The impact of childbirth education classes on delivery outcome.

OBJECTIVE: To determine whether participating in childbirth classes is associated with pregnancy outcomes. METHODS: A retrospective study was conducted to review the medical records of all nulliparous women who participated in childbirth classes during their pregnancy and delivered in the authors' institute, between January 2014 and December 2017 (CB class group). The control group comprised nulliparous women who delivered in the same time period, but who did not participate in any education classes (Not attended CB class group). The controls were matched in a ratio of 1:1 for gestational age at delivery and neonatal birth weight. RESULTS: Overall, 159 patients were included in each group. The class group was characterized with above average income (28 [23.9%] vs 19 [16.7%]; P=0.001) and higher education level (80 [64.0%] vs 60 [45.1%]; P=0.002), higher rate of normal vaginal delivery (128 [80.5%] vs 93 [58.5%]; P<0.001), and lower rate of vacuum extraction (12 [7.5%] vs 36 [22.6%]; P<0.001) compared to the Not attended CB class group. By logistic regression analysis, after controlling for obstetrics and socioeconomic variables, participation in childbirth classes was found to be independently associated with successful normal vaginal delivery (odds ratio 2.90; 95% confidence interval 1.13-7.38; P=0.024). CONCLUSION: Participation in childbirth classes has a positive impact on pregnancy outcome.

Amniotic fluid transitioning from clear to meconium stained during labor-prevalence and association with adverse maternal and neonatal outcomes.

OBJECTIVE: The objective of this study is to compare pregnancy outcomes in deliveries complicated by primary meconium-stained amniotic fluid (MSAF, present at membrane rupture) and secondary MSAF (transitioned from clear to MSAF during labor). METHODS: The medical records and neonatal charts of all deliveries ≥ 370/7 weeks between October 2008 and July 2018 were reviewed. The primary outcome was composite adverse neonatal outcome that included early neonatal complications. RESULTS: Of 30,215 deliveries during the study period, 4302 (14.2 %) were included: 3845 (89.4%) in the primary MSAF group and 457 (10.6%) in the secondary MSAF group. The rate of the primary outcome was higher in the secondary MSAF group (p = 0.006). This association remained significant after controlling for background confounders. The secondary MSAF group had higher rate of cesarean deliveries (CDs) and assisted vaginal deliveries. There was a higher rate of composite adverse neonatal outcome when secondary MSAF was diagnosed < 3 vs. >3 h before delivery (p = 0.004). CONCLUSION: Secondary MSAF was associated with higher rates of adverse neonatal outcome, CDs, and assisted vaginal deliveries, compared with primary MSAF.

Does midwife experience affect the rate of severe perineal tears?

BACKGROUND: Our aim was to study whether midwife experience affects the rate of severe perineal tears (3rd and 4th degree). METHODS: A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. Exclusion criteria were instrumental deliveries and stillbirth. All midwives used a "hands on" technique for protecting the perineum. The midwife experience at each delivery was calculated as the time interval between her first delivery and current delivery. A comparison was performed between deliveries in which midwife experience was less than 2 years (inexperienced), between 2 and 10 years (moderately experienced), and more than 10 years (highly experienced). A multivariate regression analysis was performed to assess the association between midwife experience and the incidence of severe perineal tears, after controlling for confounders. RESULTS: Overall, 15 146 deliveries were included. Severe perineal tears were diagnosed in 51 (0.33%) deliveries. Women delivered by inexperienced midwives had a higher rate of severe perineal tears compared with women delivered by highly experienced midwives (0.5% vs 0.2%, respectively, P=.024). On multivariate regression analysis, midwife experience was independently associated with a lower rate of severe perineal tears, after controlling for confounding factors. Each additional year of experience was associated with a 4.7% decrease in the risk of severe perineal tears (adjusted OR 0.95 [95% CI 0.91-0.99, P=.03). CONCLUSION: More experienced midwives had a lower rate of severe perineal tears, and may be preferred for managing deliveries of women at high risk for such tears.

Male fetuses and the risk of cesarean delivery.

OBJECTIVE: To assess the reported increased rate of cesarean sections in women carrying male fetuses. STUDY DESIGN: A retrospective analysis of all deliveries in 2001 was performed. All singleton deliveries were enrolled. We compared fetal sex distribution in cesarean ased risk of cesarean sections performed for various indications. The study had 80% power to detect a explained by different parturient difference in the cesarean section rate in women carrying male and female fetuses. RESULTS: The overall cesarean section rate was similar in women with male or female fetuses, 19.7% and 19.1%, respectively. This lack of association was also found in specific subgroups of cesarean indications: non-reassuring fetal heart rate pattern, fetal distress, nonprogressive labor, elective cesarean, suspected macrosomia, abnormal lie and severe preeclampsia. CONCLUSION: In contrast with previous investigators, we did not find an increased risk of cesarean section in women carrying male fetuses.