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Jeppegaard M, Larsen MH, Thams AB, Schmidt AB, Rasmussen SC, Krebs L. Incidence of shoulder dystocia and risk factors for recurrence in the subsequent pregnancy-A historical register-based cohort study. Acta Obstet Gynecol Scand 2024. [PMID: 38409800 DOI: 10.1111/aogs.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Shoulder dystocia is a rare obstetric complication, and the risk of recurrence is important for planning future deliveries. MATERIAL AND METHODS The objectives of our study were to estimate the incidence and risk factors for recurrence of shoulder dystocia and to identify women at high risk of recurrence in a subsequent vaginal delivery. The study design was a nationwide register-based study including data from the Danish Medical Birth Registry and National Patient Register in the period 2007-2017. Nulliparous women with a singleton fetus in cephalic presentation were included for analysis of risk factors in index and subsequent delivery. RESULTS During the study period, 6002 cases of shoulder dystocia were reported with an overall incidence among women with vaginal delivery of 1.2%. Among 222 225 nulliparous women with vaginal births, shoulder dystocia complicated 2209 (1.0%) deliveries. A subsequent birth was registered in 1106 (50.1%) of the women with shoulder dystocia in index delivery of which 837 (77.8%) delivered vaginally. Recurrence of shoulder dystocia was reported in 60 (7.2%) with a six-fold increased risk compared with women without a prior history of shoulder dystocia (risk ratio [RR] 5.70, 95% confidence interval [CI]: 4.41 to 7.38; adjusted RR 3.06, 95% CI: 2.03 to 4.68). Low maternal height was a significant risk factor for recurrence of shoulder dystocia. In the subsequent delivery, significant risk factors for recurrence were birthweight >4000 g, positive fetal weight difference exceeding 250 g from index to subsequent delivery, stimulation with oxytocin and operative vaginal delivery. In the subsequent pregnancy following shoulder dystocia, women who underwent a planned cesarean (n = 176) were characterized by more advanced age and a higher prevalence of diabetes in the subsequent pregnancy. Furthermore, they had more often experienced operative vaginal delivery, severe perineal lacerations, and severe neonatal complications at the index delivery. CONCLUSIONS The incidence of shoulder dystocia among nulliparous women with vaginal delivery was 1.0% with a 7.2% risk of recurrence in a population where about 50% had a subsequent birth and of these 78% had subsequent vaginal delivery. Important risk factors for recurrence were low maternal height, increase of birthweight ≥250 g from index to subsequent delivery and operative vaginal delivery.
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Affiliation(s)
- Maria Jeppegaard
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-Holbaek, Holbaek, Denmark
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marie H Larsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - Amalie B Thams
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Amalie B Schmidt
- Department of Gynecology and Obstetrics, Copenhagen University, Hospital-Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Steen C Rasmussen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-Holbaek, Holbaek, Denmark
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Centre of Diagnostic Investigation, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Lone Krebs
- Department of Gynecology and Obstetrics, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Upadhyaya S, Chudal R, Luntamo T, Hinkka‐Yli‐Salomäki S, Sucksdorff M, Lehtonen L, Sourander A. Perinatal risk factors and reactive attachment disorder: A nationwide population-based study. Acta Paediatr 2020; 109:1603-1611. [PMID: 31899934 DOI: 10.1111/apa.15156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 11/28/2022]
Abstract
AIM To examine the association between several perinatal and obstetric risk factors and reactive attachment disorder in children diagnosed in specialised services. METHODS In this nested case-control study, 614 cases with reactive attachment disorder and 2423 controls matched with age and sex were identified from Finnish national registers. Conditional logistic regression was used to examine the association between a number of perinatal risk factors and reactive attachment disorder. RESULTS In the adjusted analysis, a low birthweight of <2500 g was associated with an increased odds of reactive attachment disorder, with an odds ratio (OR) of 1.96 and 95% confidence interval (CI) of 1.17, 3.30 and a birthweight of 4000-4499 grams was associated with decreased odds OR 0.49 (95% CI 0.31, 0.75). The odds for being diagnosed with reactive attachment disorder increased with a gestational age of <32 weeks OR 3.72 (95% CI 1.52, 9.10), induced labour OR 1.34 (95% CI 1.03, 1.75) and monitoring in a neonatal intensive care unit (NICU) OR 1.67 (95% CI 1.09, 2.55). CONCLUSION We found associations between low birthweight, preterm birth, NICU admission and reactive attachment disorder. The findings add to the current literature on the understanding of the development of reactive attachment disorder in children.
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Affiliation(s)
- Subina Upadhyaya
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | - Roshan Chudal
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | - Terhi Luntamo
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | | | - Minna Sucksdorff
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | - Liisa Lehtonen
- Department of Paediatrics Turku University Hospital Turku Finland
- Department of Paediatrics University of Turku Turku Finland
| | - Andre Sourander
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
- Department of Child Psychiatry Turku University Hospital Turku Finland
- INVEST Research Flagship University of Turku Turku Finland
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Gerli S, Fraternale F, Lucarini E, Chiaraluce S, Tortorella A, Bini V, Giardina I, Moretti P, Favilli A. Obstetric and psychosocial risk factors associated with maternity blues. J Matern Fetal Neonatal Med 2019; 34:1227-1232. [PMID: 31185763 DOI: 10.1080/14767058.2019.1630818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To identify risk factors for maternity blues (MB) and to evaluate the impact of obstetric factors on MB prevalence. MATERIALS AND METHODS 194 mothers have completed the Edinburgh Postnatal Depression Scale (EPDS) 2 days after delivery. Bivariate and multivariate logistic regression models were used to identify the predictors of MB. RESULTS 57 women (29.4%) were positive at screening. Comparing the two groups, no statistically significant difference was found in age (p = .536), nationality (p = .065) and BMI before pregnancy (p = .224). Interestingly, no significant differences were highlighted in terms of assisted reproduction technology or spontaneous pregnancies and the presence of labor analgesia, while MB was significantly more frequent in case of cesarean section (CS) (p = .035). Statistical differences have been found in previous CS (p = .022), previous voluntary interruption of pregnancy (p = .021), number of previous pregnancies (p = .007), Apgar 5' (p = .026), lower level of education (p = .009), and previous postpartum depression (PPD) (p = .026). A logistic regression analysis was realized according to a multivariate model incorporating all the variables with a p-value ≤.25 in bivariate analysis. In the final model vaginal delivery (OR 0.451, 95% CI [0.224-0.911], p = .026) resulted to be MB protective factor, while a lower level of education (OR 3.657, 95% CI [1.482-9.023], p = .005) as well as previous PPD (OR 4.714, 95% CI [1.273-17.458], p = .020) were identified as independent risk factors. CONCLUSION This study showed that a lower education level and a previous PPD resulted to be important risk factors for MB development, while natural delivery was revealed as a protective factor. These results could be used to develop a better and more accurate prevention program after delivery.
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Affiliation(s)
- Sandro Gerli
- Department of Obstetrics and Gynecology, Univerisity of Perugia, Perugia, Italy
| | - Federica Fraternale
- Department of Obstetrics and Gynecology, Univerisity of Perugia, Perugia, Italy
| | | | - Sofia Chiaraluce
- Department of Pediatrics, S Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Irene Giardina
- Department of Obstetrics and Gynecology, Univerisity of Perugia, Perugia, Italy
| | | | - Alessandro Favilli
- Department of Obstetrics and Gynecology, Univerisity of Perugia, Perugia, Italy
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Asoglu MR, Bears B, Turan S, Harman C, Turan OM. The factors associated with mode of delivery in fetuses with congenital heart defects. J Matern Fetal Neonatal Med 2018; 33:816-824. [PMID: 30153755 DOI: 10.1080/14767058.2018.1505855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: It is not evident whether the mode of delivery (MOD) should be modified in pregnancies complicated by fetal congenital heart defects (CHDs). The question as to whether MOD of CHD infants has a significant impact on neonatal outcome remains elusive. The aim of this study was to evaluate factors associated with MOD and its impact on immediate neonatal outcomes in a cohort of late preterm or term fetuses with CHDs born in a tertiary center.Methods: This retrospective study comprised of singleton pregnancies with known fetal CHDs who delivered after 34 0/7 weeks of gestation over a 7-year period. Fetuses with chromosomal abnormality or stillbirths were excluded. Obstetric risk factors were classified as maternal medical, maternal surgical or fetal comorbidities. MOD was classified as elective cesarean delivery (CD) or attempted vaginal delivery (VD). The latter was further categorized as successful VD or intrapartum CD. The study population was stratified into four categories based on the severity of cardiac abnormalities diagnosed by fetal echocardiography. Immediate neonatal outcomes included Apgar scores and umbilical cord artery pH.Results: Of a total of 222 patients, 79.8% underwent attempted VD and 20.2% had elective CD. Of the attempted VD group, 80.2% had successful VD and 19.8% had intrapartum CD. The frequencies of maternal medical, maternal surgical and fetal comorbidities were higher in the elective CD group than in the attempted VD group and also were higher in the intrapartum CD group than in the successful VD group (p < .05 for all). Multivariate logistic regression models revealed that maternal surgical or fetal comorbidities increased the chance of elective CD and maternal medical or fetal comorbidities decreased the chance of successful VD. The severity of CHDs was not an independent factor that affected MOD. Elective or intrapartum CD did not improve immediate neonatal outcomes.Conclusion: Our results demonstrated that preexisting obstetric comorbidities were significant variables that affected the MOD in fetuses with CHD. Vaginal delivery should be attempted unless obstetric and medical contraindications accompany index pregnancy.
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Affiliation(s)
- Mehmet Resit Asoglu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Breanne Bears
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sifa Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher Harman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ozhan M Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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Li Y, Townend J, Rowe R, Brocklehurst P, Knight M, Linsell L, Macfarlane A, McCourt C, Newburn M, Marlow N, Pasupathy D, Redshaw M, Sandall J, Silverton L, Hollowell J. Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study. BJOG 2015; 122:741-53. [PMID: 25603762 PMCID: PMC4409851 DOI: 10.1111/1471-0528.13283] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth. DESIGN Prospective cohort study. SETTING OUs and planned home births in England. POPULATION 8180 'higher risk' women in the Birthplace cohort. METHODS We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. MAIN OUTCOME MEASURES Composite perinatal outcome measure encompassing 'intrapartum related mortality and morbidity' (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. RESULTS The risk of 'intrapartum related mortality and morbidity' or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31-0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure 'intrapartum related mortality and morbidity' (RR adjusted for parity 1.92, 95% CI 0.97-3.80). Maternal interventions were lower in planned home births. CONCLUSIONS The babies of 'higher risk' women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups.
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Affiliation(s)
- Y Li
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordOxford, UK
| | - J Townend
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordOxford, UK
| | - R Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordOxford, UK
| | - P Brocklehurst
- Institute for Women's Health, University College LondonLondon, UK
| | - M Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordOxford, UK
| | - L Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordOxford, UK
| | - A Macfarlane
- Centre for Maternal and Child Health Research, City University LondonLondon, UK
| | - C McCourt
- Centre for Maternal and Child Health Research, City University LondonLondon, UK
| | | | - N Marlow
- Institute for Women's Health, University College LondonLondon, UK
| | - D Pasupathy
- Division of Women's Health, King's College LondonLondon, UK
| | - M Redshaw
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordOxford, UK
| | - J Sandall
- Division of Women's Health, King's College LondonLondon, UK
| | | | - J Hollowell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of OxfordOxford, UK
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