How does uterine contractile activity affect the success of trial of labour after caesarean section, and the risk of uterine rupture? An exploratory, blinded analysis of a cohort from a randomised controlled trial.

OBJECTIVE: To investigate the impact of uterine contractile activity on the outcome of trial of labour after caesarean section (TOLAC). DESIGN: Secondary, blinded analyses of a prospective TOLAC cohort. SETTING: Two labour wards, one in a university tertiary hospital and the other in a central hospital. POPULATION: A total of 194 TOLAC parturients with intrauterine tocodynamometry during labour. METHODS: Analysis of intrauterine pressure, frequency of contractions and baseline tonus of uterine muscle in 30-minute periods for 4 hours before birth. MAIN OUTCOME MEASURES: Primary outcome: uterine contractile activity during TOLAC. Secondary aims: contributors associated with failed TOLAC and uterine rupture. RESULTS: TOLAC succeeded in 74% of cases. Uterine contractile activity, expressed as intrauterine pressure, was significantly higher in successful TOLAC compared with failed TOLAC (210 versus 170 Montevideo units). The statistically significant risk factors of failed TOLAC, after multivariate regression analysis, were prolonged gestational age, reduced cervical dilatation at admission and lower mean intrauterine pressure. In cases of uterine rupture, contractile activity did not differ from that in failed TOLAC. Cervical ripening with a Foley catheter appeared to be a risk factor for uterine rupture, as well as cervical dilatation <3 cm at admission. The incidence of total uterine rupture was 2.6% (n = 5). CONCLUSIONS: Women with successful vaginal birth had higher uterine contractile activity than those experiencing failed TOLAC or uterine rupture despite similar use of oxytocin. Induction of labour with a Foley catheter turned out to be a risk factor for uterine rupture during TOLAC among parturients with no previous vaginal delivery. TWEETABLE ABSTRACT: During VBAC the response to oxytocin, assessed as intrauterine pressure, is greater and adequate, in contrast to failed TOLAC.

Intrauterine versus external tocodynamometry in monitoring labour: a randomised controlled clinical trial.

OBJECTIVE: To investigate whether the use of intrauterine tocodynamometry versus external tocodynamometry (IT versus ET) during labour reduces operative deliveries and improves newborn outcome. As IT provides more accurate information on labour contractions, the hypothesis was that it may more appropriately guide oxytocin use than ET. DESIGN: Randomised controlled trial. SETTING: Two labour wards, in a university tertiary hospital and a central hospital. POPULATION: A total of 1504 parturients with singleton pregnancies, gestational age ≥37 weeks and fetus in cephalic position: 269 women with uterine scars, 889 nulliparas and 346 parous women with oxytocin augmentation. METHODS: Participants underwent IT (n = 736) or ET (n = 768) during the active first stage of labour. MAIN OUTCOME MEASURES: Primary outcome: rate of operative deliveries. SECONDARY OUTCOMES: duration of labour, amount of oxytocin given, adverse neonatal outcomes. RESULTS: Operative delivery rates were 26.9% (IT) and 25.9% (ET) (odds ratio 1.05, 95% CI 0.84-1.32, P = 0.663). The ET to IT conversion rate was 31%. We found no differences in secondary outcomes (IT versus ET). IT reduced oxytocin use during labours with signs of fetal distress, and trial of labour after caesarean section. CONCLUSIONS: IT did not reduce the rate of operative deliveries, use of oxytocin, or adverse neonatal outcomes, and it did not shorten labour duration. TWEETABLE ABSTRACT: IT (versus ET) reduced oxytocin use in high-risk labours but did not influence operative delivery rate or adverse neonatal outcomes.

Prevalence and Clinical Significance of Streptococcus dysgalactiae subspecies equisimilis (Groups C or G Streptococci) Colonization in Pregnant Women: A Retrospective Cohort Study.

Objectives: Little is known about the significance of Streptococcus G or C colonization in pregnant women. The objective of this study was to assess whether vaginal Streptococcus group G or C colonization detected in late pregnancy increases the infectious morbidity of the mother or newborn. Methods: A total of 15,114 rectovaginal cultures taken at 35-37 weeks of pregnancy were analyzed at Tampere University Hospital, Finland, between 2012 and 2014. From this laboratory data, all Streptococcus G or C-positive cultures were included to study maternal and neonatal infectious morbidity after delivery. This study population was compared to women with a positive Streptococcus B culture and to women with a negative culture. Results: The prevalence of Streptococcus G or C colonization was 2.9%. Significantly more postpartum endometritis was found in this study group. No association was found between colonization and neonatal bacteremia. Conclusions: Streptococcus G or C colonization is associated with postpartum endometritis. More research is needed to clarify if antibiotic prophylaxis is reasonable for this group during delivery.

Opinions on the counselling, care and outcome of extremely premature birth among healthcare professionals in Finland.

AIM: To study the opinions of paediatric and obstetric personnel on the perinatal treatment and delivery outcome of infants from 22(+0) to 27(+6)  weeks' gestation. METHODS: An email questionnaire was sent to 2963 professionals in 32 maternity hospitals in Finland. RESULTS: The questionnaire survey was completed by 856 (28%) professionals in 30 hospitals. Opinions on outcome were most pessimistic if the infant was very premature. More than a third (37%) assumed no survival at the earliest gestational age, but none dismissed the possibility at 26 weeks' gestation. Paediatric professionals took a more active approach to the treatment of a premature birth and baby than obstetric personnel. Opinions on treatment activity were based firstly on what was best for the baby and secondly on experience. Gynaecologists reported discussing matters regarding premature birth with the parents more often than paediatricians and were much more likely to be influenced by these discussions. CONCLUSION: Paediatric personnel showed a more positive attitude and a more active approach to extremely premature deliveries and babies than obstetric personnel. There would appear to be some inconsistency between prenatal counselling and treatment activity after birth at the limit of viability.