.12 (1.05–4.28)] and body mass index [AOR = 5.71 (3.26–10.01)] were found to be significantly associated with failed induction of labor. Conclusion The prevalence of failed induction of labour was found to be high. Preparation of the cervix before induction in primi-parity women is suggested to improve the success of induction. To achieve the normal weight of women and newborns, proper nutritional interventions should be given for women of reproductive age. It is better to use analgesia/anesthesia for labor induction when it becomes mandatory and there are no other optional methods of no- pharmacologic pain management. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03862-x.
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Affiliation(s)
- Amare Genetu Ejigu
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia.
| | - Shewangizaw H/Mariam Lambyo
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia
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van der Nelson H, O'Brien S, Burnard S, Mayer M, Alvarez M, Knowlden J, Winter C, Dailami N, Marques E, Burden C, Siassakos D, Draycott T. Intramuscular oxytocin versus Syntometrine ® versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life. BJOG 2021; 128:1236-1246. [PMID: 33300296 DOI: 10.1111/1471-0528.16622] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare intramuscular oxytocin, Syntometrine® and carbetocin for prevention of postpartum haemorrhage after vaginal birth. DESIGN Randomised double-blinded clinical trial. SETTING Six hospitals in England. POPULATION A total of 5929 normotensive women having a singleton vaginal birth. METHODS Randomisation when birth was imminent. MAIN OUTCOME MEASURES Primary: use of additional uterotonic agents. Secondary: weighed blood loss, transfusion, manual removal of placenta, adverse effects, quality of life. RESULTS Participants receiving additional uterotonics: 368 (19.5%) oxytocin, 298 (15.6%) Syntometrine and 364 (19.1%) carbetocin. When pairwise comparisons were made: women receiving carbetocin were significantly more likely to receive additional uterotonics than those receiving Syntometrine (odds ratio [OR] 1.28, 95% CI 1.08-1.51, P = 0.004); the difference between carbetocin and oxytocin was non-significant (P = 0.78); Participants receiving Syntometrine were significantly less likely to receive additional uterotonics than those receiving oxytocin (OR 0.75, 95% CI 0.65-0.91, P = 0.002). Non-inferiority between carbetocin and Syntometrine was not shown. Use of Syntometrine reduced non-drug PPH treatments compared with oxytocin (OR 0.64, 95% CI 0.42-0.97) but not carbetocin (P = 0.64). Rates of PPH and blood transfusion were not different. Syntometrine was associated with an increase in maternal adverse effects and reduced ability of the mother to bond with her baby. CONCLUSIONS Non-inferiority of carbetocin to Syntometrine was not shown. Carbetocin is not significantly different to oxytocin for use of additional uterotonics. Use of Syntometrine reduced use of additional uterotonics and need for non-drug PPH treatments compared with oxytocin. Increased maternal adverse effects are a disadvantage of Syntometrine. TWEETABLE ABSTRACT IM carbetocin does not reduce additional uterotonic use compared with IM Syntometrine or oxytocin.
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Affiliation(s)
- H van der Nelson
- North Bristol NHS Trust, Bristol, UK.,University of Bristol, Bristol, UK
| | - S O'Brien
- North Bristol NHS Trust, Bristol, UK.,University of Bristol, Bristol, UK
| | - S Burnard
- Royal United Hospitals NHS Trust, Bath, UK
| | - M Mayer
- North Bristol NHS Trust, Bristol, UK
| | - M Alvarez
- North Bristol NHS Trust, Bristol, UK
| | | | - C Winter
- North Bristol NHS Trust, Bristol, UK
| | - N Dailami
- University of the West of England, Bristol, UK
| | - E Marques
- North Bristol NHS Trust, Bristol, UK
| | - C Burden
- North Bristol NHS Trust, Bristol, UK.,University of Bristol, Bristol, UK
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Shinohara S, Okuda Y, Hirata S, Suzuki K. Predictive factors for secondary postpartum hemorrhage: a case-control study in Japan. J Matern Fetal Neonatal Med 2020; 35:3943-3947. [PMID: 33167729 DOI: 10.1080/14767058.2020.1844654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Secondary postpartum hemorrhage (PPH) is defined as excessive vaginal blood loss occurring between 24 h and 6-12 weeks after birth. The incidence of secondary PPH varies from 0.2% to 3.0%, and the peak incidence ranges from 1 to 2 weeks postpartum. There is no clinical evidence regarding the cause of secondary PPH. Therefore, this study aimed to determine the predictive factors for secondary PPH in an Asian population. METHODS A case-control study was performed. The clinical data of 25 secondary PPH patients who had been admitted to our hospital between June 2012 and January 2019 were obtained for this study. Control patients (n = 100) were selected from pregnant women who delivered at the hospital during the same period; they were matched to secondary PPH patients using propensity score matching to adjust for maternal age at delivery, parity, and the use of assisted reproductive technology (ART). A multiple logistic regression analysis was used to determine the predictive factors for secondary PPH. RESULTS The median maternal age was 34 years (range, 24-42 years); 85 (68.0%) women were nulliparous, 31 (24.8%) used ART, and 116 (92.8%) had term deliveries. Immediate PPH (adjusted odds ratio [OR], 2.84; 95% confidence interval [CI], 1.04-7.75) and manual removal of the placenta (adjusted OR, 6.14; 95% CI, 1.21-31.1) were associated with secondary PPH. CONCLUSION Increasing the awareness of the predictive factors for secondary PPH could play an important role in the recognition and treatment of postpartum morbidity.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Yasuhiko Okuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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20
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Erickson EN, Carlson NS. Predicting Postpartum Hemorrhage After Low-Risk Vaginal Birth by Labor Characteristics and Oxytocin Administration. J Obstet Gynecol Neonatal Nurs 2020; 49:549-563. [PMID: 32971015 DOI: 10.1016/j.jogn.2020.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine the odds of postpartum hemorrhage (PPH) in low-risk women who gave birth vaginally and were exposed to different durations and dosages of oxytocin across a range of labor durations during spontaneous or induced labor. DESIGN A retrospective cross-sectional analysis of data from the Consortium for Safe Labor. SETTING Data were gathered from 12 clinical institutions across the United States from 2002 to 2008. PARTICIPANTS After exclusion of high-risk conditions associated with PPH, we examined data from 27,072 women who gave birth vaginally. METHODS PPH was defined as estimated blood loss of greater than 500 ml at the time of birth and/or a diagnostic code for PPH before hospital discharge. We included covariates were if they were associated with oxytocin use and PPH and did not mediate oxytocin use. We used regression models to determine the likelihood of PPH overall and within the induced and spontaneous labor groups separately. We used subgroup analyses within specific durations of labor to clarify the findings. RESULTS The overall rate of PPH was 3.9%. Women with induced labor experienced PPH more frequently than women who labored spontaneously. Labor augmentation was associated with greater adjusted odds for PPH when oxytocin was infused for more than 4 hours. Longer duration of spontaneous labor and the second stage of labor did not change this association. Oxytocin use during labor induction increased the odds for PPH when administered for more than 7 hours. The odds further increased when induction lasted longer than 12 hours and/or the second stage of labor was longer than 3 hours. CONCLUSION Strategies for judicious oxytocin administration may help mitigate PPH in low-risk women having vaginal birth.
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21
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Vecchioli E, Cordier AG, Chantry A, Benachi A, Monier I. Maternal and neonatal outcomes associated with induction of labor after one previous cesarean delivery: A French retrospective study. PLoS One 2020; 15:e0237132. [PMID: 32764773 PMCID: PMC7413415 DOI: 10.1371/journal.pone.0237132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/21/2020] [Indexed: 12/03/2022] Open
Abstract
Background The safety of methods of labor induction in women with previous cesarean deliveries is still debated. We investigated perinatal outcomes associated with labor induction among women with a trial of labor after one cesarean delivery. Methods This retrospective study included 339 women with a trial of labor after one prior cesarean and a singleton term fetus in cephalic presentation in 2013–2016 in a French maternity unit. Labor induction was performed with oxytocin, artificial rupture of membranes and/or prostaglandin E2, according to the Bishop score. The primary outcome was a composite of uterine rupture, low Apgar score, neonatal resuscitation or admission to a neonatal unit. The secondary outcomes included cesarean delivery after onset of labor, postpartum hemorrhage and maternal hospital stay after delivery. We used logistic regression to estimate odds ratios adjusted (aOR) for potential confounders. Results In our sample, 67.3% of women had spontaneous labor and 32.7% were induced. More than half of the women received oxytocin during labor regardless of the mode of labor. The proportions of the composite outcome and of cesarean after onset of labor were higher in the induced group compared to the spontaneous group (26.1% vs 15.8%, p = 0.02 and 45.0% vs 27.6%, p<0.01, respectively). There were 9 uterine ruptures (2.6%) and this proportion was higher in the induced group compared to the spontaneous group, although this difference was not statistically significant (3.6% vs 2.2%, p = 0.48). After adjustment, labor induction was associated with higher risks of the composite outcome (aOR = 2.45, 95% CI: 1.29–4.65), cesarean after onset of labor (aOR = 2.06, 95% CI: 1.15–3.68) and maternal hospital stay after delivery ≥6 days (aOR = 6.20, 95% CI: 3.25–11.81). No association was found with postpartum hemorrhage. Conclusion Labor induction after one prior cesarean was associated with a higher risk of adverse perinatal outcome. Nevertheless, the higher proportion of uterine rupture did not differ significantly from that in the spontaneous labor group.
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Affiliation(s)
- Emma Vecchioli
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
- Midwifery School of Baudelocque, Paris-Descartes University, AP-HP, DHU Risks in Pregnancy, Paris, France
| | - Anne-Gaël Cordier
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
| | - Anne Chantry
- Midwifery School of Baudelocque, Paris-Descartes University, AP-HP, DHU Risks in Pregnancy, Paris, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université de Paris, Epidemiology and Statistics Research Center (CRESS), INSERM, INRA, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
| | - Isabelle Monier
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université de Paris, Epidemiology and Statistics Research Center (CRESS), INSERM, INRA, Paris, France
- * E-mail:
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22
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The Effect of Pregnancy in the Hemoglobin Concentration of Pregnant Women: A Longitudinal Study. J Pregnancy 2020; 2020:2789536. [PMID: 32566297 PMCID: PMC7290874 DOI: 10.1155/2020/2789536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background The objective of this study was to estimate and identify the determinants of hemoglobin concentration before pregnancy, during pregnancy, and after labor and delivery. Methods A prospective cohort study design was implemented. Data were collected from May 2015 to September 2018. A simple random sampling technique was used to select the participants. An interview technique was used to collect the data. Blood samples were collected before pregnancy, during each trimester, during labor and delivery, after third stage of labor, and at the 6-week postpartum period. Descriptive statistics were used to describe the profile of study participants. Generalized estimating equations were used to identify the determinants of hemoglobin concentration during each phase of pregnancy. Results The mean hemoglobin concentrations of primigravida and multigravida before pregnancy were 12.41 g/dl and 10.78 g/dl, respectively. The hemoglobin concentration decreases with consecutive trimester reaching the lowest level at 42 days after delivery. The hemoglobin concentrations of pregnant women were decreased by hookworm 0.24 g/dl [95% CI:0.18-0.29], multiple pregnancy 0.16 g/dl [95% CI: 0.07-0.24], episiotomy 0.05 g/dl [95% CI: 0.01-0.09], gravidity 0.15 g/dl [95% CI: 0.09-0.21], age 0.03 g/dl [95% CI: 0.03-0.04], and gestational age 0.1 g/dl [95% CI: 0.09-0.11]. The hemoglobin concentration increased by iron supplementation 1.02 g/dl [95% CI: 0.97-1.07] and birth weight 0.14 g/dl [95% CI: 0.02-0.11]. Conclusion Pregnancy significantly decreases the hemoglobin concentration of pregnant women reaching the lowest point during labor and delivery. Recommendation. Regular anemia screening intervention should be implemented after delivery.
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23
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Erickson EN, Lee CS, Carlson NS. Predicting Postpartum Hemorrhage After Vaginal Birth by Labor Phenotype. J Midwifery Womens Health 2020; 65:609-620. [PMID: 32286002 DOI: 10.1111/jmwh.13104] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Postpartum hemorrhage (PPH) is an important contributor to maternal morbidity and mortality. Predicting which laboring women are likely to have a PPH is an active area of research and a component of quality improvement bundles. The purpose of this study was to identify phenotypes of labor processes (ie, labors that have similar features, such as duration and type of interventions) in a cohort of women who had vaginal births, estimate the likelihood of PPH by phenotype, and analyze how maternal and fetal characteristics relate to PPH risk by phenotype. METHODS This study utilized the Consortium for Safe Labor dataset (2002-2008) and examined term, singleton, vaginal births. Using 16 variables describing the labor and birth processes, a latent class analysis was performed to describe distinct labor process phenotypes. RESULTS Of 24,729 births, 1167 (4.72%) women experienced PPH. Five phenotypes best fit the data, reflecting labor interventions, duration, and complications. Women who had shorter duration of admission after spontaneous labor onset (admitted in latent or active labor) had the lowest rate of PPH (3.8%-3.9%). The 2 phenotypes of labor progress characterized by women who had complicated prolonged labors (spontaneous or induced) had the highest rate of PPH (8.0% and 12.0%, respectively). However, the majority of PPH (n = 881, 75%) occurred in the phenotypes with fewer complications. Prepregnancy body mass index did not predict PPH. Overall, the odds of PPH were highest among nulliparous women (odds ratio [OR], 1.52; 95% CI, 1.30-1.77), as well as Black women (OR, 1.39; 95% CI, 1.13-1.73) and Hispanic women (OR, 1.85; 95% CI, 1.56-2.20). Within phenotypes, maternal race and ethnicity, nulliparity, macrosomia, hypertension, and depression were associated with increased odds of PPH. DISCUSSION Women who were classified into a lower-risk labor phenotype and still experienced PPH were more likely to be nulliparous, a person of color, or diagnosed with hypertension.
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Affiliation(s)
- Elise N Erickson
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts
| | - Nicole S Carlson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Arthuis C, Diguisto C, Lorphelin H, Dochez V, Simon E, Perrotin F, Winer N. Perinatal outcomes of intrahepatic cholestasis during pregnancy: An 8-year case-control study. PLoS One 2020; 15:e0228213. [PMID: 32074108 PMCID: PMC7029845 DOI: 10.1371/journal.pone.0228213] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/10/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Previous studies of fetal effects have suggested that intrahepatic cholestasis of pregnancy is associated with a higher rate of adverse neonatal outcomes including preterm birth, neonatal respiratory distress syndrome, meconium-stained amniotic fluid, neonatal intensive care unit admission, and stillbirth. The objective was to compare the neonatal and maternal consequences in pregnancies affected by intrahepatic cholestasis and normal pregnancies. MATERIAL AND METHODS This case-control study compares pregnancies affected by intrahepatic cholestasis (pruritus and bile acid ≥ 10 μmol/L) with low-risk pregnancies managed between December 2006 and December 2014 at a French university hospital center. RESULTS There were 83 (59.3%) cases of mild cholestasis (10≤ BA ≤39 μmol/L), 46 (32.8%) of moderate cholestasis (40≤ BA ≤99 μmol/L), and 11 (7.9%) of severe cholestasis (BA ≥100 μmol/L). No in utero fetal deaths occurred in the 140 women with cholestasis or the 560 controls analyzed. The rate of respiratory distress syndrome was higher in neonates of women with intrahepatic cholestasis (17.1% vs. 4.6%, P<0.001; crude OR 4.46 (CI95% 2.49-8.03)). This risk was also significant after adjustment for gestational age at birth and mode of delivery, adjusted OR 2.56 (CI95%1.26-5.18). The postpartum hemorrhage rate was twice as high among the case mothers (25% versus 14.1% for controls, P = 0.002). CONCLUSION After adjustment on the confounding factors we found a higher rate of respiratory distress syndrome and neonatal morbidity among neonates of the cholestasis group.
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Affiliation(s)
- Chloé Arthuis
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
- Department of Gynecology and Obstetrics, University Hospital Center Nantes, Nantes, France
- * E-mail:
| | - Caroline Diguisto
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
| | - Henri Lorphelin
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
| | - Vincent Dochez
- Department of Gynecology and Obstetrics, University Hospital Center Nantes, Nantes, France
| | - Emmanuel Simon
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
| | - Franck Perrotin
- Department of Gynecology and Obstetrics, University Hospital Regional Center Tours, Tours, France
| | - Norbert Winer
- Department of Gynecology and Obstetrics, University Hospital Center Nantes, Nantes, France
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Abstract
OBJECTIVES For many years, routine elective induction of labour at gestational week (GW) 42+0 has been recommended in Denmark. In 2011, a more proactive protocol was introduced aimed at reducing stillbirths, and practice changed into earlier routine induction, i.e. between 41+3 and 41+5 GW. The present study evaluates a national change in induction of labour regime. The trend of maternal and neonatal consequences are monitored in the preintervention period (2000-2010) compared with the postintervention period (2012-2016). DESIGN A national retrospective register-based cohort study. SETTING Denmark. PARTICIPANTS All births in Denmark 41+3 to 45+0 GWs between 2000 and 2016 (N = 152 887). OUTCOME MEASURES Primary outcomes: stillbirths, perinatal death, and low Apgar scores. Additional outcomes: birth interventions and maternal outcomes. RESULTS For the primary outcomes, no differences in stillbirths, perinatal death, and low Apgar scores were found comparing the preintervention and postintervention period. Of additional outcomes, the trend changed significantly postintervention concerning use of augmentation of labour, epidural analgesia, induction of labour and uterine rupture (all p<0.05). There was no significant change in the trend for caesarean section and instrumental birth. Most notable for clinical practice was the increase in induction of labour from 41% to 65% (p<0.01) at 41+3 weeks during 2011 as well as the rare occurrence of uterine ruptures (from 2.6 to 4.2 per thousand, p<0.02). CONCLUSIONS Evaluation of a more proactive regimen recommending induction of labour from GW 41+3 compared with 42+0 using national register data found no differences in neonatal outcomes including stillbirth. The number of women with induced labour increased significantly.
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Affiliation(s)
- Eva Rydahl
- Department of Midwifery, University College Copenhagen, Copenhagen N, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus N, Denmark
| | - Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mette Juhl
- Department of Midwifery, University College Copenhagen, Copenhagen N, Denmark
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus Universitet, Aarhus N, Denmark
- Department of Gynaecology Obstetrics, Aarhus University Hospital, Aarhus Universitet, Aarhus, Denmark
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Delporte V, Grabarz A, Ramdane N, Bodart S, Debarge V, Subtil D, Garabedian C. Cesarean during labor: Is induction a risk factor for complications? J Gynecol Obstet Hum Reprod 2019; 48:757-761. [PMID: 31479772 DOI: 10.1016/j.jogoh.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Evaluate the impact of labor induction on maternal complications following caesarean section during labor. MATERIAL AND METHODS Retrospective, single-center study between 2015 and 2017. Were included singleton pregnancies who had cesarean section during labor after 37WG. Labor induction procedures included either transcervical balloon catheters or prostaglandins. Degree of emergency of the cesarean was decided according to color code (green, orange and red). We identified and compared intra and postoperative complications according to the mode of labor onset, and then to the mode of labor induction. RESULTS 882 patients were included, 416 with spontaneous labor and 464 with labor induction. No significant difference was found for postoperative complications between the two groups. Patients with spontaneous labor had fewer green-code caesareans than patients with elective induction (29.3% vs. 40.3% p<0.001) and had more uterine pedicle injuries (6.3% vs. 3.0% p=0.022). Nevertheless, no difference was found for postpartum hemorrhage (PPH) between these two groups (41.59% vs. 43.32% p=0.60). The subgroup study of patients with labor induction showed that those necessitating 2 methods of labor induction had more severe PPH (22.2% vs. 8.1% p after Bonferroni correction = 0.002). CONCLUSIONS Elective induction does not result in an increased risk of cesarean section during labor complications. Only the use of prostaglandin following transcervical balloon catheter increased the risk of severe postpartum hemorrhage.
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Affiliation(s)
- Victoire Delporte
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France.
| | - Anne Grabarz
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France
| | - Nassima Ramdane
- Univ. Lille, CHU Lille, EA 2694 - Public Health: Epidemiology and Quality of Patient Care, F-59000 Lille, France
| | - Sophie Bodart
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France
| | - Véronique Debarge
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France; University of Lille, EA 4489 - Perinatal Health and Environment, F-59000 Lille, France
| | - Damien Subtil
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France
| | - Charles Garabedian
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France
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27
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Induction of labor and postpartum blood loss. BMC Pregnancy Childbirth 2019; 19:265. [PMID: 31345178 PMCID: PMC6659310 DOI: 10.1186/s12884-019-2410-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To analyze blood loss after delivery in women with induction of labor compared to women with spontaneous onset of labor. METHODS In this secondary analysis of a prospective cohort study investigating postpartum hemorrhage, 965 deliveries were analyzed including 380 women with induction of labor (39%) between 2015 and 2016. Primary outcome parameters were rate of postpartum hemorrhage, estimated blood loss and post-partum decrease in hemoglobin. RESULTS Rates of postpartum hemorrhage and estimated blood loss were not significantly different in women with induction of labor. Women with induction of labor had a significantly reduced decrease in hemoglobin after delivery. In the multivariate linear regression analysis, induction of labor remained associated with reduced decrease in hemoglobin. Secondary maternal and neonatal outcomes were unaffected. CONCLUSIONS Induction of labor is not associated with increased blood loss after delivery and should not be regarded as a risk factor for postpartum hemorrhage.
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Erickson EN, Lee CS, Grose E, Emeis C. Physiologic childbirth and active management of the third stage of labor: A latent class model of risk for postpartum hemorrhage. Birth 2019; 46:69-79. [PMID: 30168198 PMCID: PMC8191508 DOI: 10.1111/birt.12384] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/23/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is a threat to maternal mortality worldwide. Evidence supports active management of third stage labor (AMTSL) for preventing PPH. However, trials of AMTSL include women at varying risk levels, such as women undergoing physiologic labor and those with labor complications. Counseling women about their risk for PPH and AMTSL is difficult as many women who appear low-risk can still have PPH. METHODS This study uses outcomes of 2322 vaginal births from a hospital midwifery service in the United States to examine risks for PPH and effectiveness of AMTSL. Using a latent class analysis approach, physiologic birth practices and other risk factors for PPH were analyzed to understand if discrete classes of clinical characteristics would emerge. The effect of AMTSL on the PPH outcome was also considered by class. RESULTS A four-class solution best fit the data; each class was clinically distinct. The two largest Classes (A and B) represented women with term births and lower average parity, with higher rates of nulliparity in Class B. Class A women had more physiologic birth elements and less labor induction or labor dysfunction compared with Class B. PPH and AMTSL use was higher in Class B. In Class B, AMTSL lowered risk for PPH. However, in Class A, AMTSL was associated with higher risk for PPH and delayed placental delivery (>30 minutes). DISCUSSION AMTSL may not be as beneficial to women undergoing physiologic birth. Further study of the etiology of PPH in these women is indicated to inform preventive care.
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Affiliation(s)
| | | | - Emily Grose
- Southdale ObGyn Consultants in Edina, Edina, Minnesota
| | - Cathy Emeis
- Oregon Health and Science University, Portland, Oregon
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29
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Shinohara S, Okuda Y, Hirata S, Suzuki K. Association between time from cessation of oxytocin infusion for labor to delivery and intraoperative severe blood loss during cesarean section: a retrospective cohort study. J Matern Fetal Neonatal Med 2018; 33:1532-1537. [PMID: 30196739 DOI: 10.1080/14767058.2018.1521798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: Prolonged oxytocin infusion during labor results in receptor desensitization and increases the risk of obstetric hemorrhage. We aimed to examine the association between recovery time (RT) and intraoperative severe blood loss in women who underwent a cesarean section after oxytocin pretreatment.Methods: We retrospectively assessed 103 Japanese women who underwent cesarean section after oxytocin pretreatment. RT (time from cessation of oxytocin infusion during labor to delivery) and intraoperative severe blood loss (active bleeding exceeding 1000 mL) were measured. Confounding factors were controlled, and RT cut-off value associated with severe blood loss and association between RT and intraoperative severe blood loss were assessed.Results: The mean maternal age was 34 years, and 100 (97.1%) women delivered at term. Mean RT was 121.6 min. The overall incidence of intraoperative severe blood loss was 22.3% (23/103). The cut-off point to predict intraoperative severe blood loss was 96 min (sensitivity, 65.2%; specificity, 81.3%). On multivariate analysis, an RT of ≤96 min [adjusted odds ratio (OR), 11.9; 95% confidence interval (CI), 3.32-42.7] and macrosomia (adjusted OR, 3.91; 95% CI, 1.10-13.8) were associated with intraoperative severe blood loss.Conclusions: Consideration of RT is helpful in the management of women undergoing cesarean section after oxytocin pretreatment.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yasuhiko Okuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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Bouchè C, Wiesenfeld U, Ronfani L, Simeone R, Bogatti P, Skerk K, Ricci G. Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage. Ther Clin Risk Manag 2018; 14:1671-1675. [PMID: 30254448 PMCID: PMC6140737 DOI: 10.2147/tcrm.s150049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background/aim Clinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population. Patients and methods A retrospective cohort study evaluated 78,542 consecutive women who had a vaginal delivery between 24th and 44th weeks of gestation. The women who had undergone cesarean section were excluded to avoid possible bias. Postpartum blood loss was measured with graduated blood sack. Postpartum blood loss between 1,000 and 2,000 mL and >2,000 mL were classified as moderate and severe PPH, respectively. Results A total of 74,144 patients were available for analysis. According to the color of amniotic fluid (AF), two groups of patients were identified: MSAF (n=10,997) and clear AF (n=63,147). The rates of severe and massive PPH were found to be significantly higher in the MSAF group than that of clear AF group (OR=1.3, 95% CI: 1.2-1.5, p<0.001 and OR=2.5, 95% CI: 1.5-4.2, p<0.001). Operative vaginal delivery rate was found to be higher in the MSAF group than that of clear AF group, but the difference was only borderline significant (OR=1.5, 95% CI: 1.0-2.2, p=0.05). There were no significant differences between the MSAF and the clear AF groups with respect to episiotomies, second- or third-degree perineal tears, vaginal-perineal thrombus, cervical lacerations, vaginal births after cesarean section, twin deliveries, and placental retention rates. Conclusion To the best of our knowledge, this is the first clinical study that has investigated the role of MSAF as a risk factor for PPH after vaginal delivery in an unselected population. Our results suggest that MSAF is significantly associated with higher risk of moderate and severe PPH than clear AF.
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Affiliation(s)
- Carlo Bouchè
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Uri Wiesenfeld
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Luca Ronfani
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Roberto Simeone
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy,
| | - Paolo Bogatti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Kristina Skerk
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy, .,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy,
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Flood M, McDonald SJ, Pollock W, Cullinane F, Davey M. Incidence, trends and severity of primary postpartum haemorrhage in Australia: A population‐based study using Victorian Perinatal Data Collection data for 764 244 births. Aust N Z J Obstet Gynaecol 2018; 59:228-234. [DOI: 10.1111/ajo.12826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/10/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Margaret Flood
- Judith Lumley CentreSchool of Nursing and MidwiferyLa Trobe University Melbourne Victoria Australia
| | - Susan J. McDonald
- School of Nursing and MidwiferyLa Trobe University Melbourne Victoria Australia
| | - Wendy Pollock
- School of Nursing and MidwiferyLa Trobe University Melbourne Victoria Australia
- Maternal Critical Care Melbourne Victoria Australia
- Department of NursingThe University of Melbourne Melbourne Victoria Australia
| | - Fiona Cullinane
- Maternity ServicesRoyal Women's Hospital Melbourne Victoria Australia
| | - Mary‐Ann Davey
- Department of Obstetrics and GynaecologyMonash University Melbourne Victoria Australia
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Biesty LM, Egan AM, Dunne F, Smith V, Meskell P, Dempsey E, Ni Bhuinneain GM, Devane D. Planned birth at or near term for improving health outcomes for pregnant women with pre-existing diabetes and their infants. Cochrane Database Syst Rev 2018; 2:CD012948. [PMID: 29423911 PMCID: PMC6491338 DOI: 10.1002/14651858.cd012948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pregnant women with pre-existing diabetes (Type 1 or Type 2) have increased rates of adverse maternal and neonatal outcomes. Current clinical guidelines support elective birth, at or near term, because of increased perinatal mortality during the third trimester of pregnancy.This review replaces a review previously published in 2001 that included "diabetic pregnant women", which has now been split into two reviews. This current review focuses on pregnant women with pre-existing diabetes (Type 1 or Type 2) and a sister review focuses on women with gestational diabetes. OBJECTIVES To assess the effect of planned birth (either by induction of labour or caesarean birth) at or near term gestation (37 to 40 weeks' gestation) compared with an expectant approach, for improving health outcomes for pregnant women with pre-existing diabetes and their infants. The primary outcomes relate to maternal and perinatal mortality and morbidity. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (15 August 2017), and reference lists of retrieved studies. SELECTION CRITERIA We planned to include randomised trials (including those using a cluster-randomised design) and non-randomised trials (e.g. quasi-randomised trials using alternate allocation) which compared planned birth, at or near term, with an expectant approach for pregnant women with pre-existing diabetes. DATA COLLECTION AND ANALYSIS Two of the review authors independently assessed study eligibility. In future updates of this review, at least two of the review authors will extract data and assess the risk of bias in included studies. We will also assess the quality of the evidence using the GRADE approach. MAIN RESULTS We identified no eligible published trials for inclusion in this review.We did identify one randomised trial which examined whether expectant management reduced the incidence of caesarean birth in uncomplicated pregnancies of women with gestational diabetes (requiring insulin) and with pre-existing diabetes. However, published data from this trial does not differentiate between pre-existing and gestational diabetes, and therefore we excluded this trial. AUTHORS' CONCLUSIONS In the absence of evidence, we are unable to reach any conclusions about the health outcomes associated with planned birth, at or near term, compared with an expectant approach for pregnant women with pre-existing diabetes.This review demonstrates the urgent need for high-quality trials evaluating the effectiveness of planned birth at or near term gestation for pregnant women with pre-existing (Type 1 or Type 2) diabetes compared with an expectant approach.
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Affiliation(s)
- Linda M Biesty
- National University of Ireland GalwaySchool of Nursing and MidwiferyAras MoyolaGalwayIreland
| | - Aoife M Egan
- National University of Ireland Galway/University Hospital GalwayGalway Diabetes Research CentreNewcastle RoadGalwayIreland
| | | | - Valerie Smith
- Trinity College DublinSchool of Nursing and Midwifery24 D'Olier StreetDublinIreland2
| | - Pauline Meskell
- University of LimerickDepartment of Nursing and MidwiferyHealth Sciences BuildingUniversity of LimerickLimerickIreland
| | - Eugene Dempsey
- Cork University Maternity HospitalNeonatologyWiltonCorkIreland
| | - G Meabh Ni Bhuinneain
- Mayo University Hospital, SaoltaDepartment of Obstetrics and GynaecologyWestport RoadCastlebarMayoIreland
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyAras MoyolaGalwayIreland
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Biesty LM, Egan AM, Dunne F, Dempsey E, Meskell P, Smith V, Ni Bhuinneain GM, Devane D. Planned birth at or near term for improving health outcomes for pregnant women with gestational diabetes and their infants. Cochrane Database Syst Rev 2018; 1:CD012910. [PMID: 29303230 PMCID: PMC6491311 DOI: 10.1002/14651858.cd012910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gestational diabetes is a type of diabetes that occurs during pregnancy. Women with gestational diabetes are more likely to experience adverse health outcomes such as pre-eclampsia or polyhydramnios (excess amniotic fluid). Their babies are also more likely to have health complications such as macrosomia (birthweight > 4000 g) and being large-for-gestational age (birthweight above the 90th percentile for gestational age). Current clinical guidelines support elective birth, at or near term in women with gestational diabetes to minimise perinatal complications, especially those related to macrosomia.This review replaces a review previously published in 2001 that included "diabetic pregnant women", which has now been split into two reviews. This current review focuses on pregnant women with gestational diabetes and a sister review focuses on women with pre-existing diabetes (Type 1 or Type 2). OBJECTIVES To assess the effect of planned birth (either by induction of labour or caesarean birth), at or near term (37 to 40 weeks' gestation) compared with an expectant approach for improving health outcomes for women with gestational diabetes and their infants. The primary outcomes relate to maternal and perinatal mortality and morbidity. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (15 August 2017), and reference lists of retrieved studies. SELECTION CRITERIA We included randomised trials comparing planned birth, at or near term (37 to 40 weeks' gestation), with an expectant approach, for women with gestational diabetes. Cluster-randomised and non-randomised trials (e.g. quasi-randomised trials using alternate allocation) were also eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS Two of the review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included study. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS The findings of this review are based on a single trial involving 425 women with gestational diabetes. The trial compared induction of labour with expectant management (waiting for the spontaneous onset of labour in the absence of any maternal or fetal issues that may necessitate birth) in pregnant women with gestational diabetes at term. We assessed the overall risk of bias as being low for most domains, apart from performance, detection and attrition bias (for outcome perineum intact), which we assessed as being at high risk. It was an open-label trial, and women and healthcare professionals were not blinded.There were no clear differences between women randomised to induction of labour and women randomised to expectant management for maternal mortality or serious maternal morbidity (risk ratio (RR) 1.48, 95% confidence interval (CI) 0.25 to 8.76, one trial, 425 women); caesarean section (RR 1.06, 95% CI 0.64 to 1.77, one trial, 425 women); or instrumental vaginal birth (RR 0.81, 95% CI 0.45 to 1.46, one trial, 425 women). For the primary outcome of maternal mortality or serious maternal morbidity, there were no deaths in either group and serious maternal morbidity related to admissions to intensive care unit. The quality of the evidence contributing to these outcomes was assessed as very low, mainly due to the study having high risk of bias for some domains and because of the imprecision of effect estimates.In relation to primary neonatal outcomes, there were no perinatal deaths in either group. The quality of evidence for this outcome was judged as very low, mainly due to high risk of bias and imprecision of effect estimates. There were no clear differences in infant outcomes between women randomised to induction of labour and women randomised to expectant management: shoulder dystocia (RR 2.96, 95% CI 0.31 to 28.21, one trial, 425 infants, very low-quality evidence); large-for-gestational age (RR 0.53, 95% CI 0.28 to 1.02, one trial, 425 infants, low-quality evidence).There were no clear differences between women randomised to induction of labour and women randomised to expectant management for postpartum haemorrhage (RR 1.17, 95% CI 0.53 to 2.54, one trial, 425 women); admission to intensive care unit (RR 1.48, 95% CI 0.25 to 8.76, one trial, 425 women); and intact perineum (RR 1.02, 95% CI 0.73 to 1.43, one trial, 425 women). No infant experienced a birth trauma, therefore, we could not draw conclusions about the effect of the intervention on the outcomes of brachial plexus injury and bone fracture at birth. Infants of women in the induction-of-labour group had higher incidences of neonatal hyperbilirubinaemia (jaundice) when compared to infants of women in the expectant-management group (RR 2.46, 95% CI 1.11 to 5.46, one trial, 425 women).We found no data on the following prespecified outcomes of this review: postnatal depression, maternal satisfaction, length of postnatal stay (mother), acidaemia, intracranial haemorrhage, hypoxia ischaemic encephalopathy, small-for-gestational age, length of postnatal stay (baby) and cost.The authors of this trial acknowledge that it is underpowered for their primary outcome of caesarean section. The authors of the trial and of this review note that the CIs demonstrate a wide range, therefore making it inappropriate to draw definite conclusions. AUTHORS' CONCLUSIONS There is limited evidence to inform implications for practice. The available data are not of high quality and lack power to detect possible important differences in either benefit or harm. There is an urgent need for high-quality trials evaluating the effectiveness of planned birth at or near term gestation for women with gestational diabetes compared with an expectant approach.
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Affiliation(s)
- Linda M Biesty
- National University of Ireland GalwaySchool of Nursing and MidwiferyAras MoyolaGalwayIreland
| | - Aoife M Egan
- National University of Ireland Galway/University Hospital GalwayGalway Diabetes Research CentreNewcastle RoadGalwayIreland
| | | | - Eugene Dempsey
- Cork University Maternity HospitalNeonatologyWiltonCorkIreland
| | - Pauline Meskell
- University of LimerickDepartment of Nursing and MidwiferyHealth Sciences BuildingUniversity of LimerickLimerickIreland
| | - Valerie Smith
- Trinity College DublinSchool of Nursing and Midwifery24 D'Olier StreetDublinIreland2
| | - G Meabh Ni Bhuinneain
- Mayo University Hospital, SaoltaDepartment of Obstetrics and GynaecologyWestport RoadCastlebarMayoIreland
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyAras MoyolaGalwayIreland
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Kjerulff KH, Attanasio LB. Validity of Birth Certificate and Hospital Discharge Data Reporting of Labor Induction. Womens Health Issues 2018; 28:82-88. [DOI: 10.1016/j.whi.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 12/17/2022]
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Abstract
BACKGROUND This is one of a series of reviews of methods of cervical ripening and labour induction. The use of complementary therapies is increasing. Women may look to complementary therapies during pregnancy and childbirth to be used alongside conventional medical practice. Acupuncture involves the insertion of very fine needles into specific points of the body. Acupressure is using the thumbs or fingers to apply pressure to specific points. The limited observational studies to date suggest acupuncture for induction of labour has no known adverse effects to the fetus, and may be effective. However, the evidence regarding the clinical effectiveness of this technique is limited. OBJECTIVES To determine, from the best available evidence, the effectiveness and safety of acupuncture and acupressure for third trimester cervical ripening or induction of labour. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2016), PubMed (1966 to 25 November 2016), ProQuest Dissertations & Theses (25 November 2016), CINAHL (25 November 2016), Embase (25 November 2016), the WHO International Clinical Trials Registry Portal (ICTRP) (3 October 2016), and bibliographies of relevant papers. SELECTION CRITERIA Randomised controlled trials comparing acupuncture or acupressure, used for third trimester cervical ripening or labour induction, with placebo/no treatment or other methods on a predefined list of labour induction methods. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy. The quality of the evidence was assessed using GRADE. MAIN RESULTS This updated review includes 22 trials, reporting on 3456 women. The trials using manual or electro-acupuncture were compared with usual care (eight trials, 760 women), sweeping of membranes (one trial, 207 women), or sham controls (seven trials, 729 women). Trials using acupressure were compared with usual care (two trials, 151 women) or sham controls (two trials, 239 women). Many studies had a moderate risk of bias.Overall, few trials reported on primary outcomes. No trial reported vaginal delivery not achieved within 24 hours and uterine hyperstimulation with fetal heart rate (FHR) changes. Serious maternal and neonatal death or morbidity were only reported under acupuncture versus sham control. Acupuncture versus sham control There was no clear difference in caesarean sections between groups (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.56 to 1.15, eight trials, 789 women; high-quality evidence). There were no reports of maternal death or perinatal death in the one trial that reported this outcome. There was evidence of a benefit from acupuncture in improving cervical readiness for labour (mean difference (MD) 0.40, 95% CI 0.11 to 0.69, one trial, 125 women), as measured by cervical maturity within 24 hours using Bishop's score. There was no evidence of a difference between groups for oxytocin augmentation, epidural analgesia, instrumental vaginal birth, meconium-stained liquor, Apgar score < 7 at five minutes, neonatal intensive care admission, maternal infection, postpartum bleeding greater than 500 mL, time from the trial to time of birth, use of induction methods, length of labour, and spontaneous vaginal birth. Acupuncture versus usual care There was no clear difference in caesarean sections between groups (average RR 0.77, 95% CI 0.51 to 1.17, eight trials, 760 women; low-quality evidence). There was an increase in cervical maturation for the acupuncture (electro) group compared with control (MD 1.30, 95% CI 0.11 to 2.49, one trial, 67 women) and a shorter length of labour (minutes) in the usual care group compared to electro-acupuncture (MD 124.00, 95% CI 37.39 to 210.61, one trial, 67 women).There appeared be a differential effect according to type of acupuncture based on subgroup analysis. Electro-acupuncture appeared to have more of an effect than manual acupuncture for the outcomes caesarean section (CS), and instrumental vaginal and spontaneous vaginal birth. It decreased the rate of CS (average RR 0.54, 95% CI 0.37 to 0.80, 3 trials, 327 women), increased the rate of instrumental vaginal birth (average RR 2.30, 95%CI 1.15 to 4.60, two trials, 271 women), and increased the rate of spontaneous vaginal birth (average RR 2.06, 95% CI 1.20 to 3.56, one trial, 72 women). However, subgroup analyses are observational in nature and so results should be interpreted with caution.There were no clear differences between groups for other outcomes: oxytocin augmentation, use of epidural analgesia, Apgar score < 7 at 5 minutes, neonatal intensive care admission, maternal infection, perineal tear, fetal infection, maternal satisfaction, use of other induction methods, and postpartum bleeding greater than 500 mL. Acupuncture versus sweeping if fetal membranes One trial of acupuncture versus sweeping of fetal membranes showed no clear differences between groups in caesarean sections (RR 0.64, 95% CI 0.34 to 1.22, one trial, 207 women, moderate-quality evidence), need for augmentation, epidural analgesia, instrumental vaginal birth, Apgar score < 7 at 5 minutes, neonatal intensive care admission, and postpartum bleeding greater than 500 mL. Acupressure versus sham control There was no evidence of benefit from acupressure in reducing caesarean sections compared to control (RR, 0.94, 95% CI 0.68 to 1.30, two trials, 239 women, moderate-quality evidence). There was no evidence of a clear benefit in reduced oxytocin augmentation, instrumental vaginal birth, meconium-stained liquor, time from trial intervention to birth of the baby, and spontaneous vaginal birth. Acupressure versus usual care There was no evidence of benefit from acupressure in reducing caesarean sections compared to usual care (RR 1.02, 95% CI 0.68 to 1.53, two trials, 151 women, moderate-quality evidence). There was no evidence of a clear benefit in reduced epidural analgesia, Apgar score < 7 at 5 minutes, admission to neonatal intensive care, time from trial intervention to birth of the baby, use of other induction methods, and spontaneous vaginal birth. AUTHORS' CONCLUSIONS Overall, there was no clear benefit from acupuncture or acupressure in reducing caesarean section rate. The quality of the evidence varied between low to high. Few trials reported on neonatal morbidity or maternal mortality outcomes. Acupuncture showed some benefit in improving cervical maturity, however, more well-designed trials are needed. Future trials could include clinically relevant safety outcomes.
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Affiliation(s)
- Caroline A Smith
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797SydneyNew South WalesAustralia2751
| | - Mike Armour
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797SydneyNew South WalesAustralia2751
| | - Hannah G Dahlen
- Western Sydney UniversitySchool of Nursing and MidwiferyLocked Bag 1797PenrithNSWAustralia2751
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Erickson EN, Lee CS, Emeis CL. Role of Prophylactic Oxytocin in the Third Stage of Labor: Physiologic Versus Pharmacologically Influenced Labor and Birth. J Midwifery Womens Health 2017; 62:418-424. [DOI: 10.1111/jmwh.12620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 11/29/2022]
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Nyfløt LT, Sandven I, Stray-Pedersen B, Pettersen S, Al-Zirqi I, Rosenberg M, Jacobsen AF, Vangen S. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy Childbirth 2017; 17:17. [PMID: 28068990 PMCID: PMC5223545 DOI: 10.1186/s12884-016-1217-0] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 12/29/2016] [Indexed: 11/16/2022] Open
Abstract
Background In high-income countries, the incidence of severe postpartum hemorrhage (PPH) has increased. This has important public health relevance because severe PPH is a leading cause of major maternal morbidity. However, few studies have identified risk factors for severe PPH within a contemporary obstetric cohort. Methods We performed a case-control study to identify risk factors for severe PPH among a cohort of women who delivered at one of three hospitals in Norway between 2008 and 2011. A case (severe PPH) was classified by an estimated blood loss ≥1500 mL or the need for blood transfusion for excessive postpartum bleeding. Using logistic regression, we applied a pragmatic strategy to identify independent risk factors for severe PPH. Results Among a total of 43,105 deliveries occurring between 2008 and 2011, we identified 1064 cases and 2059 random controls. The frequency of severe PPH was 2.5% (95% confidence interval (CI): 2.32–2.62). The most common etiologies for severe PPH were uterine atony (60%) and placental complications (36%). The strongest risk factors were a history of severe PPH (adjusted OR (aOR) = 8.97, 95% CI: 5.25–15.33), anticoagulant medication (aOR = 4.79, 95% CI: 2.72–8.41), anemia at booking (aOR = 4.27, 95% CI: 2.79–6.54), severe pre-eclampsia or HELLP syndrome (aOR = 3.03, 95% CI: 1.74–5.27), uterine fibromas (aOR = 2.71, 95% CI: 1.69–4.35), multiple pregnancy (aOR = 2.11, 95% CI: 1.39–3.22) and assisted reproductive technologies (aOR = 1.88, 95% CI: 1.33–2.65). Conclusions Based on our findings, women with a history of severe PPH are at highest risk of severe PPH. As well as other established clinical risk factors for PPH, a history of severe PPH should be included as a risk factor in the development and validation of prediction models for PPH.
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Affiliation(s)
- Lill Trine Nyfløt
- Division of Gynecology and Obstetrics, Oslo University Hospital, Rikshospitalet, P.O.box 4950, Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 1171, Blindern, 0318, Oslo, Norway. .,Department of Gynecology and Obstetrics, Drammen Hospital, P.O.box 800, 3004, Drammen, Norway.
| | - Irene Sandven
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Sogn Arena, P.O.box 4950, Nydalen, 0424, Oslo, Norway
| | - Babill Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 1171, Blindern, 0318, Oslo, Norway
| | - Silje Pettersen
- Division of Gynecology and Obstetrics, Oslo University Hospital, Rikshospitalet, P.O.box 4950, Nydalen, 0424, Oslo, Norway
| | - Iqbal Al-Zirqi
- Division of Gynecology and Obstetrics, Oslo University Hospital, Rikshospitalet, P.O.box 4950, Nydalen, 0424, Oslo, Norway
| | - Margit Rosenberg
- Department of Gynecology and Obstetrics, Drammen Hospital, P.O.box 800, 3004, Drammen, Norway
| | - Anne Flem Jacobsen
- Division of Gynecology and Obstetrics, Oslo University Hospital, Rikshospitalet, P.O.box 4950, Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 1171, Blindern, 0318, Oslo, Norway
| | - Siri Vangen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 1171, Blindern, 0318, Oslo, Norway.,Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, P.o.box 4950, Nydalen, 0424, Oslo, Norway
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Initial management of postpartum hemorrhage: A cohort study in Benin and Mali. Int J Gynaecol Obstet 2016; 135 Suppl 1:S84-S88. [PMID: 27836091 DOI: 10.1016/j.ijgo.2016.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the components of initial management associated with a decreased risk of severe postpartum hemorrhage (PPH) in Benin and Mali. METHODS A cohort study was conducted between May 2013 and September 2014 that included all women who delivered vaginally in seven participating centers and who presented excessive bleeding after birth. Severe PPH was defined as PPH that required surgical treatment (vascular ligature and/or hysterectomy), and/or blood transfusion, and/or transfer to an intensive care unit, and/or an outcome of maternal death. Logistic regression was used to identify the components of initial PPH management that were associated with severe PPH, adjusting for case mix. RESULTS A total of 223 women presented a primary PPH presumably caused by uterine atony. Among those, 88 (39.5%) had severe PPH. Nearly one-third of women (30.4%) had a late injection of oxytocin (>10 minutes) after PPH diagnosis or no injection. Oxytocin injection within 10 minutes after the PPH diagnosis was significantly associated with a decreased risk of severe PPH (adjusted OR=0.3; 95% CI, 0.14-0.77). CONCLUSION Decrease in the delays in oxytocin administration is a key determinant to improve maternal outcomes related to PPH in this context.
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Risk factors for post-partum hemorrhage following vacuum assisted vaginal delivery. Arch Gynecol Obstet 2016; 295:75-80. [DOI: 10.1007/s00404-016-4208-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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Springhall E, Wallace EM, Stewart L, Knight M, Mockler JC, Davies-Tuck M. Customised management of the third stage of labour. Aust N Z J Obstet Gynaecol 2016; 57:302-307. [PMID: 27593398 DOI: 10.1111/ajo.12517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postpartum haemorrhage (PPH) rates are increasing worldwide. The rate is particularly high in women undergoing an induced or augmented labour. In response to this, we altered our hospital's protocol for the management of the third stage of labour to recommend Syntometrine, in preference to oxytocin alone, for women being induced or augmented. We set out to assess the impact of the protocol change on the PPH rate. MATERIALS AND METHODS A random sample of 1200 women who had a singleton, term vaginal birth before and after the protocol change was taken. Exclusion criteria were then applied to match PPH risk status. Using a quasi-experimental study design, PPH rates were compared between women who had received oxytocin or Syntometrine for third stage management. RESULTS Five hundred and forty-nine women received oxytocin prior to the protocol change and were compared with 333 women who received Syntometrine after protocol change. There was no difference in the PPH rate with respect to uterotonic used (P = 0.9). There was no evidence of an interaction between labour type, third stage uterotonic and PPH (P = 0.4). PPH rates were lowest for women who laboured spontaneously and received Syntometrine (19% oxytocin, 14% Syntometrine). The PPH rate was unchanged by uterotonic in women whose labour was augmented (34% for both). PPH was more common in women being induced who received Syntometrine (22% oxytocin, 27% Syntometrine). None of these differences were statistically significant. CONCLUSION Compared to oxytocin, Syntometrine did not reduce the rate of PPH in women with augmented or induced labour. Other approaches to reducing PPH rates are required.
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Affiliation(s)
- Edward Springhall
- Monash Women's Services, Monash Health, Melbourne, Victoria, Australia
| | - Euan M Wallace
- Monash Women's Services, Monash Health, Melbourne, Victoria, Australia.,The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Lynne Stewart
- Monash Women's Services, Monash Health, Melbourne, Victoria, Australia
| | - Michelle Knight
- Monash Women's Services, Monash Health, Melbourne, Victoria, Australia
| | - Joanne C Mockler
- Monash Women's Services, Monash Health, Melbourne, Victoria, Australia.,The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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42
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Thangarajah F, Scheufen P, Kirn V, Mallmann P. Induction of Labour in Late and Postterm Pregnancies and its Impact on Maternal and Neonatal Outcome. Geburtshilfe Frauenheilkd 2016; 76:793-798. [PMID: 27582577 DOI: 10.1055/s-0042-107672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION This study aimed to determine the effects of induction of labour in late-term pregnancies on the mode of delivery, maternal and neonatal outcome. METHODS We retrospectively analyzed deliveries between 2000 and 2014 at the University Hospital of Cologne. Women with a pregnancy aged between 41 + 0 to 42 + 6 weeks were included. Those who underwent induction of labour were compared with women who were expectantly managed. Maternal and neonatal outcomes were evaluated. RESULTS 856 patients were included into the study. The rate of cesarean deliveries was significantly higher for the induction of labour group (33.8 vs. 21.1 %, p < 0.001). Aside from the more frequent occurrence of perineal lacerations (induction of labour group vs. expectantly managed group = 38.1 % compared with 26.4 %, p = 0.002) and all types of lacerations (induction of labour group vs. expectantly managed group = 61.5% vs. 52.2 %, p = 0.021) in women with vaginal delivery, there were no significant differences in maternal outcome. Besides, no differences regarding neonatal outcome were observed. CONCLUSIONS Our study suggests that induction of labour in late and postterm pregnancies is associated with a significantly higher cesarean section rate. Other maternal and fetal parameters were not influenced by induction of labour.
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Affiliation(s)
- F Thangarajah
- University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - P Scheufen
- University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - V Kirn
- University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - P Mallmann
- University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
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Nair M, Choudhury MK, Choudhury SS, Kakoty SD, Sarma UC, Webster P, Knight M. Association between maternal anaemia and pregnancy outcomes: a cohort study in Assam, India. BMJ Glob Health 2016; 1:e000026. [PMID: 28588921 PMCID: PMC5321311 DOI: 10.1136/bmjgh-2015-000026] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives To examine the association between maternal anaemia and adverse maternal and infant outcomes, and to assess the feasibility of conducting epidemiological studies through the Indian Obstetric Surveillance System–Assam (IndOSS-Assam). Design Retrospective cohort study using anonymised hospital records. Exposure: maternal iron deficiency anaemia; outcomes: postpartum haemorrhage (PPH), low birthweight, small-for-gestational age babies, perinatal death. Setting 5 government medical colleges in Assam. Study population 1007 pregnant women who delivered in the 5 medical colleges from January to June 2015. Main outcome measures ORs with 95% CIs to estimate the association between maternal iron deficiency anaemia and the adverse maternal and infant outcomes. Potential interactive roles of infections and induction of labour on the adverse outcomes were explored. Results 35% (n=351) pregnant women had moderate–severe anaemia. Women with severe anaemia had a higher odds of PPH (adjusted OR (aOR) =9.45; 95% CI 2.62 to 34.05), giving birth to low birthweight (aOR=6.19; 95% CI 1.44 to 26.71) and small-for-gestational age babies (aOR=8.72; 95% CI 1.66 to 45.67), and perinatal death (aOR=16.42; 95% CI 4.38 to 61.55). Odds of PPH increased 17-fold among women with moderate–severe anaemia who underwent induction of labour, and 19-fold among women who had infection and moderate–severe anaemia. Conclusions Maternal iron deficiency anaemia is a major public health problem in Assam. Maternal anaemia was associated with increased risks of PPH, low birthweight, small-for-gestational age babies and perinatal death. While the best approach is prevention, a large number of women present with severe anaemia late in pregnancy and there is no clear guidance on how these women should be managed during labour and delivery.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Manoj K Choudhury
- Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India
| | | | | | - Umesh C Sarma
- Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India
| | | | - Marian Knight
- NPEU, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Coulm B, Blondel B, Alexander S, Boulvain M, Le Ray C. Elective induction of labour and maternal request: a national population-based study. BJOG 2015; 123:2191-2197. [PMID: 26615965 DOI: 10.1111/1471-0528.13805] [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: 10/13/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the rate of elective inductions in France and the proportion of them that were maternally requested, and to study the factors associated with elective inductions that were or were not requested by women. DESIGN Cross-sectional population-based study. SETTING All maternity units in France. POPULATION About 14 681 women from the 2010 French National Perinatal Survey of a representative sample of births. METHODS Inductions were classified as elective based on their indications and maternal and fetal characteristics, collected from medical records. Elective inductions requested by women were identified from the mother's postpartum interviews. Polytomous logistic regression analysis was used to study the determinants of inductions that were or were not maternally requested. Women with spontaneous labour served as the comparison group. MAIN OUTCOME MEASURE Rate of elective inductions. RESULTS The induction rate was 22.6, 13.9% elective. Among elective inductions, 47.3% were requested by women. The characteristics of mothers, pregnancies, and maternity units were similar in both groups of elective inductions. The main associated factors were parity 2 or more [adjusted odds ratio (OR) 4.7, 95% confidence interval (CI) 3.1-7.2 for maternally requested inductions and aOR of 1.8 (95% CI1.2-2.7) for unrequested inductions, compared with parity 0] and private hospital status [aOR 4.5 95% (CI 3.3-6.0) for maternally requested inductions and aOR 3.7 (95% CI 2.8-4.9) for inductions not requested by the mother]. We found no association between maternal social characteristics and type of elective induction. CONCLUSION Parity and organisational factors appear to influence the decision about elective inductions. It would be interesting to determine how obstetricians and women make this decision and for what reasons. TWEETABLE ABSTRACT About 13.9% of inductions of labour were elective in France, 47.3% of these requested by women.
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Affiliation(s)
- B Coulm
- INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics (U1153), DHU Risk in Pregnancy, Paris-Descartes University, Paris, France
| | - B Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics (U1153), DHU Risk in Pregnancy, Paris-Descartes University, Paris, France
| | - S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - M Boulvain
- Department of Obstetrics and Gynaecology, University Hospitals of Geneva, Geneva, Switzerland
| | - C Le Ray
- INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics (U1153), DHU Risk in Pregnancy, Paris-Descartes University, Paris, France.,Maternité Port Royal, Hôpital Cochin Saint-Vincent-de-Paul, Assistance Publique Hôpitaux de Paris, Paris-Descartes University, Paris, France
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Macharey G, Ulander VM, Kostev K, Väisänen-Tommiska M, Ziller V. Emergency peripartum hysterectomy and risk factors by mode of delivery and obstetric history: a 10-year review from Helsinki University Central Hospital. J Perinat Med 2015; 43:721-8. [PMID: 24756039 DOI: 10.1515/jpm-2013-0348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to estimate the occurrence of emergency peripartum hysterectomy (EPH) and to quantify its risk factors in connection with the mode of delivery and the obstetric history of patients at the Helsinki University Central Hospital, Finland. METHODS In a retrospective, matched case-control study we identified 124 cases of EPH from 2000 to 2010 at our hospital. These were matched with 248 control patients. RESULTS The incidence rate of EPH was 9.9/10,000. Patients whose current delivery was vaginal, and had a cesarean section (CS) in their history had a six-fold risk for EPH. Women who underwent their first CS had a nine times higher risk, while patients who currently underwent CS and had a history of previous CS, had a 22 times higher risk. Those who experienced prostaglandin-E1 induction had a five-fold risk. Maternal age >35 years, previous curettage, and twin pregnancy were identified as significant risk factors. In 41 cases, interventions to reduce bleeding were performed. CONCLUSION Obstetric emergency training and guidelines for massive hemorrhage should be established in any delivery department. Moreover, all possible precautions should be taken to avoid the first CS if it is obstetrically unnecessary. Induction with prostaglandin-E1, maternal age >35 years, previous curettage, twin pregnancies, and early gestation were identified as risk factors for EPH.
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Bonsack CF, Lathrop A, Blackburn M. Induction of Labor: Update and Review. J Midwifery Womens Health 2014; 59:606-615. [DOI: 10.1111/jmwh.12255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Straface G, Bassi E, De Santis M, Scambia G, Zanardo V. Tranfusion risk: is "two-step" vaginal delivery a risk for postpartum hemorrhage? J Matern Fetal Neonatal Med 2014; 28:2172-5. [PMID: 25354292 DOI: 10.3109/14767058.2014.980232] [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: 11/13/2022]
Abstract
OBJECTIVE In the active management strategy of third stage of labor, the optimal timing for clamping the umbilical cord after birth has been a subject of controversy. We want to evaluate if "two-step" delivery is a risk factor for postpartum hemorrhage (PPH), defined as need of transfusion, comparing to operative delivery, elective caesarean delivery and emergency caesarean delivery. METHODS This is a retrospective cohort study conducted in division of Perinatal Medicine, Policlinico Abano Terme. We evaluated the need of transfusion in all cases of PPH verified in all single deliveries between January 2011 and December 2012. The main outcome measure was blood loss and red blood cell transfusion. RESULTS We found 17 cases of PPH (0.88%). The distribution of PPH in relation to mode of delivery was 0.71%, 2.46% and 1.98% respectively for two-step vaginal delivery (RR = 0.81 (0.56-1.22)), emergency cesarean section (RR = 2.88 (1.27-7.77)) and operative vaginal delivery (RR = 2.88 (0.59-5.66)). In labor induction there is a stronger relative risk association between PPH and as emergency cesarean delivery (p < 0.05) as operative vaginal delivery (p < 0.05). CONCLUSION "Two-step" delivery approach did not increase the risk of PPH with respect to operative delivery, elective caesarean section and emergency caesarean section.
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Affiliation(s)
- Gianluca Straface
- a Division of Perinatal Medicine , Policlinico Abano Terme , Abano Terme , Italy and
| | - Emma Bassi
- a Division of Perinatal Medicine , Policlinico Abano Terme , Abano Terme , Italy and
| | - Marco De Santis
- b Department of Obstetrics and Gynaecology , Catholic University of Sacred Heart , Rome , Italy
| | - Giovanni Scambia
- b Department of Obstetrics and Gynaecology , Catholic University of Sacred Heart , Rome , Italy
| | - Vincenzo Zanardo
- a Division of Perinatal Medicine , Policlinico Abano Terme , Abano Terme , Italy and
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Faraoni D, Carlier C, Samama CM, Levy JH, Ducloy-Bouthors AS. [Efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of post-partum haemorrhage: a systematic review with meta-analysis]. ACTA ACUST UNITED AC 2014; 33:563-71. [PMID: 25450729 DOI: 10.1016/j.annfar.2014.07.748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/10/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE(S) Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage. STUDY DESIGN Systematic review with meta-analysis. MATERIAL AND METHODS Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage. RESULTS Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: -177.9mL, IC 95%: -189.51 to -166.35, total blood loss: -183.94, IC 95%: -198.29 to -169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30 minutes after randomisation (P=0.03) and confirmed after 6 hours (median: 170mL (58-323) vs 221mL (110-543), P=0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration. CONCLUSION Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.
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Affiliation(s)
- D Faraoni
- Service d'anesthésie, hôpital universitaire des enfants Reine-Fabiola, centre hospitalier universitaire (CHU) Brugmann, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique.
| | - C Carlier
- Service d'anesthésie, hôpital universitaire des enfants Reine-Fabiola, centre hospitalier universitaire (CHU) Brugmann, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique
| | - C M Samama
- Service d'anesthésie-réanimation, CHU Cochin, Assistance-publique-Hôpitaux de Paris, 27, rue du Faubourg-St-Jacques, 75014 Paris, France
| | - J H Levy
- Service d'anesthésie-réanimation, Duke University School of Medicine, Durham, 27710 Caroline du Nord, États-Unis
| | - A S Ducloy-Bouthors
- Service d'anesthésie-réanimation, CHRU de Lille Jeanne-de-Flandre, avenue Oscar-Lambret, 59037 Lille, France
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Schierding W, O'Sullivan JM, Derraik JGB, Cutfield WS. Genes and post-term birth: late for delivery. BMC Res Notes 2014; 7:720. [PMID: 25316301 PMCID: PMC4203931 DOI: 10.1186/1756-0500-7-720] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/29/2014] [Indexed: 12/13/2022] Open
Abstract
Background Recent evidence suggests that prolonged pregnancies beyond 42 weeks of gestation (post-term births) are associated with long-term adverse health outcomes in the offspring. Discussion There is evidence that post-term birth has not only environmental causes, but also significant heritability, suggesting genetic and/or epigenetic influences interact with environmental cues to affect gestational length. Summary As prolonged gestation is associated with adverse short- and long-term outcomes in the offspring, further research into the underlying genetic and epigenetic causes of post-term birth could be of importance for improving obstetric management.
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Affiliation(s)
| | | | | | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Incidence, étiologies et facteurs de risque de l’hémorragie du post-partum : étude en population dans 106 maternités françaises. ACTA ACUST UNITED AC 2014; 43:244-53. [DOI: 10.1016/j.jgyn.2013.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/22/2013] [Accepted: 05/15/2013] [Indexed: 11/20/2022]
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