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Objective: To create a personalised machine learning model for prediction of severe adverse neonatal outcomes (SANO) during the second stage of labour. Design: Retrospective Electronic‐Medical‐Record (EMR) ‐based study. Population: A cohort of 73 868 singleton, term deliveries that reached the second stage of labour, including 1346 (1.8%) deliveries with SANO. Methods: A gradient boosting model was created, analysing 21 million data points from antepartum features (e.g. gravidity and parity) gathered at admission to the delivery unit, and intrapartum data (e.g. cervical dilatation and effacement) gathered during the first stage of labour. Deliveries were allocated to high‐risk and low‐risk groups based on the Youden index to maximise sensitivity and specificity. Main outcome measures: SANO was defined as either umbilical cord pH levels ≤7.1 or 1‐minute or 5‐minute Apgar score ≤7. Results: The model for prediction of SANO yielded an area under the receiver operating curve (AUC) of 0.761 (95% CI 0.748–0.774). A third of the cohort (33.5%, n = 24 721) were allocated to a high‐risk group for SANO, which captured up to 72.1% of these cases (odds ratio 5.3, 95% CI 4.7–6.0; high‐risk versus low‐risk groups). Conclusions: Data acquired throughout the first stage of labour can be used to predict SANO during the second stage of labour using a machine learning model. Stratifying parturients at the beginning of the second stage of labour in a 'time out' session, can direct a personalised approach to management of this challenging aspect of labour, as well as improve allocation of staff and resources. Personalised prediction score for severe adverse neonatal outcomes in labour using machine learning model. Personalised prediction score for severe adverse neonatal outcomes in labour using machine learning model. [ABSTRACT FROM AUTHOR]

Objective: To compare the predictive performance of estimated fetal weight (EFW) percentiles, according to eight growth standards, to detect fetuses at risk for adverse perinatal outcome.Methods: This was a retrospective cohort study of 3437 African-American women. Population-based (Hadlock, INTERGROWTH-21st , World Health Organization (WHO), Fetal Medicine Foundation (FMF)), ethnicity-specific (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)), customized (Gestation-Related Optimal Weight (GROW)) and African-American customized (Perinatology Research Branch (PRB)/NICHD) growth standards were used to calculate EFW percentiles from the last available scan prior to delivery. Prediction performance indices and relative risk (RR) were calculated for EFW < 10th and > 90th percentiles, according to each standard, for individual and composite adverse perinatal outcomes. Sensitivity at a fixed (10%) false-positive rate (FPR) and partial (FPR < 10%) and full areas under the receiver-operating-characteristics curves (AUC) were compared between the standards.Results: Ten percent (341/3437) of neonates were classified as small-for-gestational age (SGA) at birth, and of these 16.4% (56/341) had at least one adverse perinatal outcome. SGA neonates had a 1.5-fold increased risk of any adverse perinatal outcome (P < 0.05). The screen-positive rate of EFW < 10th percentile varied from 6.8% (NICHD) to 24.4% (FMF). EFW < 10th percentile, according to all standards, was associated with an increased risk for each of the adverse perinatal outcomes considered (P < 0.05 for all). The highest RRs associated with EFW < 10th percentile for each adverse outcome were 5.1 (95% CI, 2.1-12.3) for perinatal mortality (WHO); 5.0 (95% CI, 3.2-7.8) for perinatal hypoglycemia (NICHD); 3.4 (95% CI, 2.4-4.7) for mechanical ventilation (NICHD); 2.9 (95% CI, 1.8-4.6) for 5-min Apgar score < 7 (GROW); 2.7 (95% CI, 2.0-3.6) for neonatal intensive care unit (NICU) admission (NICHD); and 2.5 (95% CI, 1.9-3.1) for composite adverse perinatal outcome (NICHD). Although the RR CIs overlapped among all standards for each individual outcome, the RR of composite adverse perinatal outcome in pregnancies with EFW < 10th percentile was higher according to the NICHD (2.46; 95% CI, 1.9-3.1) than the FMF (1.47; 95% CI, 1.2-1.8) standard. The sensitivity for composite adverse perinatal outcome varied substantially between standards, ranging from 15% for NICHD to 32% for FMF, due mostly to differences in FPR; this variation subsided when the FPR was set to the same value (10%). Analysis of AUC revealed significantly better performance for the prediction of perinatal mortality by the PRB/NICHD standard (AUC = 0.70) compared with the Hadlock (AUC = 0.66) and FMF (AUC = 0.64) standards. Evaluation of partial AUC (FPR < 10%) demonstrated that the INTERGROWTH-21st standard performed better than the Hadlock standard for the prediction of NICU admission and mechanical ventilation (P < 0.05 for both). Although fetuses with EFW > 90th percentile were also at risk for any adverse perinatal outcome according to the INTERGROWTH-21st (RR = 1.4; 95% CI, 1.0-1.9) and Hadlock (RR = 1.7; 95% CI, 1.1-2.6) standards, many times fewer cases (2-5-fold lower sensitivity) were detected by using EFW > 90th percentile, rather than EFW < 10th percentile, in screening by these standards.Conclusions: Fetuses with EFW < 10th percentile or EFW > 90th percentile were at increased risk of adverse perinatal outcomes according to all or some of the eight growth standards, respectively. The RR of a composite adverse perinatal outcome in pregnancies with EFW < 10th percentile was higher for the most-stringent (NICHD) compared with the least-stringent (FMF) standard. The results of the complementary analysis of AUC suggest slightly improved detection of adverse perinatal outcome by more recent population-based (INTERGROWTH-21st ) and customized (PRB/NICHD) standards compared with the Hadlock and FMF standards. Published 2019. This article is a U.S. Government work and is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

Methods This is a retrospective study, gathering the results of ES in structurally normal fetuses performed in our tertiary centre. Exome sequencing (ES) is usually performed in the prenatal setup as part of the investigation of fetal malformation/s. However, some patients are willing to perform fetal ES without a medical indication. The yield of chromosomal microarray analysis (CMA) is well established in structurally normal fetuses. [Extracted from the article]

Cervical dilation progression rate was significantly slower in twin deliveries compared to singletons: twins mean 1.89 cm/h (95 SP th sp centile-0.51 cm/h) and singletons mean 2.48 cm/h (95 SP th sp centile 0.73 cm/h) (p < 0.001). Conclusions Twin labours are characterised by slower progression of the active and 2nd stages of labour as compared to singletons in nulliparas and multiparas. Failure to progress is one of the leading indications for Caesarean delivery in trials of labour of twin gestations. [Extracted from the article]

We sought to investigate the variations between fetal and neonatal HC and estimated fetal weight (EFW) and birth weight (BW). 8173 term singleton fetuses with biometry recorded within 1 week of delivery as well as neonatal HC and BW were collected. Mean difference between postnatal and fetal HC, and BW and EFW, were determined for 10 centile subgroups of fetal HC and EFW (based on AC and FL). [Extracted from the article]

To evaluate the impact of expected macrosomia (estimated fetal weight>4000 g) on mode of delivery and obstetric outcomes. Multinomial logistic regression provided adjusted ORs for mode of delivery with EFW and ABW>4kg, while controlling for possible confounders. Expected macrosomia (EFW>4kg) significantly increased risk for urgent (OR 1.8) or elective (OR 5.4) Caesarean delivery (CD). [Extracted from the article]

An abstract of the article "The impact of head circumference on obstetric outcomes: implications for management" by S. Yagel and colleagues is presented.

An abstract of the article "Persistent occiput posterior position: impact of head circumference on obstetric outcomes," by O. Yagel and colleagues is presented.