Outcomes of induction versus spontaneous onset of labour at 40 and 41 GW: findings from a prospective database, Sri Lanka.

OBJECTIVES: The World Health Organization recommends induction of labour (IOL) for low risk pregnancy from 41 + 0 gestational weeks (GW). Nevertheless, in Sri Lanka IOL at 40 GW is a common practice. This study compares maternal/newborn outcomes after IOL at 40 GW (IOL40) or 41 GW (IOL41) versus spontaneous onset of labour (SOL). METHODS: Data were extracted from the routine prospective individual patient database of the Soysa Teaching Hospital for Women, Colombo. IOL and SOL groups were compared using logistic regression. RESULTS: Of 13,670 deliveries, 2359 (17.4%) were singleton and low risk at 40 or 41 GW. Of these, 456 (19.3%) women underwent IOL40, 318 (13.5%) IOL41, and 1585 (67.2%) SOL. Both IOL40 and IOL41 were associated with an increased risk of any maternal/newborn negative outcomes (OR = 2.21, 95%CI = 1.75-2.77, p < 0.001 and OR = 1.91, 95%CI = 1.47-2.48, p < 0.001 respectively), maternal complications (OR = 2.18, 95%CI = 1.71-2.77, p < 0.001 and OR = 2.34, 95%CI = 1.78-3.07, p < 0.001 respectively) and caesarean section (OR = 2.75, 95%CI = 2.07-3.65, p < 0.001 and OR = 3.01, 95%CI = 2.21-4.12, p < 0.001 respectively). Results did not change in secondary and sensitivity analyses. CONCLUSIONS: Both IOL groups were associated with higher risk of negative outcomes compared to SOL. Findings, potentially explained by selection bias, local IOL protocols and CS practices, are valuable for Sri Lanka, particularly given contradictory findings from other settings.

Relationship between changes of high-density lipoprotein cholesterol levels in advanced pregnancy and the risk of neonatal small for gestational age in healthy full-term puerpera.

OBJECTIVE: To explore the relationship between changes in blood high-density lipoprotein cholesterol (HDL-C) levels in advanced pregnancy and the risk of small for gestational age (SGA) in healthy full-term pregnant women. METHODS: In this retrospective nested case-control study, pregnant women who got antenatal visits and experienced a healthy full-term delivery in Affiliated Women's Hospital, Zhejiang University School of Medicine in 2017 were enrolled. From the cohort, 249 women delivered SGA infants with completed clinical data were set as SGA group, 996 women who delivered normal neonates were randomly selected as matched controls (1∶4). The data of baseline characteristics, the HDL-C levels in 24 th-27 th week and after 37 th week were collected, the average HDL-C changes every four weeks in the third trimester (ΔHDL-C) were calculated. Paired t test was used to compare the differences of HDL-C and ΔHDL-C between cases and controls, and a conditional logistic regression model was applied to analyze the association between ΔHDL-C and the risk of SGA. RESULTS: HDL-C levels after the 37 th week in both groups were lower than those in mid-pregnancy (ΔHDL-C<0 and P<0.05 for both groups), while the ΔHDL-C levels in SGA group were significantly higher ( P<0.05). Compared with women with low ΔHDL-C, the risk of SGA was higher for women with middle and high ΔHDL-C ( OR=1.74, 95% CI：1.22-2.50; OR=2.48, 95% CI：1.65-3.70, both P<0.05). CONCLUSION: In healthy full-term pregnant women, the risk of SGA is associated with the HDL-C changing trend, HDL-C level decreasing slowly or even raising in the third trimester indicate that SGA may be likely to occur.

Gestational age and the long-term impact on children's infectious urinary morbidity.

PURPOSE: Given the negative impact of prematurity on offspring's health, we sought to determine whether different gestational ages at birth impact differently on the prevalence of childhood infectious urinary morbidity in the offspring. METHODS: In this population-based cohort analysis, all singleton deliveries occurring between 1991 and 2014 at a single regional tertiary medical center were included. Gestational age upon delivery was sub-divided into early preterm (< 34 weeks), late preterm (34-36 6/7 weeks), early term (37-38 6/7 weeks), full term (39-40 6/7 weeks), late term (41-41 6/7 weeks) and post-term (> 42 weeks). Congenital malformations were excluded. Rates of infectious urinary morbidity-related hospitalizations of offspring up to age 18 years were assessed using a survival curve and a Cox multivariable model. RESULTS: During the study period, 238,620 deliveries met the inclusion criteria. Urinary-related hospitalization (n = 1395) rates decreased as gestational age increased, from 1.7% in the early preterm group, 0.9% in the late preterm group, 0.6% in the early-term group and only 0.5% in the full, late and post-term groups (p > 0.001; chi-square test for trends). In the Cox model, controlled for maternal age, preterm as well as early-term deliveries exhibited an independent association with pediatric urinary morbidity as compared with full term (early preterm: aHR-3.305, 95% CI 2.4-4.54; late preterm: aHR-1.63, 95% CI 1.33-1.99; early term: aHR-1.26, 95% CI 1.1-1.43, p = 0.01). CONCLUSIONS: Deliveries occurring at preterm and at early term are independently associated with pediatric urinary morbidity in the offspring. This risk decreases as gestational age advances.

Association between mammographic density and pregnancies relative to age and BMI: a breast cancer case-only analysis.

PURPOSE: Percentage mammographic density (PMD) is a major risk factor for breast cancer (BC). It is strongly associated with body mass index (BMI) and age, which are themselves risk factors for breast cancer. This analysis investigated the association between the number of full-term pregnancies and PMD in different subgroups relative to age and BMI. METHODS: Patients were identified in the breast cancer database of the University Breast Center for Franconia. A total of 2410 patients were identified, for whom information on parity, age, and BMI, and a mammogram from the time of first diagnosis were available for assessing PMD. Linear regression analyses were conducted to investigate the influence on PMD of the number of full-term pregnancies (FTPs), age, BMI, and interaction terms between them. RESULTS: As in previous studies, age, number of FTPs, and BMI were found to be associated with PMD in the expected direction. However, including the respective interaction terms improved the prediction of PMD even further. Specifically, the association between PMD and the number of FTPs differed in young patients under the age of 45 (mean decrease of 0.37 PMD units per pregnancy) from the association in older age groups (mean decrease between 2.29 and 2.39 PMD units). BMI did not alter the association between PMD and the number of FTPs. CONCLUSIONS: The effect of pregnancies on mammographic density does not appear to become apparent before the age of menopause. The mechanism that drives the effect of pregnancies on mammographic density appears to be counter-regulated by other influences on mammographic density in younger patients.

Evidence that children born at early term (37-38 6/7 weeks) are at increased risk for diabetes and obesity-related disorders.

BACKGROUND: Prematurity is known to be associated with high rates of endocrine and metabolic complications in the offspring. Offspring born early term (37-38 6/7 weeks' gestation) were also shown to exhibit long-term morbidity resembling that of late preterm, in several health categories. OBJECTIVE: We aimed to determine whether early term delivery impacts on the long-term endocrine and metabolic health of the offspring. STUDY DESIGN: A population-based cohort analysis was performed, including all term singleton deliveries occurring from 1991 through 2013 at a single regional tertiary medical center. Congenital malformations and multiple pregnancies were excluded. Gestational age upon delivery was subdivided into early term deliveries and deliveries occurring at full term and later (≥39 weeks' gestation, comparison group). Endocrine and metabolic morbidity (including diabetes, obesity, hypoglycemia, hyperlipidemia, and hypothyroidism) of the offspring, up to the age of 18 years, was evaluated according to hospitalization files. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence. A Weibull parametric survival model was used to control for time to event, siblings, and other confounders. RESULTS: During the study period 225,260 term deliveries met the inclusion criteria. Of them, 24% (n = 54,073) occurred at early term. Endocrine and metabolic morbidity was significantly more common in the early term group (0.51% vs 0.41%, P = .003). Specifically, overweight and obesity were more common among the early term group (P = .002). Differences were more prominent among children >5 years, who exhibited higher rates of type 1 diabetes mellitus, as well as obesity, when born at early term (P < .05). The survival curves demonstrated higher cumulative incidence of total endocrine and metabolic morbidity in the early term group. Using the Weibull parametric survival model, while controlling for siblings, maternal diabetes, hypertension, labor induction, and Apgar score, early term delivery exhibited an independent association with long-term childhood endocrine and metabolic morbidity of the offspring (adjusted hazard ratio, 1.17; 95% confidence interval, 1.01-1.34) and more so for age >5 years (adjusted hazard ratio, 1.30; 95% confidence interval, 1.08-1.56). CONCLUSION: Deliveries occurring at early term are associated with higher rates of long-term pediatric endocrine and metabolic morbidity of the offspring as compared with deliveries occurring at a later gestational age. This association may be due to absence of full maturity of the hormonal axis in early term neonates or, alternatively, suggest an underlying fetal endocrine dysfunction as the initial mechanism responsible for spontaneous early term delivery.

Is breast cancer risk associated with alcohol intake before first full-term pregnancy?

PURPOSE: It is plausible that breast tissue is particularly susceptible to carcinogens, including ethanol, between menarche and the first full-term pregnancy ("first pregnancy"). There is some epidemiological evidence that intake before the first pregnancy is more closely associated with risk of breast cancer than is intake thereafter. We examined this association using lifetime alcohol consumption data from a prospective cohort study. METHODS: We calculated usual alcohol intake for age periods 15-19 years and for 10-year period from age 20 to current age (in grams per day) using recalled frequency and quantity of beverage-specific consumption for 13,630 parous women who had their first pregnancy at age 20 years or later, had no cancer history and were aged 40-69 years at enrollment. Cox regression was performed to estimate hazard ratios (HRs) and their 95 % confidence intervals (CIs). RESULTS: A total of 651 incident invasive adenocarcinomas of the breast were diagnosed during a mean follow-up of 16.1 years. Alcohol consumption was low overall with only a few drinking ≥40 g/day. Intake before the first pregnancy was markedly lower (mean intake: 2.5 g/day; abstention: 58.8 %) than intake thereafter (mean intake: 6.0 g/day; abstention: 33.6 %). Any alcohol intake before the first pregnancy was associated with an increased risk of breast cancer (HR 1.35, 95 % CI 1.10-1.66 for drinking compared with abstention), whereas any intake after the first pregnancy was not (HR 0.89, 95 % CI 0.72-1.09). CONCLUSIONS: Limiting alcohol intake before the first pregnancy might reduce women's risk of breast cancer.

Breast cancer risk after full-term pregnancies among African women from Nigeria, Cameroon, and Uganda.

BACKGROUND: The breast cancer (BC) risk profiles of African women differ significantly from those of women of European ancestry. African women are younger at the age of onset and tend to have high parity. The purpose of this study was to examine the relationship between full-term pregnancy (FTP) and the risk of BC. METHODS: A case-control study was conducted among 1995 women with invasive BC and 2631 controls in Nigeria, Cameroon, and Uganda. Odds ratios (ORs) for individual ages at FTP according to the time since delivery were calculated and adjusted for confounders. A fitted spline model was used to assess the impact of the number of pregnancies on BC risk. RESULTS: In comparison with a nulliparous woman, a parous woman with her first FTP at 20 years showed an OR of 0.76 (95% confidence interval [CI], 0.57-0.99) for developing BC in the following 5 years. Ten years later, this risk was 0.76 (95% CI, 0.58-0.99) and 0.76 (95% CI, 0.58-0.98) for women aged 25 and 30 years, respectively. Similarly, a parous woman with 1 pregnancy had an OR of 0.69 (95% CI, 0.49-0.96), whereas the OR was 0.66 (95% CI, 0.48-0.91) with 2 or 5 pregnancies and 0.67 (95% CI, 0.47-0.94) with 6 pregnancies in comparison with nulliparous women. CONCLUSIONS: In contrast to studies in women of European ancestry, this study showed no transient increase in the risk of developing BC after FTP among African women. Further studies are needed to examine the impact of reproductive factors on early-onset BC in African women.

A Full-Term Pregnancy in a Patient With Uterus Didelphys.

Müllerian duct anomalies (MDAs) are congenital uterine abnormalities resulting from incorrectly developed Müllerian ducts. Uterus didelphys is an uncommon MDA linked to fetal growth restriction, dysmenorrhea, dyspareunia, and higher rates of infertility. We present an unusual case of a 21-year-old woman who presented at the emergency room with no previous history of medical illness. An ultrasound report showed her uterus with an irregular shape. An official departmental scan indicated an anteverted, bicornuate uterus harboring a normal-looking intrauterine gestational sac and a 2.5 cm cervical length. Because of this borderline cervical length and the associated anomaly, the patient was scheduled for an elective cervical cerclage. Before starting the procedure, the patient was found to have a thick longitudinal vaginal septum and the cervix could not be evaluated for which the procedure was halted and the patient kept on progesterone. Elective cesarean surgery (LSCS, lower-section cesarean surgery) at 37 weeks of gestation was arranged due to the previous findings and breech presentation. During the LSCS, the examination revealed the presence of two non-communicating uteri, two cervical canals, and two separate vaginas dividing the introitus into two distinct openings. Diagnostic modalities such as magnetic resonance imaging (MRI), hysteroscopy, laparoscopy, hysterosalpingogram, and ultrasound (USG) are necessary for precise diagnosis of uterine didelphys. This case highlights that with careful prenatal and intrapartum supervision good pregnancy outcomes can be achieved in a uterine didelphic condition.

A model to predict delivery time following induction of labor at term with a dinoprostone vaginal insert: a retrospective study.

BACKGROUND: Dinoprostone vaginal insert is the most common pharmacological method for induction of labor (IOL); however, studies on assessing the time to vaginal delivery (DT) following dinoprostone administration are limited. AIMS: We sought to identify the primary factors influencing DT in women from central China, at or beyond term, who underwent IOL with dinoprostone vaginal inserts. METHODS: In this retrospective observational study, we analyzed the data of 1562 women at 37 weeks 0 days to 41 weeks 6 days of gestation who underwent dinoprostone-induced labor between January 1st, 2019, and December 31st, 2021. The outcomes of interest were vaginal or cesarean delivery and factors influencing DT, including maternal complications and neonatal characteristics. RESULTS: Among the enrolled women, 71% (1109/1562) delivered vaginally, with median DT of 740.50 min (interquartile range 443.25 to 1264.50 min). Of the remaining 29% (453/1562), who delivered by cesarean section, 11.9% (54/453) were multiparous. Multiple linear regression analysis showed that multiparity, advanced maternal age, fetal macrosomia, premature rupture of membranes (PROM), and daytime insertion of dinoprostone were the factors that significantly influenced DT. Time to vaginal delivery increased with advanced maternal age and fetal macrosomia and decreased with multiparity, PROM, and daytime insertion of dinoprostone. A mathematical model was developed to integrate these factors for predicting DT: Y = 804.478 - 125.284 × multiparity + 765.637 × advanced maternal age + 411.511 × fetal macrosomia-593.358 × daytime insertion of dinoprostone - 125.284 × PROM. CONCLUSIONS: Our findings may help obstetricians estimate the DT before placing a dinoprostone insert, which may improve patient management in busy maternity wards and minimize potential risks.

Effects of neuraxial labor analgesia on intrapartum maternal fever in full-term pregnancy and its influence on birth outcomes.

Introduction: This study aimed to explore the relationship between neuraxial labor analgesia and intrapartum fever and to demonstrate the influence of maternal fever on perinatal outcomes within 6 weeks after birth. Methods: This was a secondary analysis of a multicenter prospective cohort study that enrolled women with single- and full-term cephalic pregnancy in northern China. Intrapartum maternal fever was defined as the highest axillary temperature during labor ≥37.5°C. Data on baseline characteristics, maternal variables, and neonatal outcomes were all collected. The association between neuraxial labor analgesia and intrapartum maternal fever was analyzed with logistic regression models, and the cutoff point was identified by the receiver operating characteristic curve. Results: Of 577 parturients, 74 (12.8%) developed intrapartum fever. Neuraxial analgesia was associated with an increased risk of maternal intrapartum fever with or without adjusting for confounding factors (adjusted OR = 2.68; 95% CI: 1.32-5.47; p = 0.007). Further analysis showed that neuraxial analgesia of <5 h did not increase the risk of intrapartum fever compared with no analgesia (OR = 1.52; 95% CI: 0.63-3.64; p = 0.35), and longer neuraxial labor analgesia time (over 5 h) significantly increased the risk of fever (OR = 3.38; 95% CI: 1.63-7.01; p = 0.001). Parturients with intrapartum fever suffered more maternal adverse outcomes compared with those without fever (p < 0.001). Neonates of women with intrapartum fever had slightly higher rates of composite adverse neonatal outcomes compared with those without fever; however, the difference was not statistically significant (p = 0.098). Conclusion: In women with low-risk pregnancies, a longer time of neuraxial labor analgesia was associated with an increased risk of intrapartum maternal fever. Intrapartum fever was related to adverse maternal outcomes but did not significantly affect neonatal outcomes within 6 weeks after delivery.

Risk factors for respiratory distress syndrome among high-risk early-term and full-term deliveries.

OBJECTIVE: To identify whether risk factors for respiratory distress syndrome (RDS) differ between early-term and full-term births. STUDY DESIGN: This is a secondary analysis of a large NIH-funded retrospective cohort study including patients who delivered at a tertiary-care obstetric hospital between January 2002 and March 2013 with comorbid diabetes, hypertensive disorders, and/or fetal growth restriction (FGR). Pregnancies complicated by severe preeclampsia and multifetal gestations were excluded. Maternal characteristics, delivery information, and neonatal information were abstracted by trained clinicians blinded to the comorbidity leading to study inclusion. In this secondary analysis of the infant health outcomes of pregnancies with one or more of the qualifying conditions, risk factors for RDS among neonates born early term (37w0d-38w6d gestation) were compared to risk factors for RDS among full-term neonates (39w0d-40w6d). RESULTS: Among 10,532 singleton newborns, there were 99 cases of early-term RDS (0.94%) and 95 cases of full-term RDS (0.90%). Maternal demographics were similar between those with and without RDS in both groups. Among early-term infants, lower gestational age, presence of meconium, non-spontaneous labor, and cesarean delivery were positively associated with RDS, whereas hypertensive disorders, diabetes, FGR, and many other comorbid delivery conditions were not. The strongest risk factor for RDS among early-term infants was delivery via cesarean (RR 1.98, 95% CI 1.31, 3.01). Among full-term neonates, cesarean delivery was also positively associated with RDS, although presence of meconium, chorioamnionitis, and endometritis were all stronger risk factors with RRs >2.0. CONCLUSIONS: In this cohort of high-risk term deliveries, maternal demographics and comorbidities were found not to be associated with increased risk for RDS, but novel risk factors for RDS after 37 weeks' gestation - chorioamnionitis and endometritis - were identified. A focus on preventing infectious comorbidities may help reduce incidence of RDS at full-term.Key PointsRDS risk factors vary by gestational age.Novel risk factors for RDS at full-term identified.Intrauterine inflammation associated with RDS at term.

Safety and Feasibility of Vaginal Delivery in Full-Term Pregnancy After Transvaginal-Natural Orifice Transluminal Endoscopic Surgery: A Case Series.

Study Objective: The aim was to investigate the outcome of vaginal delivery of full-term pregnancies in patients after transvaginal-natural orifice transluminal endoscopic surgery (vNOTES) treatment for gynecological disorders. Design: A case series report. Setting: A medical university hospital. Patients: 12 cases of successful delivery after transvaginal-natural orifice transluminal endoscopic surgery. Interventions: Long-term follow-up of patients with fertility needs after transvaginal-natural orifice transluminal endoscopic surgery. Measurements and Main Results: From 2018 to 2021, 163 cases of gynecological diseases were treated by vNOTES. One hundred forty-seven patients were followed up, with a follow-up rate of 90.1%. The average follow-up time was 28 (15-47) months, including 66 cases with fertility requirements. Among these 66 patients, 12 patients successfully got pregnant and completed delivery, including 10 cases of vaginal delivery and 2 cases of cesarean section, with no adverse pregnancy outcomes associated with vNOTES arising. Conclusion: Vaginal delivery of a full-term pregnancy after transvaginal-natural orifice transluminal endoscopic surgery appears to be safe and feasible and would not be one of the bases for elective cesarean delivery.

Clinical analysis of uterine torsion and fibroids in full-term pregnancy: A case report and review of the literature.

This study was performed to describe the clinical features, risk factors, and treatment methods of uterine torsion in pregnancy. The most common symptoms are abdominal pain, fetal heart rate changes, and failure of cervical dilatation and are often accompanied by complete or partial placental abruption. Preoperative diagnosis is challenging even with the use of ultrasound. Uterine torsion in the third trimester is correlated with the presence of multiple uterine fibroids. The causes of gravid uterine torsion vary and the clinical manifestations are nonspecific. Early diagnosis and improved detection approaches are the keys to treatment of patients with uterine torsion. However, the preoperative diagnosis remains difficult and the diagnosis is often made during cesarean section.

Synergistic Effect Between Full-Term Pregnancy/Breastfeeding And Familial Susceptibility On Breast Cancer Risk.

BACKGROUND: Breast cancer is the most common cancer in women worldwide, and reproductive factors and family history of malignancy are considered as high risk factors. The present study aimed to evaluate the synergistic effect of reproductive factors and family history on breast cancer. METHOD: A total of 1215 breast cancer patients and 1215 control participants from two medical centers were enrolled, and reproductive factor history and family cancer history information was collected. Multivariate logistic regression analyses were performed to estimate the adjusted odds ratio (OR), and synergy index (SI) was used to assess the combined effect of potential factors. RESULTS: Compared to the controls, a negative association between full-term pregnancy/breastfeeding and breast cancer was observed regardless of the status of family cancer history (OR: 0.675, 95% CI: 0.560-0.814 and OR: 0.631, 95% CI: 0.503-0.789 respectively) after adjustment of other confounders, while the risk effect of abortion was unproven. The synergistic effect of history of full-term pregnancy and family history of malignancy was indicated in the combined analyses with SI as 9.429 (95% CI:1.248-71.245). CONCLUSION: Full-term pregnancy/breastfeeding were protective factors against breast cancer and synergistic additive effect was demonstrated between no full-term pregnancy/breastfeeding and a family history of malignancy on the risk of breast cancer.

Induction of Labor in Primigravid Term Pregnancy with Misoprostol or Dinoprostone: A Comparative Study.

Objective The objective of this study was to compare the effectiveness of vaginally administered misoprostol to that of vaginally administered dinoprostone at six-hour intervals in a well-homogenized cohort of full-term, nulliparous women with an unfavorable cervix and without any pregnancy complications. Materials and methods A cohort of 100 nulliparous women at more than 40 weeks of gestation was included in this study. The primary outcomes to be measured were induction to delivery interval and incidence of vaginal births within 12 and 24 hours. Neonatal intensive care unit admissions for poor neonatal outcomes and obstetrical complications were secondary outcomes. Results A significant reduction in the induction to delivery interval was observed in the misoprostol group as compared to the dinoprostone group (10.2 ± 0.8 vs. 16.5 ± 0.7, p < 0.001). More women in the misoprostol group delivered within 12 hours as compared to the dinoprostone group (30 [60%] vs. 17 [34%], p < 0.001) and within 24 hours (48 [96%] vs. 39 [78%], p < 0.05). In the misoprostol group, spontaneous rupture of the membranes occurred more frequently (46 [92%] vs. 35 [70%], p < 0.05) with less need for oxytocin augmentation during labor (14% vs. 30%, p < 0.05). A significant reduction in additional dose requirement (7.5% vs. 22%, p < 0.05) and a lower rate of Caesarean section was observed in the misoprostol group (6% vs. 24%, p < 0.04). A statistically insignificant low Apgar score was noted in the dinoprostone group compared to the misoprostol group. Conclusion Vaginally administered misoprostol is more effective than vaginally administered dinoprostone at six-hour intervals in nulliparous women beyond 40 weeks of gestation without pregnancy complications.

Summary of best evidence for management of labor course induced by oxytocin drip in term pregnancy / 中国实用护理杂志

Objective:To search, evaluate and summarize the best evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy, and to provide reference for clinical practice in order to reduce the complications during labor, such as the proportion of instrument delivery, prolonged labor duration, uterine rupture, postpartum hemorrhage, etc. Standardize the management process of induction of labor with oxytocin, improve the satisfaction of pregnant women to participate in the decision of induction of labor, and improve the outcome of the newborn.Methods:Take the evidence-based nursing method, in view of the full-term pregnancy pregnant women oxytocin drip induced labor evidence-based labor management problems, nearly 10 years related literature retrieval from January 1st 2011 to April 9th, 2021, the Australian JBI evidence-based health care center of literature quality evaluation criteria and evidence classification system, all kinds of research evaluation and classification of retrieval.Results:Early detection to 340 articles, and eventually into 9 articles, including 1 clinical decision, 6 guides, 2 pieces of system evaluation. Totally 45 pieces evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy were sumarized, including induced labor time, oxytocin side effects, induced labor before evaluation, induced labor of guardianship, infusion solution, such as health education, and other seven aspects.Conclusions:The present study summarized 45 pieces of best evidence on the management of labor induced by oxytocin infusion during term pregnancy, which provided some evidence-based basis for midwives, obstetric nurses and managers. Through the application of the best evidence, it is beneficial to improve the outcome of pregnant women in the neonatal perinatal period, standardize the process of inducing labor with oxytocin, and improve the quality of obstetric care.

Early-term deliveries as an independent risk factor for long-term respiratory morbidity of the offspring.

OBJECTIVE: Newborns exhibit the lowest immediate respiratory morbidity rates when born following 39 completed weeks of gestation. We sought to determine whether early-term delivery (37-38 + 6 weeks' gestation) impacts on long-term pediatric respiratory morbidity. STUDY DESIGN: In this population-based prospective cohort analysis, all term singleton deliveries occurring between 1991 and 2013 at a single tertiary medical center were included. Gestational age upon delivery was sub-divided into: early (37-38 + 6 weeks' gestation), full (39-40 + 6 weeks' gestation), late (41-41 + 6 weeks' gestation), and post-term (>42 weeks) deliveries. The incidence of long-term hospitalizations (up to the age of 18 years) of the offspring due to a set of predefined respiratory morbidities was evaluated. Survival curves were used to compare cumulative morbidity incidence. A Cox hazards regression model was used to control for confounders. RESULTS: During the study period, 229,142 term deliveries met the inclusion criteria. Of those, 24% (n = 55,202) occurred at early term. Hospitalizations up to the age of 18 years, as a result of complications in the respiratory system were significantly more common in the early-term group as compared with full and late-term delivery groups. In the Cox regression model, while controlling for multiple confounders, early-term delivery exhibited an independent association with long-term respiratory morbidity (adjusted HR = 1.24, CI 1.19-1.29, P < 0.001). CONCLUSION: Deliveries occurring at early term are associated with higher rates of pediatric respiratory hospitalizations compared with full and late-term deliveries. Pediatr Pulmonol. 2017;52:198-204. © 2016 Wiley Periodicals, Inc.

Investigation on the IGF-1 and lipid level in term small for gestational age infants within 24 hours postnatally / 中国新生儿科杂志

Objective:To study the insulin-like growth factors-1 (IGF-1) and lipid level of term small for gestational age (SGA) infants within 24 hours postnatally and to explore the correlation between IGF-1 and blood lipids.Methods:A prospective study was conducted on singleton term SGA and appropriate for gestational age infant (AGA) who were delivered and admitted to the neonatal ward of Guangdong Women and Children Hospital within 24 hours after birth from May 2020 to January 2021, and the infants were divided into SGA and AGA groups to compare the differences in IGF-1 and lipid levels within 24 hours after birth and to analyze the correlation between IGF-1 and lipids.Results:A total of 95 cases in the SGA group and 84 cases in the AGA group were included in the study. The proportion of infants with IGF-1 <25 ng/ml was significantly higher in SGA group (87.4%) than in the AGA group (52.4%). It was also found that the proportion of infants with IGF-1 <25 ng/ml in SGA was significantly higher than that in AGA within different gender composition groups, early-term and full-term births groups. The triglyceride (TG) level was higher in the SGA group than that in the AGA group, but the high-density lipoprotein cholesterol (HDL-C) level was lower than that in the AGA group ( P<0.05). IGF-1 level within 24 hours postnatally in SGA and AGA was positively correlated with HDL-C levels ( P<0.01) and negatively correlated with TG ( P<0.01), and HDL-C level was a predictor of IGF-1. Conclusions:Compared with term AGA, SGA term infants showed insufficient IGF-1 and HDL-C secretion and high TG within 24 hours after birth. Nutritional support for SGA should be given promptly after birth to avoid hypoglycemia and to stimulate IGF-1 secretion.

Implantation potential of mosaic embryos.

Chromosomal mosaicism is a relatively common finding in human IVF embryos. However, the association between mosaicism in trophoectoderm and inner mass cells, the mechanisms involved, and its effects on implantation are far from established. We retrospectively reanalyzed array-CGH results from 1,362 trophoectoderm biopsies. We detected chromosomal mosaicism in 183 blastocysts (13.4%). A decrease in the clinical pregnancy rate when we compared the cycles where only mosaic embryos were transferred (26.9%) vs. euploid embryos were transferred (40.2%) was not statistically different (p = 0.127). Also a tendency to increase the biochemical miscarriage was reported (21.2% mosaic group vs. 12.3% euploid group; p=0.102). Our data suggests that the transfer of some mosaic embryos achieve full term pregnancies. Additional studies are needed to clarify how embryo mosaicism affects the outcomes of the IVF cycles.

Prognostic effect of intrauterine pregnancy induced by different methods of cervical ripening / 中国基层医药

Objective@#To investigate the effect of different cervical ripening methods on induction of labor in term pregnancy.@*Methods@#160 cases of labor induction of full-term pregnancy primipara were selected as the research subjecs.According to the different methods of cervical ripening, they were divided into two groups.The observation group (n=80) underwent dinoprostone suppositories induced labor, the control group (n=80) received intravenous infusion of small dose of oxytocin.The cervical Bishop score, cervical ripening effect, induction of labor, mode of delivery, neonatal outcome were observed in the two groups.@*Results@#Before treatment, the Bishop scores of the two groups had no statistically significant difference (t=0.436, P>0.05). After treatment for 24h, the Bishop score of the observation group was (8.3±2.6)points, which was higher than (5.9±2.0)points of the control group (t=6.544, P<0.05). In the observation group, the total effective rate of cervical ripening was 95.0%, which was higher than 66.2% of the control group (Z=-5.716, P<0.05). The duration of labor in the observation group was (12.6±4.5)h, which was significantly shorter than (21.7±7.8)h in the control group (t=9.039, P<0.05). The total labor, postpartum hemorrhage volume had no statistically significant differences between the two groups (t=2.298, 1.102, all P>0.05). In the observation group, 66cases (82.5%) were vaginal delivery, 14cases(17.5%) were cesarean section, those were 49cases(61.2%) and 31cases(38.8%) in the control group.The delivery mode of the observation group was significantly better than that of the control group(χ2=8.935, P<0.05). There were no statistically significant difference between the two groups in neonatal birth weight and postnatal 1min and 5min Apgar scores (all P>0.05).@*Conclusion@#Parturient with dinoprostone suppositories full-term pregnancy abortion can improve the cervical Bishop score and cervical ripening effect, improve the quality of delivery, it is better than oxytocin, and worthy of clinical application.