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OBJECTIVE: Fetal hemodynamic changes have already been described during open myelomeningocele repair. This study aimed to access fetal myocardial performance index (MPI) during this high-complexity surgery. METHODS: Open myelomeningocele repair was performed in 37 fetuses between the 24th and 27th week of gestation. MPI was calculated at specific periods: pre-anesthesia, postanesthesia, neurosurgery (early skin manipulation, spinal cord releasing, and sintesis), and end of surgery. Mean ± standard deviation (SD) of MPI and its related times-isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET)-was determined for each period. Analysis of variance (ANOVA) with repeated measures was used to assess differences among these periods. Tukey multiple comparison times test compared global surgery stages. RESULTS: The mean of MPI in the specific time points was 0.32, 0.32, 0.34, 0.48, 0.36, and 0.32, respectively (P < .001). In the two-tailed comparison times, neurosurgery stage presents MPI highest levels, especially on stage 3b (early skin manipulation and spinal cord releasing) related to ICT and IRT rising and ET decreased levels. CONCLUSION: Fetal global cardiac function is altered during the open myelomeningocele repair. The neurosurgery stage represents the critical phase of the procedure.
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Corazón Fetal/cirugía , Meningomielocele/cirugía , Monitoreo Intraoperatorio/métodos , Ultrasonografía Prenatal/métodos , Adulto , Estudios Transversales , Femenino , Corazón Fetal/diagnóstico por imagen , Corazón Fetal/fisiopatología , Humanos , Meningomielocele/diagnóstico por imagen , Embarazo , Estudios Prospectivos , Adulto JovenRESUMEN
AIM: To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on the basis of maternal characteristics (MC) and mean arterial pressure (MAP). METHODS: A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1st trimester ultrasound. The outcome measures were the incidences of total PE, preterm PE (delivery <37 weeks) and term PE (delivery ≥37 weeks). We performed logistic regression analysis to determine which factors made significant contributions for the prediction of the three outcomes. RESULTS: We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) of 0.79 [95% confidence interval (CI)=0.76-0.82]. For preterm PE, the best model was MC+MAP, with an AUC ROC of 0.84 (95% CI=0.81-0.87). For term PE, the best model was MC, with an AUC ROC of 0.75 (0.72-0.79). The MC+MAP model demonstrated a detection rate of 67% cases of preterm PE, with a false-positive rate of 10%, positive predictive value of 17% and negative predictive value of 99%. CONCLUSION: The MC+MAP model showed good accuracy in predicting preterm PE in the 1st trimester of gestation.
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Presión Sanguínea , Preeclampsia/epidemiología , Primer Trimestre del Embarazo/fisiología , Adulto , Brasil/epidemiología , Femenino , Humanos , Embarazo , Estudios ProspectivosRESUMEN
OBJECTIVE: The aim of this study was to assess fetal hemodynamics during intrauterine open surgery for myelomeningocele (MMC) repair by describing fetal heart rate (FHR) monitoring in detail related to each part of the procedure. METHODS: A study was performed with 57 fetuses submitted to intrauterine MMC repair between the 24th and 27th week of gestation. Evaluations of FHR were made in specific periods: before anesthesia, after anesthesia, at the beginning of laparotomy, during uterus abdominal withdrawal, hysterotomy, neurosurgery (before incision, during early skin manipulation, spinal cord releasing, and at the end of neurosurgery), abdominal cavity reintroduction, and abdominal closure, and at the end of surgery. Means ± standard deviations of FHR were established for each period, and analysis of variance with repeated measures was used to assess differences between these periods. The mean differences were assessed with 95% confidence intervals and were analyzed by Tukey's multiple comparison test. RESULTS: The mean FHR during the specific periods mentioned above was 140.2, 140, 139.2, 138.8, 135.1, 133.9, 123.1, 134.0, 134.5, 137.9, and 139.9 bpm, respectively (p < 0.0001). Comparing the different periods, the highest frequencies were observed in the initial and final moments. The neurosurgery stage presents lower frequencies, especially during the release of the spinal cord. CONCLUSION: FHR monitoring revealed interesting findings in terms of physiological fetal changes during MMC repair, especially during neurosurgery, which was the most critical period.
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Monitoreo Fetal , Feto/cirugía , Frecuencia Cardíaca Fetal , Meningomielocele/cirugía , Adulto , Análisis de Varianza , Estudios Transversales , Femenino , Feto/fisiopatología , Edad Gestacional , Humanos , Meningomielocele/fisiopatología , Embarazo , Estudios ProspectivosAsunto(s)
Meningomielocele , Femenino , Feto , Humanos , Parto , Embarazo , Atención Prenatal , Estudios RetrospectivosRESUMEN
RhD alloimmunization in pregnancy is still the main cause of hemolytic disease of the fetus and neonate (HDFN). Nevertheless, there are other antigens that may be associated with the occurrence of this phenomenon and that have been growing in proportion, given that current prevention strategies focus only on anti-RhD antibodies. Although not widespread, the screening and diagnostic management of the disease caused by these antibodies has recommendations in the literature. For this reason, the following review was carried out with the objective of listing the main red blood cell antigen groups described - such as Rh, ABO, Kell, MNS, Duffy, Kidd, among others - addressing the clinical importance of each one, prevalence in different countries, and recommended management when detecting such antibodies during pregnancy.
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OBJECTIVES: To analyze the self-reported perception of obstetric medical teams regarding the practice of delivering bad news in public and private hospitals. METHODS: Cross-sectional study considering physicians delivering obstetric care at the Municipal Hospital Vila Santa Catarina, Municipal Hospital Dr. Moysés Deutsch, and Albert Einstein Israelite Hospital, in São Paulo, Brazil. The applied questionnaire reflected the steps of the SPIKES protocol for delivering difficult news, with the questions adapted to obstetric and fetal medicine practice context. RESULTS: Specialists self-reported higher levels of knowledge, better emotional management, and superior strategy planning and summarization skills than residents. Participants with more than five years of experience reported higher knowledge levels, better emotional management, and superior strategy development skills. When comparing professionals from private and public hospitals, no significant differences emerged in self-reported communication aspects. CONCLUSIONS: Experience duration significantly influences professionals' impressions in their ability to provide information, manage emotions, and plan post-diagnosis. Specialists and those with more years of experience self-report enhanced readiness in executing communication steps effectively. PRACTICE IMPLICATIONS: Our findings underscore the importance of tailored training and experience in navigating sensitive medical conversations in the field of Obstetrics.
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Tuberous sclerosis complex (TSC) is a multiple system neurocutaneous syndrome with a genetic disorder caused by different mutations in TSC1 or TSC2. Usually, TSC causes tumors in the heart, brain, kidneys, eyes, and lungs. However, tumors can also develop in any other organs. The prenatal diagnosis of TCS is based on the identification of fetal cardiac tumors by ultrasound and brain subependymal nodules, usually identified by fetal magnetic resonance imaging (MRI). We present two case reports of the prenatal diagnosis of TCS using both ultrasound and MRI, which were confirmed by clinical and radiological methods in the postnatal period accordingly.
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The aim of this review is to present a wide spectrum of placental and umbilical cord pathologies affecting the pregnancy. Placental and umbilical cord anomalies are highly associated with high-risk pregnancies and may jeopardize fetal well-being in utero as well as causing a predisposition towards poor perinatal outcome with increased fetal and neonatal mortality and morbidity. The permanent, computerized perinatology databases of different international centers have been searched and investigated to fulfil the aim of this manuscript. An extended gallery of prenatal imaging with autopsy correlation in specific cases will help to provide readers with a useful iconographic tool and will assist with the understanding and definition of this critical obstetrical and perinatological issue.
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Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.
A ultrassonografia é um instrumento que está presente na avaliação materno-fetal durante toda a gestação e com benefícios largamente documentados, porém sua utilização no intraparto vem sendo cada vez mais pertinente. Desde a avaliação de progressão de trabalho de parto a avaliação das desordens placentárias, a ultrassonografia pode ser empregada correlacionando com os achados fisiológicos e do exame físico, pois o seu benefício na sala de parto ainda não pode ser comprovado. Há ainda poucos profissionais com treinamento adequado para seu uso na sala de parto e para interpretação correta dos dados. Dessa forma, este artigo tem como finalidade apresentar uma revisão de toda a aplicabilidade do ultrassom na sala de parto, considerando as principais etapas do trabalho de parto. Ainda são limitadas as pesquisas em medicina baseada em evidências sobre os diversos usos possíveis no intraparto, mas espera-se que novos estudos possam trazer melhorias na qualidade da saúde materno-neonatal durante o trabalho de parto.
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Salas de Parto , Trabajo de Parto , Recién Nacido , Embarazo , Femenino , Humanos , Ultrasonografía Prenatal , Placenta , UltrasonografíaRESUMEN
Zika virus (ZIKV) is a widespread flavivirus transmitted to humans through the bite of Aedes mosquitoes. The number of ZIKV cases increased significantly between 2015 and 2016, and Brazil was the first to report autochthonous transmission of infection. The main neurological disorder related to ZIKV infection is microcephaly. Fetal magnetic resonance imaging (MRI) is the gold standard examination for the analysis of fetal brain infection, followed by obstetric ultrasonography. Cerebral atrophy, intracranial calcifications, ventriculomegaly, cerebellar, and brain gyrus abnormalities are some of the most common findings. Postnatal MRI shows high sensitivity and specificity. Corpus callosum abnormalities, cerebellar hypoplasia, and choroid plexus dilation can be also observed. We present a review of congenital ZIKV infection with emphasis on pre and postnatal brain findings using ultrasonography, MRI, computed tomography, and three-dimensional reconstruction models.
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Microcefalia , Complicaciones Infecciosas del Embarazo , Infección por el Virus Zika , Virus Zika , Embarazo , Femenino , Humanos , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/diagnóstico por imagen , Infección por el Virus Zika/congénito , Microcefalia/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Encéfalo/anomalías , Complicaciones Infecciosas del Embarazo/diagnóstico por imagen , Neuroimagen/métodosRESUMEN
OBJECTIVE: The objective of this study was to analyze the relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes in an average city in the state of Minas Gerais, Brazil. METHODS: This was a prospective and observational study. The variables analyzed were obtained through a questionnaire administered to postpartum women (between 1 and 48 h postpartum) and information contained in prenatal cards. The pregnant women were classified into three groups: Group I, <3 prenatal care visits; Group II, 3-5 prenatal care visits; and Group III, ≥6 prenatal care visits. RESULTS: Group I had a lower median weight (57.0 vs. 64.0 kg, p<0.001), body mass index (22.1 vs. 24.3 kg/m2, p<0.001), and weight gain (9.0 vs. 12 kg, p=0.002) than Group III. The prevalence of admission to the neonatal intensive care unit (11.6 vs. 4.2%, p=0.02) and the newborn mortality rate within the first 72 h of life (2.3 vs. 0%, p<0.001) were higher in Group I than in Group III. Group II had a higher prevalence of admission to the adult intensive care unit (5.7 vs. 0.6%, p<0.001) and a higher newborn mortality rate within the first 72 h of life (1.6% vs. 0%, p<0.001) than Group III. CONCLUSIONS: Having ≥6 prenatal care visits was associated with lower rates of admission to the neonatal and adult intensive care unit, as well as a lower newborn mortality rate within the first 72 h of life.
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Resultado del Embarazo , Atención Prenatal , Adulto , Femenino , Humanos , Recién Nacido , Periodo Posparto , Embarazo , Resultado del Embarazo/epidemiología , Estudios Prospectivos , Aumento de PesoRESUMEN
OBJECTIVE: The main aim of this study was to evaluate the impact of using interventions in low- and high-risk parturients on maternal and perinatal adverse outcomes during labor. METHODS: This is a prospective study. The analyzed variables were obtained through a questionnaire with puerperal women (between 1- and 48-h postpartum) and through medical record searches. The study population was divided into two groups as follows: Group I included parturients who underwent at least one type of obstetric intervention and Group II included parturients who did not undergo any type of obstetric intervention. RESULTS: Most parturients (75.3%) underwent at least one type of intervention, with oxytocin being the most prevalent intervention (49.5%), followed by misoprostol use (28.7%), elective cesarean section at the request of the patient (23.0%), amniotomy (21.2%), and episiotomy (21.0%). Regarding the adverse perinatal outcomes related to low-risk pregnancies, the prevalence of the second- or third-degree perineal tears (17.8% vs. 36.7%, p=0.001) was lower in Group I than in Group II. Moreover, in high-risk pregnancies, the prevalence of hospitalization in the neonatal intensive care unit (2.8% vs. 16.7%, p<0.001), adult intensive care unit admission (0.8% vs. 3.9%, p=0.004), and the need for oxygen therapy (26.8% vs. 40.4%, p<0.001) was lower in Group I than in Group II. CONCLUSIONS: In low-risk parturients, the interventions performed were associated with lower prevalence of second- or third-degree perineal tears. There was a lower prevalence of neonatal and adult intensive care unit admissions, the need for oxygen therapy, intracranial hemorrhage, and neonatal infection among high-risk parturients.
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Trabajo de Parto , Complicaciones del Embarazo , Adulto , Cesárea , Femenino , Hospitales Universitarios , Humanos , Recién Nacido , Oxígeno , Embarazo , Estudios ProspectivosRESUMEN
OBJECTIVE: To compare fetuses with intrauterine growth restriction (IUGR) and those with normal growth, in terms of skull and brain measurements obtained by magnetic resonance imaging (MRI). MATERIALS AND METHODS: This was a prospective cohort study including 26 single fetuses (13 with IUGR and 13 with normal growth), evaluated from 26 to 38 weeks of gestation. Using MRI, we measured skull and brain biparietal diameters (BPDs); skull and brain occipitofrontal diameters (OFDs); corpus callosum length and area; transverse cerebellar diameter; extracerebral cerebrospinal fluid (eCSF); and right and left interopercular distances (IODs). RESULTS: The following were significantly smaller in IUGR fetuses than in control fetuses: skull BPD (76.9 vs. 78.2 mm; p = 0.0029); brain BPD (67.8 vs. 71.6 mm; p = 0.0064); skull OFD (93.6 vs. 95 mm; p = 0.0010); eCSF (5.5 vs. 8.2 mm; p = 0.0003); right IOD (9.8 vs. 13.9 mm; p = 0.0023); and left IOD (11.8 vs. 16.3 mm; p = 0.0183). The skull BPD/eCSF, brain BPD/eCSF, skull OFD/eCSF, and brain OFD/eCSF ratios were also lower in IUGR fetuses. CONCLUSION: IUGR fetuses had smaller OFD and BPD, both skull and brain, and less eCSF when compared to normal growth fetuses.
OBJETIVO: Comparar medidas do crânio e encéfalo por meio da ressonância magnética (RM) de fetos com restrição do crescimento intrauterino (RCIU) e com crescimento adequado. MATERIAIS E MÉTODOS: Realizou-se um estudo de coorte prospectivo com 13 fetos com RCIU e 13 controles entre 26 e 38 semanas. Foram realizadas as seguintes medidas por RM: diâmetro biparietal (DBP) e diâmetro occipitofrontal (DOF) cerebral e ósseo, comprimento e área do corpo caloso (CPC), diâmetro transverso do cerebelo, líquido cerebroespinhal (LCE) extracerebral e distância interopercular (DIO) direita e esquerda. RESULTADOS: Observaram-se diferenças significativas nas medidas do DBP ósseo (76,9 vs. 78,2 mm; p = 0,0029), DBP cerebral (67,8 vs. 71,6 mm; p = 0,0064) e DOF ósseo (93,6 vs. 95 mm; p = 0,0010) em fetos com RCIU em relação aos fetos com crescimento normal. Observaram-se, ainda, diferenças significativas nas médias do LCE extracerebral (5,5 vs. 8,2 mm; p = 0,0003) e DIO direita (9,8 vs. 13,9 mm; p = 0,0023) e esquerda (11,8 vs. 16,3 mm; p = 0,0183) em fetos com RCIU em relação aos controles. Fetos com RCIU e normais tiveram diferenças entre DBP ósseo/LCE, DBP cerebral/LCE, DOF/LEC, e DOF cerebral/LCE. CONCLUSÃO: Fetos com RCIU tiveram menores DBP e DOF, ambos crânio e encéfalo, e menor LCE extracerebral que fetos com crescimento adequado.
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Abstract RhD alloimmunization in pregnancy is still the main cause of hemolytic disease of the fetus and neonate (HDFN). Nevertheless, there are other antigens that may be associated with the occurrence of this phenomenon and that have been growing in proportion, given that current prevention strategies focus only on anti-RhD antibodies. Although not widespread, the screening and diagnostic management of the disease caused by these antibodies has recommendations in the literature. For this reason, the following review was carried out with the objective of listing the main red blood cell antigen groups described — such as Rh, ABO, Kell, MNS, Duffy, Kidd, among others — addressing the clinical importance of each one, prevalence in different countries, and recommended management when detecting such antibodies during pregnancy.
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The aim of the current review is to report a-CGH abnormalities identified in fetuses with prenatally diagnosed fetal malformations in whom a normal karyotype was diagnosed with conventional cytogenetic analysis. A systematic electronic search of databases (PubMed/Medline, EMBASE/SCOPUS) has been conducted from inception to May, 2017. Bibliographic analysis has been performed according to PRISMA statement for review. The following keywords were used: 'array-CGH' and 'fetal malformations" and "prenatal diagnosis"; alternatively, "microarray", "oligonucleotide array", "molecular biology", "antenatal diagnostics", "fetal diagnostics", "congenital malformations" and "ultrasound" were used to capture both "a-CGH" and "prenatal". One-hundred and twelve fetuses with prenatally diagnosed fetal malformations with normal karyotyping and a-CGH abnormalities detected are described. Single or multiple microarray abnormalities diagnosed have been classified in relation to different organ/system affected. The most frequent a-CGH abnormalities were detected in cases of congenital heart diseases (CDHs), multiple malformations and central nervous system (CNS) malformations. Maternal or paternal carrier-state was seen in 19.64% (22/112), of cases while the number of reported de novo mutations accounted for 46.42% (52/112) of all CNVs microarray abnormalities. Array-comparative genomic hydridization (a-CGH) may become an integral and complemantary genetic testing when fetal malformations are detected prenatally in fetuses with normal cytogenetic karyotype. In addition, a-CGH enables the identification of CNVs and VOUS and improves the calculation of recurrent risk and the genetic counseling.
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Anomalías Múltiples/genética , Aberraciones Cromosómicas/embriología , Hibridación Genómica Comparativa , Cardiopatías Congénitas/genética , Análisis de Secuencia por Matrices de Oligonucleótidos , Diagnóstico Prenatal/métodos , Anomalías Múltiples/diagnóstico , Sistema Nervioso Central/anomalías , Sistema Nervioso Central/embriología , Femenino , Cardiopatías Congénitas/diagnóstico , Humanos , Cariotipificación/métodos , Edad Materna , Embarazo , Factores de RiesgoRESUMEN
Abstract Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.
Resumo A ultrassonografia é um instrumento que está presente na avaliação materno-fetal durante toda a gestação e com benefícios largamente documentados, porém sua utilização no intraparto vem sendo cada vez mais pertinente. Desde a avaliação de progressão de trabalho de parto a avaliação das desordens placentárias, a ultrassonografia pode ser empregada correlacionando com os achados fisiológicos e do exame físico, pois o seu benefício na sala de parto ainda não pode ser comprovado. Há ainda poucos profissionais com treinamento adequado para seu uso na sala de parto e para interpretação correta dos dados. Dessa forma, este artigo tem como finalidade apresentar uma revisão de toda a aplicabilidade do ultrassom na sala de parto, considerando as principais etapas do trabalho de parto. Ainda são limitadas as pesquisas em medicina baseada em evidências sobre os diversos usos possíveis no intraparto, mas espera-se que novos estudos possam trazer melhorias na qualidade da saúde materno-neonatal durante o trabalho de parto.
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Humanos , Femenino , Embarazo , Salas de PartoRESUMEN
SUMMARY OBJECTIVE: The objective of this study was to analyze the relationship between the number of prenatal care visits and the occurrence of adverse perinatal outcomes in an average city in the state of Minas Gerais, Brazil. METHODS: This was a prospective and observational study. The variables analyzed were obtained through a questionnaire administered to postpartum women (between 1 and 48 h postpartum) and information contained in prenatal cards. The pregnant women were classified into three groups: Group I, <3 prenatal care visits; Group II, 3-5 prenatal care visits; and Group III, ≥6 prenatal care visits. RESULTS: Group I had a lower median weight (57.0 vs. 64.0 kg, p<0.001), body mass index (22.1 vs. 24.3 kg/m2, p<0.001), and weight gain (9.0 vs. 12 kg, p=0.002) than Group III. The prevalence of admission to the neonatal intensive care unit (11.6 vs. 4.2%, p=0.02) and the newborn mortality rate within the first 72 h of life (2.3 vs. 0%, p<0.001) were higher in Group I than in Group III. Group II had a higher prevalence of admission to the adult intensive care unit (5.7 vs. 0.6%, p<0.001) and a higher newborn mortality rate within the first 72 h of life (1.6% vs. 0%, p<0.001) than Group III. CONCLUSIONS: Having ≥6 prenatal care visits was associated with lower rates of admission to the neonatal and adult intensive care unit, as well as a lower newborn mortality rate within the first 72 h of life.
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Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Atención Prenatal , Resultado del Embarazo/epidemiología , Aumento de Peso , Estudios Prospectivos , Periodo PospartoRESUMEN
SUMMARY OBJECTIVE: The main aim of this study was to evaluate the impact of using interventions in low- and high-risk parturients on maternal and perinatal adverse outcomes during labor. METHODS: This is a prospective study. The analyzed variables were obtained through a questionnaire with puerperal women (between 1- and 48-h postpartum) and through medical record searches. The study population was divided into two groups as follows: Group I included parturients who underwent at least one type of obstetric intervention and Group II included parturients who did not undergo any type of obstetric intervention. RESULTS: Most parturients (75.3%) underwent at least one type of intervention, with oxytocin being the most prevalent intervention (49.5%), followed by misoprostol use (28.7%), elective cesarean section at the request of the patient (23.0%), amniotomy (21.2%), and episiotomy (21.0%). Regarding the adverse perinatal outcomes related to low-risk pregnancies, the prevalence of the second- or third-degree perineal tears (17.8% vs. 36.7%, p=0.001) was lower in Group I than in Group II. Moreover, in high-risk pregnancies, the prevalence of hospitalization in the neonatal intensive care unit (2.8% vs. 16.7%, p<0.001), adult intensive care unit admission (0.8% vs. 3.9%, p=0.004), and the need for oxygen therapy (26.8% vs. 40.4%, p<0.001) was lower in Group I than in Group II. CONCLUSIONS: In low-risk parturients, the interventions performed were associated with lower prevalence of second- or third-degree perineal tears. There was a lower prevalence of neonatal and adult intensive care unit admissions, the need for oxygen therapy, intracranial hemorrhage, and neonatal infection among high-risk parturients.