Trends in intrapartum fetal death, 1979-2003.

OBJECTIVES: This study was undertaken to analyze trends in intrapartum fetal death and rates of perinatal autopsy over a 25-year period in Dublin, Ireland. STUDY DESIGN: A retrospective multicenter analysis of 508,342 nonanomalous infants 500 g or more, delivering in 3 tertiary-referral university institutions between 1979-2003. RESULTS: There has been a significant downward trend in the rate of intrapartum fetal death over the past 25 years (P < .0001). Nulliparous labors were statistically more likely to be complicated by an intrapartum fetal demise than parous labors (odds ratio, 1.49; 95% confidence interval [CI], 1.16-1.92; P = .0018). Intrapartum deaths secondary to hypoxia fell significantly over the study period (P < .0001). Infants of multiple gestations were twice as likely to die in labor as singletons (odds ratio, 2.2; 95% CI, 1.22-3.74; P = .0058). Rates of perinatal autopsy fell significantly over the 25 years studied (P < .0001). CONCLUSION: There has been a significant fall in rates of intrapartum fetal death. This has primarily resulted from a reduction in deaths attributable to intrapartum hypoxia. Infants of multiple gestations still retain a significantly higher chance of intrapartum death. The fall in uptake rates of perinatal autopsy in recent years is concerning.

Obstetric management of hepatitis C-positive mothers: analysis of vertical transmission in 559 mother-infant pairs.

OBJECTIVE: The objective of the study was to determine vertical transmission rates of hepatitis C in 2 tertiary level maternity units. STUDY DESIGN: This was a retrospective review of all hepatitis C-positive mothers and their pregnancy outcomes. RESULTS: Of 74,629 deliveries, 559 liveborn infants were born to 545 hepatitis C mothers; the rate of antenatal hepatitis C infection was 0.7%. In the neonatal period, 423 infants tested negative for hepatitis C ribonucleic acid (RNA) (75.7%), 18 were positive (3.2%), and 118 infants were not tested or were lost to follow-up (21.1%). The overall vertical transmission rate is 18 of 441 (4.1%, 95% confidence interval 2.3% to 5.9%). The vertical transmission rate for infants following vaginal delivery or emergency cesarean in labor was no different when compared with those delivered by planned cesarean (4.2% vs 3.0%, P = NS). Among women in whom hepatitis C RNA was detected antenatally, this finding remained (7.2% vs 5.3%, P = NS). No case of vertical transmission was noted among hepatitis C RNA-negative mothers. CONCLUSION: This study reports a vertical transmission rate for hepatitis C of 4.1%. These results do not support a recommendation of planned cesarean to reduce vertical transmission of hepatitis C infection.

Intrauterine insemination-No more Mr. N.I.C.E. guy?

OBJECTIVE: To determine the per cycle chance of a live birth and to identify factors that may support a more individualised application of IUI in view of National Institute for Health and Care Excellence (NICE) updated guideline on fertility 2013. STUDY DESIGN: A retrospective, cohort study of 851 couples (1688 cycles) with unexplained, mild endometriosis, one patent Fallopian tube (with ovulation occurring in the corresponding ovary), mild male factor or ovulatory dysfunction, who initiated their first cycle of IUI/COH during the study period 2009-2013 and completed up to 3 cycles. Exclusion criteria included donor sperm and diminished ovarian reserve. Success factors and probabilities were determined based on live birth rates. RESULTS: Mean age was 33.8±3.3years and mean duration of subfertility was 2.28±1.47years. Independent associates of successful outcome factors were lower age (AOR 0.93; 95%CI 0.89-0.98, p=0.007) and multiparity (AOR 1.72; 95%CI 1.17-2.52). Live-birth rates declined independently of other factors from 15.3% (n=130/851) in cycle 1-7.0% (n=19/273) in cycle 3 (AOR 0.76; 95%CI, 0.62-0.93, p=0.008). Per cycle probabilities of live birth ranged from 21.4% to 5.1% dependent on age, cycle number and previous parity. The unadjusted cumulative pregnancy rate for live birth per cycle started, over three cycles, was 34.9% with a multiple live birth rate per cycle started of 5.4%. The associates of live birth amongst those with unexplained sub-fertility only (n=632, first cycle attempt) were also analysed, yielding similar results. CONCLUSIONS: IUI/COH is a simple treatment that produces good live birth rates, especially in younger patients and/or those with previous parity. More than 90% of total live births with IUI/COH is achieved during the first two cycles. As a retrospective, observational study, there is no comparator group and therefore we cannot comment on the relative efficacy of up to three IUI cycles over expectant management in a similar cohort. Our study suggests that probabilities of success can be used to individualise treatment decisions and that there is merit in continuing to offer IUI before resorting to IVF for certain patients.