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OBJECTIVE: Gestational diabetes mellitus (GDM) is a condition in which women without diabetes are diagnosed with glucose intolerance during pregnancy, typically in the second or third trimester. Early diagnosis, along with a better understanding of its pathophysiology during the first trimester of pregnancy, may be effective in reducing incidence and associated short-term and long-term morbidities. DESIGN: We comprehensively profiled the gut microbiome, metabolome, inflammatory cytokines, nutrition and clinical records of 394 women during the first trimester of pregnancy, before GDM diagnosis. We then built a model that can predict GDM onset weeks before it is typically diagnosed. Further, we demonstrated the role of the microbiome in disease using faecal microbiota transplant (FMT) of first trimester samples from pregnant women across three unique cohorts. RESULTS: We found elevated levels of proinflammatory cytokines in women who later developed GDM, decreased faecal short-chain fatty acids and altered microbiome. We next confirmed that differences in GDM-associated microbial composition during the first trimester drove inflammation and insulin resistance more than 10 weeks prior to GDM diagnosis using FMT experiments. Following these observations, we used a machine learning approach to predict GDM based on first trimester clinical, microbial and inflammatory markers with high accuracy. CONCLUSION: GDM onset can be identified in the first trimester of pregnancy, earlier than currently accepted. Furthermore, the gut microbiome appears to play a role in inflammation-induced GDM pathogenesis, with interleukin-6 as a potential contributor to pathogenesis. Potential GDM markers, including microbiota, can serve as targets for early diagnostics and therapeutic intervention leading to prevention.
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Diabetes Gestacional , Microbiota , Embarazo , Femenino , Humanos , Diabetes Gestacional/diagnóstico , Tercer Trimestre del Embarazo , Inflamación , CitocinasRESUMEN
INTRODUCTION: Synthetic oxytocin is one of the most regularly administered medications to facilitate labor induction and augmentation. The present study examined the associations between oxytocin administration during childbirth and postpartum posttraumatic stress symptoms (PTSS). MATERIALS AND METHODS: In a multicenter longitudinal study, women completed questionnaires during pregnancy and at 2 months postpartum (N = 386). PTSS were assessed with the Impact of Event Scale. Logistic regression was used to examine the difference in PTSS at Time 2 between women who received oxytocin and women who did not. RESULTS: In comparison with women who did not receive oxytocin, women who received oxytocin induction were 3.20 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-9.52), and women who received oxytocin augmentation were 3.29 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-10.03), after controlling for being primiparous, preeclampsia, prior mental health diagnosis, mode of birth, postpartum hemorrhage, and satisfaction with staff. DISCUSSION: Oxytocin administration was associated with a 3-fold increased risk of PTSS. The findings may reflect biological and psychological mechanisms related to postpartum mental health and call for future research to establish the causation of this relationship.
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BACKGROUND: The COVID-19 pandemic is an ongoing global healthcare crisis that negatively affects pregnant women. Although patients with an acute infection during pregnancy have been widely studied, information regarding labor and delivery while infected is sparse. The aim of the study was to ascertain maternal, obstetrical, and perinatal outcomes of women who gave birth while infected with SARS-CoV-2. METHODS: Patients diagnosed with COVID-19 during pregnancy at a tertiary medical center in 4/20-2/21 were identified by a retrospective database search. Those with an active intrapartum SARS-CoV-2 infection were compared with those who recovered at least 10 days before labor and delivery. RESULTS: Of the 176 women included in the study, 84 had a SARS-CoV-2 infection at the time of delivery and 92 had recovered from the infection. There was no statistically significant between-group difference in mean gestational age at delivery (39 weeks for both, p = 0.71) and overall rate of cesarean delivery (26.2% vs 17.4%, respectively, p = 0.35) or non-elective cesarean delivery (10.71% vs 4.34%, respectively, p = 0.48). In the active-infection group, the rate of severe disease was 2.4%, and of critical disease (with intensive care unit admission, mechanical ventilation, and ECMO), 3.6%, compared to zero for both in the recovered group. No differences were found between the groups in adverse perinatal outcomes. CONCLUSION: Delivery is safe and feasible in women with active SARS-CoV-2 infection. Nevertheless, we found a non-significant trend for more severe disease and for cesarean delivery and urgent cesarean delivery (for COVID-19-related indications) in women with an intrapartum SARS-CoV-2 infection.
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COVID-19 , Complicaciones Infecciosas del Embarazo , Nacimiento Prematuro , COVID-19/epidemiología , Parto Obstétrico , Femenino , Humanos , Pandemias , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Estudios Retrospectivos , SARS-CoV-2RESUMEN
In this prospective study, we evaluated postpartum voiding dysfunction stratified by mode of delivery - vaginal delivery versus elective caesarean delivery (CD). We recruited nulliparous women carrying singleton gestation at term admitted to delivery room or elective CD. Pre-labour voiding function was assessed by recording the post-voiding residual volume (PVRV) using a bladder scan. PVRV evaluation was repeated at least 12 hours following delivery and before discharge. PVRVs were considered abnormal if ≥150 mL. PVRVs were compared between vaginal and CD. Overall, 54 women were included. Of them, 34 (63%) delivered vaginally and 20 (37%) had an elective CD. Postpartum mean PVRVs were significantly higher compared to pre-labour PVRVs (215 vs. 133 mL, p<.001). Abnormal postpartum PVRV was significantly higher in vaginal delivery compared to CD (73.5% vs. 45%, p<.05). In conclusion, delivery adversely affects voiding function. Vaginal delivery is associated with more severe voiding dysfunction compared to elective CD.Impact StatementWhat is already known on this subject? Delivery is associated with voiding dysfunction. While most studies on postpartum voiding dysfunction were related to vaginal delivery, little is known on the effect of mode of delivery (vaginal versus caesarean delivery (CD)) on voiding dysfunction.What the results of this study add? In this study, we found that postpartum post-voiding residual volume is significantly higher than the pre-labour PVRV in women delivered vaginally. In addition, postpartum PVRV was significantly higher in women delivered vaginally compared to elective CD.What the implications are of these findings for clinical practice and/or further research? This study implicates that women with vaginal delivery are more prone to voiding dysfunction compared to elective CD. However, larger observational studies are warranted to confirm these results and evaluate whether this difference still exists beyond the post-partum period.
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Cesárea , Trabajo de Parto , Cesárea/efectos adversos , Parto Obstétrico/efectos adversos , Femenino , Humanos , Periodo Posparto , Embarazo , Estudios ProspectivosRESUMEN
This is a retrospective analysis of mothers with abnormal 1-hour, 50-grams glucose challenge test (GCT) who did not take a 3-hour, 100-gram oral glucose tolerance test (OGTT). This study group of women was compared to three control groups, based on an OGTT diagnostic test- normal OGTT, single pathological value and gestational diabetes mellitus. Overall- 4,185 women were included and sub-divided accordingly into four groups: Group A-340 (8.12%)- no OGTT; Group B-2,585 (61.77%)- Norm OGTT (All values normal); Group C- 564 (13.48%)- SinOGTT (single pathological value) and Group D- 696 (16.63%)- Gestational Diabetes Mellitus (GDM, ≥ 2 pathological values). Groups A, C and D had higher rates of intrapartum Caesarean Delivery (10.29%, 11.52% and 10.19% vs. 8.43%, p < .0001). Group A had highest rates of neonatal adverse outcomes, as neonatal intensive care unit (NICU) admission (12.4% vs. 8.4%, 11.0% and 10.0%, p = .039), small for gestational age (SGA) neonates (7.0% vs. 5.3%, 3.7% and 6.0%, p = .0092) and neonatal hypoglycaemia (3.5% vs. 1.3%, 3.2% and 2.9%, p = .007). A multivariable regression revealed that having an abnormal GCT without an OGTT was an independent risk factor for neonatal intensive care unit admission, neonatal hypoglycaemia and intrapartum caesarean delivery. We concluded that women with pathological GCT who did not complete OGTT have higher rates of obstetric adverse outcomes. They should be closely monitored during delivery and should not be overlooked.IMPACT STATEMENTWhat is already known on this subject? Adverse outcomes of gestational diabetes mellitus are well established. But, the group of women who fail to complete a confirmatory OGTT following a pathological GCT is not well described.What the results of this study add? Our results point out that women who fail to complete an OGTT, suffer from higher rates of obstetric complications, presumably attributed to disrupted glucose values, but also to poor prenatal care.What the implications are of these findings for clinical practice and/or further research? These women should not be overlooked. They should be closely monitored during labour and delivery.
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Glucemia/análisis , Diagnóstico Tardío/efectos adversos , Diabetes Gestacional/diagnóstico , Prueba de Tolerancia a la Glucosa/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adulto , Estudios de Casos y Controles , Cesárea/estadística & datos numéricos , Femenino , Prueba de Tolerancia a la Glucosa/métodos , Humanos , Recién Nacido , Embarazo , Resultado del Embarazo , Atención Prenatal/métodos , Estudios RetrospectivosRESUMEN
INTRODUCTION: Various biopsychosocial factors affect women's preferences with respect to mode of birth, but they are usually not examined simultaneously and prospectively. In the current study, we assessed the contribution of personal characteristics of first-time mothers, their prior prenatal perceptions, events during birth, and subjective birth experiences, on their preference about mode of second birth. METHODS: This was a secondary analysis of two prospective birth cohort studies. Participants included 832 primiparous women recruited mostly from women's health centers in Israel, and through natural birth communities and cesarean birth websites. Women completed questionnaires prenatally and were followed up at 6-8 weeks postpartum to understand their preferences for a second birth. RESULTS: Regression models indicated that after vaginal first birth, being less religious, believing that birth is a medical process, and having a negative experience increased the odds of preferring primary cesarean for the second birth. After cesarean birth, being more religious, having higher education, conceiving spontaneously, having a more negative birth experience, and perceiving better treatment from the staff during birth contributed to preferring vaginal birth for the second birth. CONCLUSIONS: Religiosity is central to women's preferences, probably because of its association with the desire to have many children. Modifiable factors, such as women's beliefs about the nature of birth, their overall birth experience, and their perceived treatment from the staff, could influence the uptake of having vaginal births. Intrapartum care that is empathic and encouraging, along with education about modes of birth, could help decrease cesarean birth rates.
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Cesárea/psicología , Conducta de Elección , Parto , Prioridad del Paciente , Adulto , Cesárea/estadística & datos numéricos , Cesárea Repetida/psicología , Femenino , Humanos , Israel , Embarazo , Estudios Prospectivos , Análisis de Regresión , Religión , Encuestas y Cuestionarios , Parto Vaginal Después de Cesárea/psicologíaRESUMEN
Recent epidemiological surveys performed in Australia, USA and Israel demonstrate that Rotavirus vaccination correlates with an attenuated prevalence and/or incidence of early childhood diabetes (T1D). Other studies failed to confirm the above.
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Diabetes Mellitus Tipo 1 , Infecciones por Rotavirus , Vacunas Virales/efectos adversos , Niño , Diabetes Mellitus Tipo 1/etiología , Gastroenteritis , Humanos , Incidencia , Israel , VacunaciónRESUMEN
OBJECTIVE: To compare pregnancy outcomes following induction of labor with prostaglandins versus extra-amniotic balloon catheter indicated for term isolated oligohydramnios. STUDY DESIGN: Retrospective cohort study of all women who underwent induction of labor due to term isolated oligohydramnios at a university affiliated medical center (2007-2016). The cohort was divided into two subgroups, according to induction method: vaginal prostaglandins E2 versus extra-amniotic balloon catheter. Primary outcomes were successful cervical ripening, defined as a Bishop score ≥ 8, and vaginal delivery rate. Secondary outcomes were neonatal adverse events. RESULTS: Five hundred and ten women were included, of whom 454 (89%) underwent induction by prostaglandins and 56 (11%) by extra-amniotic balloon. Cervical ripening success rate was significantly higher in the prostaglandins group (89.4 vs. 76.79%, p = 0.006), as was the rate of vaginal delivery (77.53 vs. 48.21%, p < 0.0001). Induction with prostaglandins remained superior to extra-amniotic balloon in vaginal delivery rate following adjustment to potential confounders (aOR 3.470, 95% CI 1.296-9.296, p < 0.0001). Neonates delivered following induction with extra-amniotic balloon catheter were more often admitted to the neonatal intensive care unit (14.55 vs. 3.39%, p = 0.002). CONCLUSION: Both prostaglandins and extra-amniotic balloon catheter are reasonable interventions for isolated term oligohydramnios. Prostaglandins were superior to extra-amniotic balloon both in cervical ripening success and in vaginal delivery rates.
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Trabajo de Parto Inducido/métodos , Oligohidramnios/cirugía , Prostaglandinas/uso terapéutico , Adulto , Femenino , Humanos , Embarazo , Resultado del Embarazo , Prostaglandinas/farmacología , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the association between antenatal corticosteroid treatment and neonatal outcome when delivery occurs at term. STUDY DESIGN: A retrospective cohort study of all women with singleton gestations who delivered at term (37 + 0 to 41 + 6 weeks) in a tertiary medical center (2012-2015). Women with diabetes, suspected fetal growth restriction, antepartum fetal death, and fetal structural or chromosomal anomalies were excluded. The cohort was divided according to prior preterm (24 + 0 to 33 + 6 weeks) antenatal corticosteroids treatment due to threatened preterm labor (study group), vs. no such treatment (control group). Primary outcome was birthweight at delivery. Secondary outcomes were composites neonatal adverse outcomes. Logistic regression analysis was utilized to adjust results for potential confounders. RESULTS: Of 25,872 women who were included in the study, 722 (3%) were treated with antenatal corticosteroids. Women in the treatment group had higher rates of nulliparity compared to controls (43% vs. 38%, p = 0.002). Birth weight was significantly lower in the corticosteroid treatment group (3077 g vs. 3264 g, p = 0.001), with higher rates of small for gestational age (11% vs. 6%, p = 0.001). Multivariate analysis adjusting for parity and gestational age demonstrated that corticosteroid treatment was associated with lower birth weight (B = - 93 g, 95% CI - 123 to - 66, p = 0.001). Treatment was not found to be associated with adverse neonatal outcomes composites. CONCLUSION: Antenatal corticosteroid treatment is associated with lower birth weight and higher rates of small for gestational age neonates among women who eventually deliver at term. However, it is not associated with short-term adverse neonatal outcomes.
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Corticoesteroides/uso terapéutico , Nacimiento Prematuro/tratamiento farmacológico , Atención Prenatal/métodos , Corticoesteroides/farmacología , Adulto , Peso al Nacer , Estudios de Cohortes , Femenino , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Masculino , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Women perceive what birth is even before they are pregnant for the first time. Part of this conceptualization is the basic belief about birth as a medical and natural process. These two separate beliefs are pivotal in the decision-making process about labor and birth. Adapting Engel's biopsychosocial framework, we explored the importance of a wide range of factors which may contribute to these beliefs among first-time mothers. METHOD: This observational study included 413 primiparae ≥24 weeks' gestation, recruited in medical centers and in natural birth communities in Israel. The women completed a questionnaire which included the Birth Beliefs Scale and a variety of biopsychosocial characteristics such as obstetric history, birth environment, optimism, health-related anxiety, and maternal expectations. RESULTS: Psychological dispositions were more related to the birth beliefs than the social or biomedical factors. Sociodemographic characteristics and birth environment were only marginally related to the birth beliefs. The basic belief that birth is a natural process was positively related to optimism and to conceiving spontaneously. Beliefs that birth is a medical process were related to pessimism, health-related anxiety, and to expectations that an infant's behavior reflects mothering. Expectations about motherhood as being naturally fulfilling were positively related to both beliefs. CONCLUSION: Psychological factors seem to be most influential in the conceptualization of the beliefs. It is important to recognize how women interpret the messages they receive about birth which, together with their obstetric experience, shape their beliefs. Future studies are recommended to understand the evolution of these beliefs, especially within diverse cultures.
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Ansiedad/psicología , Toma de Decisiones , Trabajo de Parto/psicología , Parto/psicología , Adulto , Ansiedad/etiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Israel , Modelos Lineales , Embarazo , Encuestas y CuestionariosRESUMEN
BACKGROUND: We aimed to describe the length of second stage of labor in a contemporary cohort. We calculated the 5th, 50th, and 95th percentiles for second-stage length stratified by parity and epidural analgesia use and evaluated the effect of labor induction and oxytocin augmentation in our cohort. METHODS: We did a retrospective analysis of all live, singleton, term vaginal deliveries in one tertiary hospital. Multivariate linear regression was used to evaluate second-stage duration confounders. First, we calculated the second-stage length and presented it as 5th, 50th, and 95th percentiles stratified by epidural analgesia and parity. Second, we evaluated the effect of labor induction and oxytocin augmentation on second-stage length, and third, we determined the demographic and obstetrical confounders that affected second-stage length. RESULTS: Overall, 15 500 deliveries were included. Nulliparity, oxytocin augmentation, epidural use, birthweight, labor induction, lower body mass index, and higher maternal age were found to be significantly associated with prolongation of the second stage. Epidural use was associated with an additional 82 minutes for the 95th percentile for both nulliparas and multiparas and tripled the rate of prolonged second stage for the entire cohort. Labor induction was associated with clinically significant prolongation of the second stage in nulliparas with epidural analgesia only. Oxytocin was associated with longer duration of the second stage for nulliparas, regardless of epidural use. DISCUSSION: Our findings suggest a significant prolongation of the second stage in women receiving epidural analgesia. Recommendations for management of second stage should be reconsidered by contemporary data.
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Analgesia Epidural/estadística & datos numéricos , Segundo Periodo del Trabajo de Parto , Trabajo de Parto Inducido/estadística & datos numéricos , Oxitocina/administración & dosificación , Adulto , Femenino , Humanos , Israel , Estimación de Kaplan-Meier , Modelos Lineales , Edad Materna , Persona de Mediana Edad , Análisis Multivariante , Paridad , Embarazo , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To determine the association between antenatal corticosteroid treatment and neonatal complications in diabetic mothers delivering after 34 weeks of gestation. METHODS: A retrospective cohort study of women with singleton pregnancies diagnosed with gestational diabetes who delivered after 34 weeks of gestation in a university-affiliated medical center (2012-2016). Mothers treated with corticosteroids prior to 34 + 0 weeks of gestation were divided according to gestational age at delivery: late-preterm (34 + 0 to 36 + 6) and term (37 + 0 to 41 + 6). Each group was compared to women delivering at the same gestational age who were not treated with corticosteroids. Primary outcome was defined as a neonatal adverse composite outcome. Birth weight was amongst secondary outcomes measured. Logistic regression analysis was utilized to adjust results to potential confounders. RESULTS: During the study period, 161 diabetic mothers delivered at late-preterm. Amongst them, 47 (30%) were treated with corticosteroids. 2101 diabetic mothers delivered at term, amongst them 82 (4%) were treated with corticosteroids. Primary outcome did not differ between groups. Multivariate analysis demonstrated that corticosteroid treatment was not associated with neonatal adverse composite outcome when delivery occurred at the late preterm, nor at term (adjusted odds ratio (aOR) = 0.708, 95% CI 0.2-2.3, p = 0.572, and aOR = 1.6, 95% CI 0.2-12.7, p = 0.635, respectively). Birth weight was significantly lower in women treated with corticosteroids (2486 vs. 2675 g, p = 0.02 at late-preterm, and 3160 vs. 3319 g, p < 0.001 at term). CONCLUSION: Corticosteroid treatment for diabetic mothers was not associated with neonatal adverse outcomes, but was found associated with a lower birth weight, when delivery occurs after 34 weeks of gestation.
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Corticoesteroides/efectos adversos , Diabetes Gestacional/tratamiento farmacológico , Feto/efectos de los fármacos , Adulto , Peso al Nacer/efectos de los fármacos , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Persona de Mediana Edad , Embarazo , Nacimiento Prematuro , Estudios RetrospectivosRESUMEN
PURPOSE: To estimate the impact of indication for vacuum-assisted vaginal delivery on neonatal and maternal adverse outcome. METHODS: Retrospective analysis of women carrying singleton-term pregnancies undergoing vacuum-assisted vaginal delivery in a tertiary hospital (2007-2014). Cohort was stratified by indication: non-reassuring fetal heart rate or prolonged second stage. Primary outcome was adverse neonatal outcome and secondary outcome was maternal morbidity. Logistic regression analysis was utilized to adjust for potential confounders. RESULT: Overall, 4931 women met inclusion criteria. Delivery indication was prolonged second stage in 3143 (64%) cases and non-reassuring fetal heart rate in 1788 (36%). In the non-reassuring fetal heart rate group, there were higher rates of cephalohematoma, low 5-min Apgar-score, and asphyxia. In the prolonged second-stage group, there were higher rates of sepsis and post-partum hemorrhage. Composite neonatal birth trauma and maternal morbidity were higher for vacuum-assisted vaginal delivery following prolonged second stage. Following adjustment for confounders cephalohematoma (aOR 1.21, 95% CI 1.04-1.41), low 5-min Apgar-score (aOR 2.91, 95% CI 1.26-4.67) and asphyxia (aOR 1.81 95% CI 1.35-2.44) remained significant in the non-reassuring fetal heart rate group and neonatal sepsis remained significant for the prolonged second-stage group (aOR 1.77, 95% CI 1.38-2.27), p < 0.05 for all. However, there was no longer difference in the composite birth trauma, other neonatal or maternal morbidity. CONCLUSION: The indication for vacuum-assisted vaginal delivery has an impact on neonatal outcome. While cephalohematoma, low 5' Apgar score, and asphyxia were more common in the non-reassuring fetal heart rate group, neonatal sepsis was more common in cases of prolonged second stage of labor.
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Resultado del Embarazo , Extracción Obstétrica por Aspiración/efectos adversos , Adulto , Asfixia Neonatal/epidemiología , Traumatismos del Nacimiento/epidemiología , Parto Obstétrico , Femenino , Frecuencia Cardíaca Fetal , Humanos , Recién Nacido , Segundo Periodo del Trabajo de Parto , Trabajo de Parto , Sepsis Neonatal/epidemiología , Hemorragia Posparto/epidemiología , Embarazo , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To determine the perinatal outcome associated with cup detachment during vacuum-assisted vaginal delivery (VAVD). METHODS: A retrospective cohort study of all women attempting VAVD in a tertiary hospital (2012-2014). Singleton-term pregnancies were included. Antepartum fetal death and major fetal structural or chromosomal abnormalities were excluded. Primary outcome was neonatal birth trauma (subgaleal hematoma, subarachnoid hematoma, subdural hematoma, skull fracture, and/or erb's palsy). Secondary outcomes were maternal complications or other neonatal morbidities. Outcomes were compared between women after ≥1 cup detachment (study group) and the rest (control group). Logistic regression analysis was utilized to adjust results to potential confounders. RESULTS: Overall, 1779 women attempted VAVD during study period. Of them, in 146 (8.2%), the cup detached prior to delivery; 130/146 (89%) had a single detachment. After detachment, 4 (2.7%) delivered by cesarean section, 77 (52.7%) delivered after cup reapplication, and 65 (44.6%) delivered spontaneously. Women in the study group were more likely to undergo VAVD due to prolonged second stage, and were characterized by lower rates of metal cup use. Neonates in the detachment group had higher rates of subarachnoid hematoma and composite neonatal birth trauma (2.7 vs. 0.1% and 4.8 vs. 1.8%, respectively, p < 0.05). This remained significant after adjustment to potential confounders (subarachnoid hematoma aOR = 45.44, 95% CI 6.42-321.62 and neonatal birth trauma aOR = 2.62, 95% CI 1.1-6.22, p < 0.05 for all). Other neonatal and maternal morbidities were similar between groups. CONCLUSION: Cup detachment is associated with a higher rate of adverse neonatal outcome. Cup reapplication should be considered carefully.
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Traumatismos del Nacimiento/epidemiología , Hematoma/epidemiología , Enfermedades del Recién Nacido/etiología , Hemorragia Subaracnoidea/epidemiología , Extracción Obstétrica por Aspiración/efectos adversos , Adulto , Traumatismos del Nacimiento/etiología , Neuropatías del Plexo Braquial/etiología , Parto Obstétrico , Femenino , Muerte Fetal/etiología , Humanos , Recién Nacido , Embarazo , Estudios RetrospectivosRESUMEN
PURPOSE: Labor induction is performed in 20 % of pregnancies. However, the impact of the indications for induction on its failure rate has hardly been investigated. We aimed to evaluate the association of indications for labor induction with failure rate. METHODS: Background and delivery-related data were retrospectively collected for all women with a viable term singleton pregnancy, who underwent labor induction with a PGE2 vaginal insert in 2013-2014. Reasons for induction were categorized as maternal indications, hypertensive disorders, premature rupture of membranes, and fetal indications. Induction failure was defined as Bishop score ≤7 at 24 h after PGE2 administration, cesarean delivery due to latent phase dystocia or removal of the insert due to non-reassuring fetal heart rate followed by emergency cesarean delivery. Outcome measures were rate of induction failure (primary) and rate of cesarean delivery (secondary). RESULTS: The cohort included 1066 women. Those who failed induction (n = 213, 20 %) were more likely to be nulliparous (69.5 vs. 45.7 %, p < 0.0001), older (31 vs. 30 years, p = 0.047), and at an earlier gestational age (39.4 vs. 40.0 weeks, p < 0.0001). Among nulliparous women, maternal indications were significantly associated with induction failure (aOR 2.52, 95 % CI 1.28-4.95, p = 0.007) and cesarean delivery (aOR 2.36, 95 % CI 0.40-2.29, p = 0.019). Among multiparous women, hypertensive disorders (aOR 7.26, 95 % CI 1.89-27.87, p = 0.004) and maternal indications (aOR 4.22, 95 %CI 1.14-15.58, p = 0.031) were significantly associated with induction failure but not cesarean delivery. CONCLUSIONS: The indication for induction of labor may impact its failure rate.
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Cesárea/métodos , Trabajo de Parto Inducido/métodos , Adulto , Estudios de Cohortes , Femenino , Humanos , Embarazo , Resultado del Embarazo , Estudios RetrospectivosRESUMEN
Childbirth is usually the most painful event of a mother's life, and resonates in individual and collective memory for years. The current study examined the relationship between the experience of labor pain and its recollection 2 days and 2 months after delivery. We found that despite the exceptional physical and emotional experiences of childbirth, the memory of the pain involved in labor was biased toward the average of the peak pain and the end pain, whereas the duration of the delivery had a relatively negligible effect on the recollected intensity of pain. A comparison of mothers whose labor ended with or without epidural analgesia corroborated previous findings that the level of pain toward the end of an experience greatly influences the way the overall experience is remembered. Although both short- and long-term retention of memories of labor exhibited the peak-and-end effect, having given birth before weakened the effect 2 months after delivery.
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Dolor de Parto/psicología , Recuerdo Mental , Madres/psicología , Adulto , Analgesia Epidural/psicología , Analgesia Obstétrica/psicología , Femenino , Estudios de Seguimiento , Humanos , Juicio , Embarazo , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
BACKGROUND: The third stage of labor is a pivotal phase in obstetric care. Management may be physiological or active. Although the use of prophylactic placental cord drainage has been assessed in prior data, there is still no clear-cut evidence supporting its effectiveness in improving key obstetric outcomes. OBJECTIVE: The aim of the study was to investigate the impact of placental cord drainage during the third stage of labor on the amount of maternal bleeding, duration of the third stage, and incidence of postpartum hemorrhage. STUDY DESIGN: A randomized controlled trial was conducted at a high-volume tertiary obstetric center between May 2021 and December 2022. A total of 212 pregnant women with a singleton uncomplicated pregnancy were randomly assigned to undergo placental cord drainage or standard care without drainage. The randomization was manual, using pre-marked cards drawn by the participants. The power calculation determined a sample size of 92 participants per group to achieve 80% power at a 5% significance level, aiming to detect 20% difference in bleeding amount between the groups. In practice, we included more than 100 women in each group. The primary outcome was the amount of bleeding during the third stage of labor, while secondary outcomes included the duration of the third stage and incidence of postpartum hemorrhage. After delivery, all participants received 10 units of oxytocin via intravenous drip and delayed cord clamping was performed. In the study group, the maternal umbilical cord was then unclamped. Blood was allowed to drain into a plastic bag placed under the women's buttocks. If an episiotomy or perineal tear was observed, pressure packing was applied to reduce bleeding. The collected blood was measured in milliliters after placental expulsion. RESULTS: A total of 212 women were recruited of whom 104 underwent placental cord drainage and 108 received standard care without drainage. No significant differences were observed between the intervention and control groups in mean duration of the third stage of labor (10.56±6.12 vs. 10.95±6.33 minutes, P=0.65), incidence of postpartum hemorrhage (3.84% vs. 7.41%, P=0.38), or mean amount of bleeding during the third stage of labor (292±200 vs. 300±242 ml, P=0.79). Furthermore, there were no significant between-group differences in the mean amount of bleeding on separate analysis of nulliparous women (356±246 vs. 330±240 ml, P=0.68), multiparous women (265±171 vs. 289±244 ml, P=0.50), women who were not exposed to external oxytocin during labor (287±204 vs. 317±250 ml, P=0.59), and women who were exposed to external oxytocin (296±198 vs. 289±238 ml, P=0.39). CONCLUSIONS: Placental cord drainage during the third stage of labor showed no statistically significant impact on bleeding amount, third-stage length, or postpartum hemorrhage rate. The findings suggest that placental cord drainage may not offer additional benefits in preventing postpartum hemorrhage in women with uncomplicated pregnancies.
Asunto(s)
Presentación de Nalgas/diagnóstico por imagen , Peso Fetal , Ultrasonografía Prenatal , Adulto , Peso al Nacer , Estudios de Cohortes , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Embarazo , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVES: The aim of this study was to assess the association between neonatal SARS-CoV-2 antibody level at delivery and infant SARS-CoV-2 infection under the age of 6 months and to identify predictive factors for neonatal antibody level at delivery. METHODS: In a prospective observational study, conducted between September 2021 and mid-February 2022, cord blood sera were tested for SARS-CoV-2 anti-spike receptor-binding domain antibodies after maternal BNT162b2 vaccination or infection. Infants were followed up for 6 months for SARS-CoV-2 infection. RESULTS: Sixty-seven mother-infant dyads were enrolled; nine of those did not meet the eligibility criteria. Of the 58 mother-infant dyads included, 6-month follow-up data were available for 57 mother-infant dyads. The mean ± standard deviation log SARS-CoV-2 anti-spike antibody level at delivery was lower among infants who were COVID-19 positive versus negative during follow-up (3.41 ± 0.74 AU/mL, n = 12; vs. 3.87 ± 0.84 AU/mL, n = 46; p 0.036); a log titre of ≥4.07 AU/mL (11 750) at delivery was associated with a significantly lower likelihood of infant infection (1/26 vs. 11/32 in infants with antibody level of <4.07 log AU/mL, OR = 0.076 [95% CI, 0.076, 0.64], p 0.018). A spline curve model showed a linear decrease in antibody levels when the last dose was administered at ≤30 weeks of gestation (50 days before delivery), after which the antibody levels increased (R2 = 0.50). In multivariate analysis, more vaccine doses, prior maternal infection, and last administered dose at ≥31 weeks of gestation were associated with higher antibody levels at delivery. DISCUSSION: Higher anti-spike antibodies at delivery were associated with decreased risk of COVID-19 at the age of <6 months; the antibody level decreased linearly when the last dose was administered at ≤30 weeks of gestation. Future research should assess the effectiveness of a second booster during pregnancy against infant infection.