Fetal Biparietal Diameter as a Potential Risk Factor for Emergency Cesarean Section due to Labor Arrest.

Labor arrest is the most common indication for emergency cesarean section (ECS). Increased biparietal diameter (BPD) has been reported as a risk factor for ECS due to labor arrest in different countries, but it is unclear whether this relationship is relevant in Japan. Considering the difference in maternal physique according to race and ethnicity, we retrospectively evaluated the association between ECS due to labor arrest and BPD, measured by ultrasonography < 7 days before term deliveries in Japanese women. BPD is routinely measured in Japan for estimating fetal weight. Information was extracted from obstetric records at the National Hospital Organization Kofu National Hospital between January 2012 and November 2019. Patients with multiple pregnancies, instrumental (forceps or vacuum) delivery, elective cesarean sections, and ECS due to reasons other than labor arrest were excluded. Thus, 2,695 women were included (age, 31.3 ± 6.2 years; pre-pregnancy body mass index, 20.9 ± 3.2 kg/m2), and 1,319 (48.9%) were nulliparous. The incidence of ECS due to labor arrest was 2.4% (64/2,695). Multivariable analysis indicated that BPD was significantly associated with ECS due to labor arrest (adjusted odds ratio, 1.12; 95% confidence interval, 1.04-1.20). The optimal BPD cut-off value for predicting ECS due to labor arrest was 94 mm (area under the curve, 0.61; sensitivity, 53.1%; specificity, 65.1%). Despite the significant association with ECS, BPD is not useful to predict ECS due to labor arrest. Thus, mothers should be encouraged for attempting vaginal deliveries, even in the case of having babies with large fetal BPD.

Fetal biparietal diameter as a potential risk factor for prolonged second stage of labor: A retrospective observational cohort study.

Prolonged second stage of labor is a common abnormality of labor progression. Very little research exists regarding the relationship between prolonged second stage of labor and antepartum sonographic fetal head biometry parameters, especially fetal biparietal diameter (BPD). Fetal BPD assessment is essential for estimating fetal weight, and these measurements are readily available to Japanese obstetricians. We conducted a retrospective observational cohort study to evaluate the association between BPD fetal Z-score and prolonged second stage of labor in a Japanese cohort. Individual BPD data measured using a GE Voluson 730 expert ultrasound system (GE, Healthcare Japan, Tokyo, Japan) were converted to Z-scores for a particular gestational age. After excluding patients with multiple pregnancies and emergency or elective cesarean sections, a total of 2,711 (nulliparity, n = 1341) Japanese women who delivered at term were included. We analyzed the incidence of prolonged second stage of labor and the association between BPD Z-score measured <7 days before delivery and prolonged second stage of labor by parity. The overall incidence of prolonged second stage of labor was 18.3% (246/1,341) in nulliparous women and 4.6% (63/1,370) in multiparous women. In nulliparous women, multivariable analysis indicated that BPD Z-score was significantly associated with prolonged second stage of labor (adjusted odds ratio, 1.18; 95% confidence interval, 1.02-1.37). Kaplan-Meier survival analysis showed that at each time point during the second stage of labor, the percentage of women who had not yet delivered was higher among those who delivered neonates with large BPD Z-scores than among those who delivered neonates with smaller BPD Z-scores. On the contrary, in multiparous women, BPD Z-score was not statistically associated with prolonged second stage of labor. Our results suggest that considering BPD Z-score is helpful in the management of nulliparous women who are at risk of developing a prolonged second stage of labor.

Evaluation of weight retention four weeks after delivery as a risk factor for gestational diabetes mellitus in a subsequent pregnancy.

AIM: We aimed to assess the association between postpartum weight retention (PPWR) in the fourth week after delivery and the risk of gestational diabetes mellitus (GDM) in a subsequent pregnancy. METHODS: We performed a retrospective cohort study of the obstetric records of women who gave birth to their second singleton between 32 and 41 weeks of gestation at the National Hospital Organization Kofu National Hospital between January 2013 and September 2019. The exclusion criteria were missing data, twin pregnancy, diabetes in pregnancy, and delivery before 22 weeks in the first pregnancy. We calculated PPWR as the BMI 4 weeks after the first birth minus the BMI before the first pregnancy and grouped the subjects into the stable PPWR (gain of <1 BMI unit) and non-stable PPWR groups (gain of ≥1 BMI units). We used the χ2 test and multivariable logistic regression analysis to investigate the association between weight retention at the postpartum checkup and GDM. RESULTS: We included 566 women in this study (mean age, 31.7±4.8 years; mean maternal pre-pregnancy BMI, 21.3±3.5 kg/m2; term delivery, n = 544 [96.1%]). The overall prevalence of GDM during the second pregnancy was 7.4% (42/566), and 33.9% (192/566) of women had stable PPWR. Non-stable PPWR was not significantly associated with GDM in the second pregnancy (adjusted odds ratio, 1.93; 95% confidence interval, 0.84-4.46) after controlling for each variable. CONCLUSION: PPWR measured in the fourth week after delivery was not associated with an increased risk of GDM in the second pregnancy.

Association between false positive glucose challenge test results and large-for-gestational-age infants: a retrospective cohort study.

OBJECTIVES: There is no consensus regarding a possible relation between false positive glucose challenge test (GCT) results and large-for-gestational-age (LGA) infants. This study aimed to clarify the association between false positive GCT results and LGA, after adjusting for potential confounding factors, using a large clinical dataset. DESIGN: Retrospective cohort study. SETTING: National Hospital Organisation Kofu National Hospital, which is a community hospital, between January 2012 and August 2019. PARTICIPANTS: Japanese women who underwent GCT between 24 and 28 weeks of gestation at the hospital were included. After excluding those with gestational diabetes mellitus, diabetes in pregnancy and multiple pregnancies, subjects were divided into a false positive GCT group (≥140 mg/dL) and a GCT negative group (<140 mg/dL). METHODS: Obstetric records of patients were examined. The χ2-test and multivariable logistic regression analysis were used to investigate the association between false positive GCT results and LGA. PRIMARY AND SECONDARY OUTCOME MEASURES: Incidence of LGA and the association between false positive GCT results and LGA. RESULTS: The mean subject age was 31.4±5.5 years, with 43.3% nulliparity (n=974) and 2160 (96.1%) term deliveries. The incidence of LGA was 9.4% (211/2248) and 11.4% (257/2248) of the women had false positive GCT results. False positive GCT results were significantly associated with an increased risk of LGA (OR, 1.51; 95% CI, 1.02 to 2.23), after controlling for maternal age, prepregnancy maternal weight, maternal weight gain during pregnancy and parity. CONCLUSIONS: It appears that there is a significant association between false positive GCT results and LGA. Additional research is required to confirm these results and to investigate appropriate interventions for women with abnormal screens for gestational diabetes mellitus.

Association between uterine contractions before elective caesarean section and transient tachypnoea of the newborn: a retrospective cohort study.

OBJECTIVE: We evaluated the association between the presence of predelivery uterine contractions and transient tachypnoea of the newborn (TTN) in women undergoing an elective caesarean section. DESIGN: A retrospective cohort study. SETTING: National Hospital Organization Kofu National Hospital, which is a community hospital, between January 2011 and May 2019. PARTICIPANTS: The study included 464 women who underwent elective caesarean section. The exclusion criteria were missing data, twin pregnancy, neonatal asphyxia, general anaesthesia and elective caesarean section before term. PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were grouped according to the presence or absence of uterine contractions on a 40-min cardiotocogram (CTG) performed within 6 hours before caesarean delivery. We performed a multivariable logistic regression analysis to examine the association between predelivery uterine contractions and TTN. RESULTS: The incidence of TTN was 9.9% (46/464), and 38.4% (178/464) of patients had no uterine contraction. The absence of uterine contractions was significantly associated with an increased risk of TTN (adjusted OR 2.04; 95% CI 1.09 to 3.82) after controlling for gestational diabetes mellitus, small for gestational age, male sex and caesarean section at 37 weeks. CONCLUSIONS: Accurate risk stratification using a CTG could assist in the management of infants who are at risk of developing TTN.