Labouring women who used a birthing pool in obstetric units in Italy: prospective observational study.

BACKGROUND: For women at low risk of childbirth complications, water immersion during labour is a care option in many high income countries. Our aims were (a) to describe maternal characteristics, intrapartum events, interventions, maternal and neonatal outcomes for all women who used a birthing pool during labour who either had a waterbirth or left the pool and had a landbirth, and for the subgroup of women who had a waterbirth in 19 obstetric units, and (b) to compare maternal characteristics, intrapartum events, interventions, and maternal and neonatal outcomes for women who used a birthing pool with a control group of women who did not use a birthing pool for whom we prospectively collected data in a single centre. METHODS: Prospective observational study in 19 Italian obstetric units 2002-2005. Participants were: (a) 2,505 women in labour using a birthing pool in 19 obstetric units; and (b) 114 women in labour using a birthing pool and 459 women who did not use a birthing pool in one obstetric unit. Descriptive statistics were calculated for the sample as a whole and, separately, for those women who gave birth in water. Categorical data were compared using Chi square statistics and continuous data by T-tests. RESULTS: Overall, 95.6% of women using a birthing pool had a spontaneous vertex delivery, 63.9% of which occurred in water. Half of nulliparas and three quarters of multiparas delivered in water. Adverse maternal and neonatal outcomes were rare. There were two cases of umbilical cord snap with waterbirth. Compared with controls, significantly more women who used a birthing pool adopted an upright birth position, had hands off delivery technique, and a physiological third stage. Significantly fewer nulliparas had an episiotomy, and more had a second degree perineal tear, with no evidence of a difference for extensive perineal tears. CONCLUSIONS: Birthing pool use was associated with spontaneous vaginal birth. The increase in second degree tears was balanced by fewer episiotomies. Undue umbilical cord traction should be avoided during waterbirth.

A case report of a successful monochorionic diamniotic twin pregnancy in a patient affected by sickle cell disease treated with erythrocytapheresis.

We describe a monochorionic diamniotic twin pregnancy in a 28-year-old woman with a severe form of sickle cell disease periodically treated with erythrocytapheresis (EA). During this high risk pregnancy, two sessions of EA were performed without complications, and pain control and fetal growth were optimal. Delivery was carried out by emergency cesarean section at 29(+3) weeks' gestation due to initial fetal distress following twin-to-twin transfusion. There were no significant complications for the newborn twins and the post-partum course was regular. The patient underwent a further EA 7 weeks after surgery. Close collaboration between obstetricians and hematologists with careful maternal-fetal monitoring and prophylactic EA during pregnancy led to a favorable outcome despite a low maternal body weight, a twin pregnancy, and a severe form of sickle cell disease.