Selective versus routine use of episiotomy for vaginal births in Shanghai hospitals, China: a comparison of policies.

BACKGROUND: To assess the effects of policy of selective versus routine episiotomy on mother and baby for women delivering vaginally in Shanghai and whether the hospital type has any effect on the outcomes. METHOD: This was a multi-center retrospective cohort study in Shanghai between March 2015 and May 2017. The study population were vaginal births with selective or routine episiotomy (n = 5478) in 20 secondary or tertiary hospitals. Main Outcome Measure was the incidence of severe perineal lacerations. The adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated by logistic regression and presented as the effect sizes. All models were stratified by the utilization of level (secondary and tertiary) and type (general and Obstetric) of hospital. RESULTS: The primary outcome was not significantly different between vaginal births with routine and selective episiotomy. Patients with selective episiotomy had a lower risk of postpartum hemorrhage, and newborns in the selective episiotomy group had a lower risk of shoulder dystocia and Neonatal Ward compared to those with routine episiotomy. Newborns in selective episiotomy group had a lower risk of birth injury in tertiary hospital. However, newborns in selective episiotomy group had a higher risk of birth injury in general hospitals. CONCLUSION: Selective episiotomy is safe and can be recommended over routine episiotomy in obstetric and tertiary hospital settings in China.

Review of Stillbirth in a Canadian Tertiary Care Centre.

OBJECTIVE: Because literature on stillbirth in Canada and its related factors is scarce, the objective of this study was to determine the causes of stillbirth in a Canadian tertiary care centre and to identify the risk factors present in these deliveries. METHODS: The charts of 180 stillbirth deliveries with a gestational age greater than or equal to 20 weeks or a birth weight greater than or equal to 500 g between 2011 and 2016 were reviewed. Information collected from maternal charts included maternal demographics, known risk factors for stillbirth during pregnancy, delivery parameters, and pathologic examination (Canadian Task Force Classification III). RESULTS: The autopsy rate was 42.5%, placental pathology rate was 100%, and karyotype was completed in 20.2% of the reviewed cases. Often, the cause of stillbirth was unexplained (43.2%). The most common causes were preterm birth (9.8%) and abruption (9.3%). The most common risk factors in this population were maternal obesity (37.6%), late prenatal care (35.0%), and maternal smoking (22.4%). CONCLUSION: Most stillbirths were unexplained in this Canadian tertiary care centre, and the rates of autopsy and karyotype were low. Identified risk factors present in this population may contribute to the significantly higher rate of stillbirth in this centre compared with the provincial rate.

Adverse maternal and neonatal outcomes among singleton pregnancies in women of very advanced maternal age: a retrospective cohort study.

BACKGROUND: There is an increasing prevalence of women who tend to delay childbirth until a very advanced age. However, there is sparse data regarding very advanced maternal age (vAMA) and the interplay between vAMA and assisted reproductive technology (ART) on adverse perinatal outcomes. The study aimed to assess the risk of adverse maternal and neonatal outcomes of vAMA women (≥43 years), and to investigate the effect of maternal age on adverse maternal and neonatal outcomes in ART pregnancies. METHODS: Data was obtained from a population-based retrospective cohort of women who delivered in Ontario, Canada, between April 1st, 2012 and March 31st, 2015. The adjusted relative risks (ARR) and 95% confidence intervals (CI) for adverse maternal and neonatal outcomes were estimated by using multivariate log-binomial regression models among age groups. All models were stratified by the utilization of ART (ART and spontaneous conceptions). RESULTS: Women at vAMA had a higher risk of composite outcome comprised of preeclampsia, intrauterine growth retardation, stillbirth, and placental abruption than the younger counterparts (ARR = 1.38, 95% CI: 1.23-1.55 compared to mothers aged 20-34; ARR = 1.26, 95% CI: 1.12-1.42 compared to mothers aged 35-42). Increased risk of the primary outcome in ART compared to spontaneous conception was only observed in women aged 20-34 years (ARR = 1.24, 95% CI: 1.14-1.35). For women conceived with ART, the risk for the primary outcome significantly increased in women at vAMA (ARR = 1.29, 95% CI: 1.01-1.65 compared to mothers aged 20-34; ARR = 1.36, 95% CI: 1.06-1.74 compared to mothers aged 35-42). CONCLUSION: Women at vAMA have higher risks of adverse maternal and neonatal outcomes. Although the utilization of ART may carry an independent role for adverse perinatal outcomes, it does not further enhance the adverse effect of vAMA.