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Prematurity is associated with morbidity and mortality. There is alot of causative factors that involved. One of the contributing factors is the presence of uterine contractions that occur prematurely. This is due to a decrease in progesterone levels. This decrease can be achieved by changing the levels of the progesterone receptor (PR) isoform in the myometrium. Objective: To determine whether there is a connection between changes in progesterone receptor isoform levels on labor. This systematic study was arranged according to Prefered Reporting Items For Systematic Review and Meta-Analysis (PRISMA). The articles studied were observational studies. Each article was tested for the quality of the Newcastle-Ottawa Scale literature because the articles used were of the case-control type. From the search results using the search strategy in PUBMED, there were 190 articles that were then selected based on title, abstract, and inclusion and exclusion criteria obtained 4 articles that fit the criteria desired by the researcher. From the results of a systematic study, it was found that the number of progesterone receptor ratios in pregnant women who had spontaneous labor compared to pregnant women who gave birth via planned cesarean section. Pregnancy within labor experienced an increase in the PR-A/PR-B ratio by 1.12 times compared to that of cesarean section delivery.

Aim In Japan, the criteria of the latent and active phases of the first stage of labor have not been decided. The Japan Society of Obstetrics and Gynecology (JSOG) Perinatal Committee conducted a study to construct a spontaneous labor curve in order to determine the point of onset of the active phase. Methods The participants were women who had spontaneous deliveries at four health facilities in Japan between September 1, 2011, and September 31, 2019. Spontaneous delivery was defined as the spontaneous onset of labor at term (37 weeks, 0 days to 41 weeks, 6 days) with vaginal delivery of a mature fetus in a cephalic position without uterotonic agents or epidural analgesia. The time points for each "cm" of dilation were collected starting from the time of full dilation retrogradely. The relationship between time since labor onset and cervical dilation was expressed as a curve using a smoothing B-spline. Results A total of 4215 primiparous and 5266 multiparous women were included in this study. The spontaneous labor curve showed that in both primiparous and multiparous women, labor progress was slow until 5 cm cervical dilation, accelerating between 5 and 6 cm dilation, and steadily progressed after 6 cm dilation. Conclusion We propose that the active phase of the first stage of labor be defined as starting at 5 cm dilation of the cervix, and that it be divided into an acceleration phase (5-6 cm dilation) and a maximal phase (>6 cm dilation).

OBJECTIVES: To determine the caesarean section rate (CSR) and frequency of different indications of caesarean section (CS) in a tertiary care hospital. METHODOLOGY: A retrospective study done in the Department of Obstetrics and Gynecology Hayatabad Medical Complex Hospital Peshawar, a tertiary care hospital, from a period of 1st January 2019 till 31st December 2019. The required data was collected from the patient’s hospital records (clinical charts) with the consent of the hospital ethical committee. RESULTS: The total number of deliveries over the study period was 5611. Out of these 1258 patients were delivered through caesarean section (CS), giving a CSR of 22%. The main contributing groups in our study were Robson Groups R5 (multiparous with prior CS, singleton, cephalic and >37 weeks), R1 (nulliparous, cephalic, singleton >37 weeks in spontaneous labor or CS) and R6 (all nulliparous breeches) with percentages of 21.1%, 17.5% and 12.9% respectively. CONCLUSION: Our study showed Robson Groups 5, 2 and 6 as the major contributors, focusing on these groups could have an impact on decreasing the cesarean section rate in future. Limiting the primary cesarean section rate can affect the overall cesarean section rate (CSR).

Raha Maroyi,1,2 Bahaya Naomi,2 Madeline K Moureau,3 Balungwe Sifa Marceline,1 Celeste Ingersoll,4 Roselyn Nerville,5 Denis Mukwege1,2,6 1Department of Obstetrics and Gynecology, Panzi Referral Hospital, Bukavu, South Kivu, Democratic Republic of Congo; 2Université Evangélique en Afrique (UEA), Bukavu, South Kivu, Democratic Republic of Congo; 3Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 4Department of Statistics, Brigham Young University, Provo, UT, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6International Center for Advanced Research and Training (ICART), Bukavu, South Kivu, Democratic Republic of CongoCorrespondence: Raha MaroyiUniversité Evangélique en Afrique (UEA), PO Box: 266, Bukavu, South Kivu, Democratic Republic of CongoTel +243 997 254 812Email ken.raha01@gmail.comPurpose: We sought to determine the success rate of VBAC and factors associated with achieving VBAC at a referral hospital in the Democratic Republic of Congo in women with a subsequent pregnancy greater than or equal to 18 months from their primary cesarean section (CS).Patients and Methods: Patients were included for participation if they had an inter-delivery interval (IDI) of at least 18 months from their primary CS, accepted TOLAC, and had no contraindications. Information was collected about patients’ demographics, obstetric history, and factors impacting their labor process. Descriptive analyses compared patients that had a successful VBAC and those who did not. Univariate and multivariate binary logistic regression models identified factors associated with a successful VBAC.Results: Among 231 eligible patients who attempted a VBAC, 57.6% (133) achieved VBAC. Participants had a mean age of 29 (SD 6), with the majority having a prior vaginal delivery (68.8%). VBAC was positively associated with a higher Bishop score (AOR 1.12, 95% CI 1.02, 1.23) and a spontaneous labor onset (AOR 3.06, 95% CI 1.52, 6.17). VBAC was negatively associated with a macrosomic fetus (AOR 0.21, 95% CI 0.08, 0.58).Conclusion: TOLAC results in VBAC more than half the time and is associated with a spontaneous labor onset and a higher Bishop score. Women with a macrosomic fetus were more likely to have an unsuccessful VBAC, resulting in an RCS. An optimal IDI was not enough to ensure a successful VBAC. Upon patients’ arrival to the hospital, practitioners should re-evaluate their eligibility to attempt a VBAC based on their Bishop score and if they had a spontaneous labor onset to decrease the health risks of an RCS.Keywords: trial of labor, delivery, repeat cesarean section, sub-Saharan Africa, Democratic Republic of Congo

Objective:. To investigate the effects of spontaneous labor before elective repeat cesarean delivery (ERCD) on short-term maternal and neonatal outcomes. Methods:. This was a prospective cohort study. All consecutive ERCDs, occurring at ≥37 weeks of gestation between July 1, 2017 and December 31, 2019 in Makassed General Hospital, were evaluated. The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery (URCD) group were compared with those of 204 women undergoing cesarean delivery (CD) without spontaneous labor (ERCD) group. Primary outcomes were “composite adverse maternal outcome” and “composite adverse neonatal outcome.” Fisher's exact and Student's t tests were used to assess the significance of differences in dichotomous and continuous variables, respectively. Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes. Results:. “Composite adverse maternal outcome” was significantly more common in women who underwent spontaneous labor ((40/183) 21.9% vs. (19/204) 9.3%, P = 0.001, relative risk (RR): 2.7, 95% confidence interval (CI): 1.50–4.90). Similarly, “composite adverse neonatal outcome” was significantly increased in the URCD group ((24/183) 13.1% vs. (12/204) 5.9%, P = 0.014, RR: 2.4, 95% CI: 1.18–4.98). These adverse effects persisted after adjustment for confounders. Multivariate regression models revealed that, besides labor, CD-order impacted maternal outcome (RR: 1.5, 95%CI: 1.02–2.30, P = 0.036), while CD-order and teenage pregnancy influenced neonatal outcome (RR: 2.1, 95%CI: 1.29–3.38, P = 0.003, and RR: 16.5, 95%CI: 2.09–129.80, P = 0.008, respectively). Conclusion:. In our study, spontaneous labor before ERCD, including deliveries at term, was associated with adverse maternal and neonatal outcomes, indicating that it is preferable to conduct ERCD before the onset of labor. Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks earlier. Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.

BACKGROUND There is a lack of consensus in the literature about the association between meal patterning during pregnancy and birth outcomes. This study examined whether maternal meal patterning in the week before birth was associated with an increased likelihood of imminent spontaneous labor. METHODS Data came from 607 participants in the third phase of the Pregnancy, Infection, and Nutrition Study (PIN3). Data were collected through an interviewer-administered questionnaire after birth, before hospital discharge. Questions included the typical number of meals and snacks consumed daily, during both the week before labor onset and the 24-hour period before labor onset. A self-matched, case-crossover study design examined the association between skipping one or more meals and the likelihood of spontaneous labor onset within the subsequent 24 hours. RESULTS Among women who experienced spontaneous labor, 87.0% reported routinely eating three daily meals (breakfast, lunch, and dinner) during the week before their labor began, but only 71.2% reported eating three meals during the 24-hour period before their labor began. Compared with the week before their labor, the odds of imminent spontaneous labor were 5.43 times as high (95% CI: 3.41-8.65) within 24 hours of skipping 1 or more meals. The association between skipping 1 or more meals and the onset of spontaneous labor remained elevated for both pregnant individuals who birthed early (37

A woman's first childbirth represents a moment of elevated maternal emotional vulnerability. Indeed, there is a prevalence of anxiety and depression symptomatology in primiparas during the postpartum period that negatively influences the well-being of the woman, of her newborn, and of the quality of their attachment bond. Much attention has been paid to the possible risk factors involved in the onset of mood disturbance in the postpartum. However, knowledge is still limited regarding the role played by the specific clinical aspects linked to labor. Therefore, the aim of the present study was to explore whether spontaneous or elective induction labor is linked to the level of postnatal depression and anxiety three months after birth. One hundred and sixty-one women (Mage = 31.63; SD = 4.88) were recruited, using the following inclusion criteria: native Italian women; age > 18 years; physically and psychologically healthy nulliparous with singleton no-risk pregnancy; no previous abortion or interruption of pregnancy; no previous psychopathological diagnoses. Exclusion criteria: twin pregnancy, fetal pathologies, and planned elective cesarean. Data was collected at two different times: T1 (day of childbirth) clinical data of labor (spontaneous or induced) from hospital records; T2 (three months after birth) level of mother's depression and anxiety. In order to explore if the level of depression and anxiety three months after childbirth differ in women according to the type of labor, spontaneous or induced, two univariate analyses of variance (ANOVA) were conducted. Results showed that women who had a spontaneous labor reported lower levels of anxiety and depression than women who had an induced labor. Our results highlight the significant implications that the mode of labor has on the emotional well-being of mothers, underlining the need to support women throughout all their transition to motherhood, including the childbirth experience.

OBJECTIVE The study aimed to describe preterm birth (PTB) rates, subtypes, and risk factors in twins compared with singletons to better understand reasons for the decline in PTB rate between 2007 and 2011. STUDY DESIGN This was a retrospective population-based analysis using the California linked birth certificates and maternal-infant hospital discharge records from 2007 to 2011. The main outcomes were overall, spontaneous (following spontaneous labor or preterm premature rupture of membranes), and medically indicated PTB at various gestational age categories

Objective: The purpose of this study is to analyze uterine electromyography burst patterns in patients with spontaneous labor and patients with uterine inertia. Materials and methods: Uterine electromyography was recorded using 4 silver/silver chloride electrodes placed periumbilical. Thirty women in the spontaneous labor were enrolled. Uterine electromyography was also recorded from patients with uterine inertia before and after oxytocin treatment. EMG bursts were characterized by analysis of multiple variables including burst frequency, duration, root mean squared, amplitude, and total power. Results: There were significant reductions (P .05) to patients in spontaneous labor. Conclusions: Uterine electromyography can be used effectively to distinguish patients progressing with spontaneous labor from patients that develop uterine inertia. Uterine inertia is characterized by reduced EMG activity and failure of cervical dilation. Uterine electromyography is a quantitative, non-invasive assessment tool that contributes to the diagnosis, evaluation and management of patients with spontaneous labor and uterine inertia.

Background: Although scar thickness is been used for predicting vaginal birth among women with previous one cesarean section but which women are good candidates for VBAC, the value of applying sonographic LUS thickness measurement in the management of VBAC remains unclear and there are no clear guidelines in this regard. Objective: To determine the frequency of successful vaginal birth after previous one cesarean section and to compare the frequency of vaginal birth after previous one cesarean section in women with scar thickness >3.5 mm compared to those with scar thickness ≤3.5 mm. Study Design: Descriptive, Case-series study. Settings: Department of Obstetrics & Gynecology, DHQ Hospital, Faisalabad. Duration: Six months from December 15, 2017 to June 15, 2018. Methodology: The Non probability, consecutive sampling technique was used in this study. A total of 151 patients in spontaneous labor at term presented to labor room and fulfilling the inclusion criteria were enrolled in this study. After taking informed written consent, the patients were placed randomly into two groups. Group A included all the women with scar thickness >3.5 mm on ultrasonography while Group B included all the women with scar thickness ≤ 3.5mm on ultrasonography. All cases were followed till delivery and outcome variables like vaginal birth was noted. Data was entered and analyzed through SPSS version 21. Results: Mean age was 27.53 ± 4.93 years. Mean gestational age was 39.09 ± 1.13 weeks. Frequency of successful vaginal birth after previous one cesarean section was found in 131(86.75%) patients, whereas there was no VBAC in 20(13.25%) patients. The results of the study showed that women with scar thickness > 3.5 mm were more likely to have vaginal birth (96.65%) versus those with scar thickness ≤3.5mm (79.27%) (P = 0.003). Conclusion: This study concluded that the frequency of vaginal birth after previous one cesarean section in women with scar thickness > 3.5 mm is much higher as compared to those with scar thickness ≤3.5mm.

We conducted a prospective study to assess serum melatonin as a biomarker to predict the development of late-term and postterm pregnancies and spontaneous beginning of labor in women with term pregnancies. Population of this prospective study included pregnant women with late-term and postterm pregnancies and term pregnancies as controls. In these study groups, serum melatonin concentrations were measured in women with or without labor and their perinatal data were collected. In the postterm pregnancies without labor, the lowest median melatonin concentrations were measured (p0.05). In the late-term and postterm pregnancies with and without labor, the median serum melatonin concentrations were significantly lower than term ones (p0.05). In the term pregnancies with labor, the highest median melatonin concentration was measured (p0.05). A serum melatonin concentration≤34 pg/mL as a cut-off value determines late-term and postterm pregnancy with a sensitivity of 80.4% and a specificity of 81.4%. A serum melatonin concentration29.35 pg/mL as a cut-off value determines presence of labor with a sensitivity of 82.1% and a specificity of 55.0%. In women with term pregnancies, with the measurement of serum melatonin, it is possible to predict the development of late-term and postterm pregnancies and whether these pregnancies undergo spontaneous labor. With further studies, these findings need to be supported before their routine clinical use.We conducted a prospective study to assess serum melatonin as a biomarker to predict the development of late-term and postterm pregnancies and spontaneous beginning of labor in women with term pregnancies. Population of this prospective study included pregnant women with late-term and postterm pregnancies and term pregnancies as controls. In these study groups, serum melatonin concentrations were measured in women with or without labor and their perinatal data were collected. In the postterm pregnancies without labor, the lowest median melatonin concentrations were measured (p0.05). In the late-term and postterm pregnancies with and without labor, the median serum melatonin concentrations were significantly lower than term ones (p0.05). In the term pregnancies with labor, the highest median melatonin concentration was measured (p0.05). A serum melatonin concentration≤34 pg/mL as a cut-off value determines late-term and postterm pregnancy with a sensitivity of 80.4% and a specificity of 81.4%. A serum melatonin concentration29.35 pg/mL as a cut-off value determines presence of labor with a sensitivity of 82.1% and a specificity of 55.0%. In women with term pregnancies, with the measurement of serum melatonin, it is possible to predict the development of late-term and postterm pregnancies and whether these pregnancies undergo spontaneous labor. With further studies, these findings need to be supported before their routine clinical use.

Cervical elastography might be an objective method for evaluating cervical ripening during pregnancy, but its usefulness has not been fully investigated. We examined the significance of cervical elastography in the last trimester of pregnancy. Cervical elastography was performed at weekly checkups after 36 weeks of gestation in 238 cases delivered at our hospital from 2017 to 2018. The correlation with the onset time of natural labor, which is an index for judging maternal delivery preparation status, was examined. A total of 765 examinations were conducted, and cervical stiffness determined by cervical elastography was positively correlated with the Bishop score (r = 0.46, p

Objective: Women with overweight/obesity have significantly lower rates of exclusive breastfeeding (EBF) at 6 weeks postpartum compared with women of normal weight. We sought to determine whether differences in Baby-Friendly Hospital Initiative (BFHI) adherence, obstetric practices, or social support explain these weight-related EBF disparities. Methods: One hundred forty-two healthy women who intended EBF (61 normal weight, 50 overweight, and 31 obese by preconception body mass index [BMI]) were enrolled in a cross-sectional study. Obstetric data were collected and participants completed modified Infant Feeding Practices Study II surveys at 6 weeks postpartum. Results: Women with obesity were significantly less likely to undergo spontaneous labor and more likely to receive synthetic oxytocin and epidural anesthesia compared with women with overweight or normal weight. Women who were overweight were less likely to report extended family support for breastfeeding compared with women with obesity or normal weight; however, BFHI components and composite BFHI score did not differ by maternal BMI. Furthermore, regardless of BMI, women with greater adherence to BFHI practices were more likely to be EBF at 6 weeks postpartum (p-value

Objective: To identify the rates and indications of cesarean section (CS) using the Robson classification during 2014- 2016 in a university hospital in southern Thailand. Material and Methods: A cross-sectional study of women who delivered between January 1, 2014 and December 31, 2016 was conducted. The data were analyzed using the Robson classification. Results: A total of 10,474 births were included in the analysis. The overall CS rate was 55.5%. The trends of CS rates in most Robson classification groups over the 3-year period were static. The CS rates in nulliparous or multiparous women with induction of labor decreased over the 3-year period, while the rate in multiparous women with fetal breech presentation increased. Women with previous cesarean section (Robson group 5) were the largest contributor to the overall CS rate (32.1%), followed by the nulliparous women with a single cephalic pregnancy, ≥37 weeks gestation in spontaneous labor (Robson group 1) (24.5%). Cephalopelvic disproportion and fetal distress were the most common indications for CS in Robson group 1. Conclusion: The CS rates in our study were high in all groups during the 3-year period, with static trends in most groups. The Robson classification is a feasible tool for monitoring CS rates in our setting. Feedback of these findings to healthcare providers and policy makers is advised.

To determine if there is a difference in the maternal and perinatal characteristics and outcomes of women undergoing a medically indicated labor induction and delivering vaginally compared to women in spontaneous labor delivering vaginally.This is a planned secondary analysis of previously published data with additional data collected for a case-control design. Maternal and perinatal characteristics and outcomes of women undergoing a medically indicated labor induction of labor and delivering vaginally were compared with the next woman who went into labor spontaneously and delivered vaginally.There were 1097 women in the medically indicated labor group and 1096 women in the spontaneous labor group. The medically indicated induction group was younger (Even with successful vaginal delivery of a medically indicated induction of labor, the risk for adverse outcomes remains elevated.

Based on preliminary studies, it is known that 80% of working mothers fail to make exclusive breastfeeding, on average babies are given formula milk 2-4 months old and stop breastfeeding at 6-18 months of age. Papaya leaves are one of the galactagogues that contain quercetin which can activate the hormone prolactin and help increase breastmilk. The purpose of this study was to determine the effect of giving papaya leaf juice for nursing mothers who work toward increasing levels of the hormone prolactin and infant weight in Tangerang. The research design used was a pre-experimental model with one group pretest-posttest design. Samples taken as many as 10 mothers who have babies aged 0-6 months who have difficulty in breastfeeding because the amount of breastmilk was a little. The study was conducted in several clinics in Tangerang. The intervention was giving papaya leaf juice for 7 consecutive days. The results obtained from this study are as follows: 90% of mothers aged between 20 and 35 years, 70% of mothers have a history of spontaneous labor and have no complications at the time of delivery, 40% of mother's education is junior high school (SMP), and 70% of mothers are primiparas. The average increase in the amount of prolactin after the intervention was 19.59ng/ml, while the average weight gain of the newborn after the intervention was 165g. Wilcoxon test results for increased levels of the hormone prolactin p-value of 0.047

Introduction: The success rate of vaginal birth after cesarean section (VBAC) varies among institutions and health care providers. It is also affected by various antepartum, intrapartum factors as well as the difference in the obstetric population. Objectives: The main aim of the study is to determine the factors that affect the success rate of vaginal birth after cesarean section. This will help us to choose the right patients for VBAC thereby decreasing the complications of an emergency cesarean section. Methods: This is a prospective, cohort study done over a period of twelve months. Based on the patient's preference a total of 211 women were divided into two groups either a trial of labor after cesarean section (TOLAC) or elective repeat cesarean section (ERCS) group. VBAC group was compared with the failed trial of labor group to determine the factors affecting the success rate. Result: The success rate of VBAC was found to be 47.9%. About 15% of failed VBAC was due to the tendency to abandon a TOLAC midway. The success rate of VBAC increased in women with previous vaginal delivery and in those who went into spontaneous labor. Epidural was found to be safe to use in the trial of the labor group. Conclusion: Women with factors that increase the likelihood for vaginal delivery following cesarean section should be motivated well and referred to a tertiary center to improve the success rate as well as to reduce the maternal and fetal morbidity

Objective: To assess the delivery outcome in nulliparous women at term and to compare the outcomes among induced versus spontaneous labor. Methods: A descriptive study was conducted at Obstetrics and Gynecology department of Patel Hospital, Karachi from April to October 2019. All women with age between 20-40 years, gestational age between 37-42 weeks, and singleton pregnancy were consecutively included. Mode of delivery and Apgar score at 5 minutes were noted. Results: Of 172 women, the mean age of the women was 29.9±4.64. Vaginal delivery was reported in 102 (59.3%) and cesarean section in 70 (40.7%) women. Cesarean delivery was found to be significantly higher among women with >29 years of age (pvalue 0.006), >38 weeks of gestational age (p-value

Background and Aims The PIEB technique is a promising approach that demonstrates certain advantages over traditional techniques epidural analgesia. We compared the incidence of motor block (MB) in women who received PIEB or traditional techniques for maintenance of labor analgesia. Methods We studied 145 subjects. Term women with spontaneous labor and cervical dilation > 1–2cm were eligible to participate in the study. All parturients divided into 5 groups: manual boluses (levobupivacaine 0.25%–10.0 ml); PCEA (levobupivacaine 0.125% – 10.0 ml every 30’); CEI (0.125% – 10.0 ml/hour) + PCEA (levobupivacaine 0.125% – 10.0 ml every 30’); CEI (0.0625% – 15 ml/hour) + PCEA (0.0625% – 10.0 ml every 20’); PIEB (0.0625% – 9.0 ml every 45 ‘) + PCEA (0.0625% – 10.0 ml every 10’). The level of the motor block evaluated by the classic Bromage scale (0-1-2-3). Results MB was reported in 80% in the 1 group by the 120th minute after analgesia, 78% and 52% in the 2 and 3 groups by the by 150 ‘ (p Conclusions The PIEB technique showed the greatest effectiveness for labor pain relief with a minimum frequency of MB development.

Background and Aims Epidural analgesia is the gold standard for the pain relief of labor. The aim of this study was to compare the analgesic efficacy of PIEB technique and traditional techniques of epidural analgesia for labor pain relief. Methods We studied 145 subjects. Term women with spontaneous labor and cervical dilation > 1–2cm were eligible to participate in the study. All parturients divided into 5 groups: manual boluses (levobupivacaine 0.25%–10.0 ml); PCEA (levobupivacaine 0.125% – 10.0 ml every 30’); CEI (0.125% – 10.0 ml/hour) + PCEA (levobupivacaine 0.125% – 10.0 ml every 30’); loading dose of levobupivacaine 0.125% – 10.0 ml, then CEI (0.0625% – 15 ml/hour) + PCEA (0.0625% – 10.0 ml every 20’); loading dose of levobupivacaine 0.125% – 10.0 ml, then PIEB (0.0625% – 9.0 ml every 45 ‘) + PCEA (0.0625% – 10.0 ml every 10’). The effectiveness of labor analgesia was evaluated using VAS. Results The analysis of the obtained data showed that the combined regimes of epidural analgesia (PCEA + CEI, PCEA + PIEB) provide a more consistent and effective analgesia of the first stage of labor than bolus techniques. However, the greatest average decrease in pain intensity in both I (p Conclusions The PIEB technique with PCEA showed the greatest efficacy of pain relief during first and second stages of labor.

To investigate the effect of preterm gestational age (GA) on neonatal outcomes of gastroschisis and to compare the neonatal outcomes after spontaneous labor versus iatrogenic delivery both in the preterm and early term gestational periods.A retrospective study of prenatally diagnosed gastroschisis cases born at Loma Linda University Medical Center and Lucile Packard Children's Hospital (Loma Linda, CA) between January 2009 and October 2016. A total of 194 prenatally diagnosed gastroschisis cases were identified and included in the analysis. We compared infants delivered37 0/7 to those ≥37 0/7 weeks' gestation. Adverse neonatal outcome was defined as any of: sepsis, short bowel syndrome, prolonged ventilation, or death. Prolonged length of stay (LOS) was defined as ≥75th percentile value. Outcomes following spontaneous versus iatrogenic delivery were compared. Analyses were performed using chi-squared test or Fisher's exact test for categorical variables, and Student'sOne hundred and six neonates were born37 weeks and 88 at ≥37 weeks. Adverse outcome was statistically similar among those born37 weeks compared to ≥37 weeks (48 versus 34%,Neonates with gastroschisis delivered37 weeks had prolonged LOS whereas the rate of adverse neonatal outcomes was similar between those delivered preterm versus term. Neonates born after spontaneous preterm labor had a higher rate of bowel atresia compared to those born after planned iatrogenic preterm delivery.

Objective: Pyroptosis is an inflammatory form of programmed cell death that is mediated by the activation of the inflammasome and depends on the pore-forming function of gasdermin D. Therefore, the...

Objectives – The main objective of this study was to describe the evolution of the relevance of dynamic dystocia management in January 2019 since January 2016. Method - This is a cross-sectional, clinical audit-type descriptive study. The data was collected via an audit grid developed by the RSPA from the national guidelines "Recommandations pour l’administration d’oxytocine au cours du travail spontanée" published in December 2016, by the CNSF.Results – We included 169 women who had spontaneous labor from January 1st to January 31, 2019. The oxytocin administration rate significantly decreased between 2016 and 2019 (46.9% vs. 30.2%, p = 0.002). Systematic administration of oxytocin during the 1st stage of labor was 9.6% versus 24.9% in 2016 and 0% versus 10.6% in 2016 during the 2nd stage. Even if the amniotomy rate remained stable (p = 0.67) we found a significant decrease in its systematic practice (p = 0,0009). The relevant administration of oxytocin during the 2nd stage of labor was 25.0% in 2016 versus 87.5% in 2019. The evolution of the relevance of the administration of oxytocin at the 1st stage is not statistically significant (p = 0.50).Conclusion –Systematic practices have decreased significantly since 2016. However there is an improvement in the relevance of administration of oxytocin during the 2nd stage of labor, this is not yet during the 1st stage of labor. External factors can impact practices and must be taken into account.; Introduction – Cette étude avait pour objectif de décrire l’évolution de la pertinence de la gestion de la dystocie dynamique en janvier 2019 depuis janvier 2016.Méthodes – Il s’agit d’une étude descriptive transversale de type audit clinique. Les données étaient recueillies via une grille d’audit élaborée au sein du RSPA à partir du référentiel national « Recommandations pour l’administration d’oxytocine au cours du travail spontané » publié en décembre 2016, par le CNSF. Le critère de jugement principal était le pourcentage de conformité d’administration d’oxytocine selon 4 critères de l’audit.Résultats – Nous avons inclus 169 femmes ayant eu un travail spontané sur la période du 1er janvier au 31 janvier 2019. Le taux d’administration d’oxytocine a significativement diminué entre 2016 et 2019 (46,9% vs. 30,2%, p = 0,002). L’administration systématique d’oxytocine lors du 1er stade du travail était de 9,6 % contre 24,9 % en 2016 et de 0% contre 10,6 % en 2016 lors du 2ème stade. Même si le taux d’amniotomie est resté stable (p = 0,67) nous avons retrouvé une diminution significative de sa pratique systématique (p = 0,0009). L’administration pertinente d’oxytocine pendant le 2ème stade du travail était de 25,0 % en 2016 versus 87,5 % en 2019. L’évolution de la pertinence de l’administration d’oxytocine au 1er stade n’est pas statistiquement significative (p = 0,50).Conclusion – Les pratiques systématiques ont beaucoup diminué depuis 2016. Malgré une amélioration de la pertinence d’administration d’oxytocine lors du 2ème stade du travail, ce n’est pas encore le cas lors du 1er stade du travail. Des facteurs externes peuvent impacter les pratiques et sont à prendre en compte.

BACKGROUND: The physiological control of human parturition at term is unknown. OBJECTIVE: This study aimed to test the hypothesis that slowing of fetal growth or elevated maternal serum levels of markers of placental hypoxia in late gestation will be associated with earlier term labor. STUDY DESIGN: We observed 2208 women having first births and performed serial blinded ultrasonography and immunoassay of soluble fms-like tyrosine kinase-1 and placenta growth factor. We estimated the probability of spontaneous delivery from 37 weeks of gestational age concerning (1) fetal growth between 20 and 36 weeks of gestational age and (2) the maternal serum soluble fms-like tyrosine kinase-1-to-placenta growth factor ratio measured at approximately 36 weeks of gestational age. Data were analyzed using logistic regression and Cox regression. RESULTS: Fetal size at 36 weeks of gestational age was not independently associated with the timing of delivery at term. However, there was an inverse relationship between fetal growth between 20 weeks of gestational age and 36 weeks of gestational age and the probability of spontaneous labor at 37 to 38 weeks' gestation (hazard ratio [95% confidence interval] for a 50 percentile increase in abdominal circumference growth velocity, 0.60 [0.47-0.78]; P=.0001). This association was weaker at 39 to 40 weeks' gestation (0.83 [0.74-0.93]; P=.0013), and there was no association at ≥41 weeks' gestation. Very similar associations were observed for estimated fetal weight growth velocity. There was a positive relationship between soluble fms-like tyrosine kinase-1-to-placenta growth factor ratio and the probability of spontaneous labor at 37 to 38 weeks' gestation (hazard ratio [95% confidence interval] for a 50 percentile increase in soluble fms-like tyrosine kinase-1-to-placenta growth factor ratio, 3.05 [2.32-4.02]; P

You are stationed in the southern part of Togo, a small country on the West African coast. An emergency Cesarean section is scheduled. The patient is 18 years old (gravida 1, para 0) and her gestation is 37 weeks. She has not been attending the prenatal clinic. Six hours ago she went into spontaneous labor. A decision to deliver the child by Cesarean section was made based on a brow presentation with the cervix 7 cm dilated and fully effaced. The patient refuses a spinal anesthetic and would prefer a general anesthetic.

Background: To compare outcomes at Mizan-Tepi University Teaching Hospital to national and regional data and to plan quality improvement and research studies based on the results. Methods: This study was a prospective hospital-based cross-sectional analysis of a convenience sample of 1, 000 women who delivered at Mizan-Tepi University Teaching Hospital. Results: Our convenience sample was young (median age 24 years) with a primarily school level or less of education (68.6%). Only about 5% of women had a history of prior cesarean birth, 2.1% reported they were human immunodeficiency virus seropositive, and the median number of prenatal visits was four. Women were commonly admitted in spontaneous labor (84.5%), transferred from another facility (49.2%; 96.8% of which were referred from a health center), and had their fetal heart rate auscultated on admission (94.7%). Only 5.2% of women did not deliver within twenty-four hours and the cesarean birth prevalence was 23.4%. Many women were delivered by midwives (73.2%; all unassisted vaginal births), 89.2% were term deliveries, and 92.5% of neonatal birthweights were 2500 grams or heavier. Less than five percent of women delivered stillbirths (4.3%) and 5.7% of livebirths experienced neonatal death by the day of discharge. There were no maternal deaths in the cohort. Conclusion: The prevalence of stillbirth and neonatal death were the most notable findings, while there was no maternal death in the cohort.

Background: Latin America has the highest regional average cesarean birth rates. One potential driver is cesarean birth by maternal request (CBMR). Methods: We analyzed of a large prospective cohort study of HIV-infected women in six Latin American countries. Results: Comparisons were made between women who chose CBMR (n = 38) and women with a medical indication for cesarean (n = 683). The only variable associated with CBMR was onset of labor (AOR 0.3 [0.1,0.9], p = 0.04). Conclusion: Spontaneous labor reduced the likelihood of a woman living with HIV to pursue CBMR in a large Latin American cohort.

Background The rate of cesarean section (CS) births has been rapidly increasing in Saudi Arabia during the last two decades. Using the Robson Ten Group Classification System (TGCS) to classify and analyze the causes of the high CS rate. Objective To assess the increasing rates of CS by the implementation of the Robson TGCS on all CS births in our chosen population. Study design An observational, cross-sectional study conducted among all deliveries at the King Abdul-Aziz Medical City (KAMC), Jeddah, Saudi Arabia during most of 2018. Over the study period, 3168 births were enrolled in the study. Results The analysis of 3168 births, where 870 women gave birth through CS, resulted in a CS rate of 27.5%. The three major TGCS which contributed to the CS rate were group 5, 2 (divided into 2A and 2B), and 3. Class 5 (Previous CS, single cephalic, ≥37 weeks) contributed the most to the CS rate by 36.5%. Followed by Class 2 (divided into 2A; nulliparous, singleton, cephalic, ≥37 weeks, induced labor and 2B; nulliparous, singleton, ≥37, pre-labor CS) which contributed by 12.9%. Class 3 (multiparous (no previous CS), singleton, ≥37 weeks, spontaneous labor) was the third-highest contributing group by 9.2%. Women who gave birth spontaneously and vaginally were 1403 (44.3%) where women whose labor was induced were 1286 (40.6%). Conclusion The CS rate in KAMC was 27.5%. After classifying these patients according to the TGCS, Class 5 had the largest percentage of patients going for CS (36.2%). While they are individually low together, Robson classes from Class 1 to 4 (which are considered as low-risk classes) were responsible for 37.8% of the patients going for CS. Since the previously mentioned groups are considered low-risk they should be targeted by health institutions to reduce the CS rate. Improved education of nulliparous and multiparous women who never underwent a CS to prevent nonmedically indicated CS is in order, to preclude repeated CS births in the future and further increase the CS rate.

OBJECTIVE Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to investigate the rates of conversion to CD for planned twin VDs and identify predictors and outcomes of conversion. STUDY DESIGN A retrospective cohort study of all women who underwent a planned twin VD at two large academic medical centers over 4 years. Demographic and outcome data were chart abstracted. Various statistical tests were used to evaluate the influence of perinatal variables on mode of delivery and identify possible predictors of conversion. RESULTS Eight hundred and eighty-five twin deliveries were identified, of which 725 (81.9%) were possible candidates for VD. Of those, 237 (32.7%) underwent successful VD of twin A. Ninety-five (40.1%) had a nonvertex second twin at time of delivery. Conversion to CD occurred in 10 planned VDs (4.2%). Conversions were higher with spontaneous labor (relative risk [RR]: 2.1; 95% confidence interval [CI] 1.6-2.7; p = 0.003), and having an intertwin delivery interval greater than 60 minutes (RR: 5.1; 95% CI: 2.5-10.8; p

Objective To determine the odds of postpartum hemorrhage (PPH) in low-risk women who gave birth vaginally and were exposed to different durations and dosages of oxytocin across a range of labor durations during spontaneous or induced labor. Design A retrospective cross-sectional analysis of data from the Consortium for Safe Labor. Setting Data were gathered from 12 clinical institutions across the United States from 2002 to 2008. Participants After exclusion of high-risk conditions associated with PPH, we examined data from 27,072 women who gave birth vaginally. Methods PPH was defined as estimated blood loss of greater than 500 ml at the time of birth and/or a diagnostic code for PPH before hospital discharge. We included covariates were if they were associated with oxytocin use and PPH and did not mediate oxytocin use. We used regression models to determine the likelihood of PPH overall and within the induced and spontaneous labor groups separately. We used subgroup analyses within specific durations of labor to clarify the findings. Results The overall rate of PPH was 3.9%. Women with induced labor experienced PPH more frequently than women who labored spontaneously. Labor augmentation was associated with greater adjusted odds for PPH when oxytocin was infused for more than 4 hours. Longer duration of spontaneous labor and the second stage of labor did not change this association. Oxytocin use during labor induction increased the odds for PPH when administered for more than 7 hours. The odds further increased when induction lasted longer than 12 hours and/or the second stage of labor was longer than 3 hours. Conclusion Strategies for judicious oxytocin administration may help mitigate PPH in low-risk women having vaginal birth.

OBJECTIVE: To categorise the variants of uncertain significance found with prenatal chromosomal microarray and determine the proportion of such variants that are associated with a well-known phenotype in order to establish how often they remain truly of uncertain significance. DESIGN: Retrospective cohort study. SETTING: The University of California, San Francisco. POPULATION: All patients with a variant of uncertain significance on prenatal microarray between 2014 and 2018. METHODS: Each variant was classified as a copy number variant that (a) contains Online Mendelian Inheritance in Man (OMIM)-annotated disease-causing genes (‘OMIM morbid genes’); (b) confers autosomal recessive carrier status; (c) is associated with incomplete penetrance; (d) is >1 Mb in size without OMIM morbid genes; (e) demonstrates mosaicism; or (f) contains significant regions of homozygosity. For each variant of uncertain significance, we examined the existing literature to determine whether the predicted phenotype(s) was known. MAIN OUTCOME MEASURE: Prevalence and classification of variants and how much information is available regarding the likelihood of an affected phenotype. RESULTS: Of 970 prenatal microarrays, 55 (5.8%) had at least one variant of uncertain significance. The most common were copy number variants containing OMIM morbid genes (36.8%). In all, 48 (84.2%) were associated with a known phenotype; 55 (96.5%) had data available regarding the likelihood of an affected phenotype. CONCLUSIONS: The prevalence of variants of uncertain significance with prenatal microarray was 5.8%. In the large majority of cases, data were available regarding the predicted phenotype.

Objectives – The main objective of this study was to make an appraisal of practices before and after the publication of national recommendations (2016) of oxytocin administration during spontaneous labor, in order to assess the impact of these on the labor, the delivery and the neonatal state. The secondary objective was to assess the application of these new recommendations. Methods – Comparative before-after, retrospective, monocentric study conducted in the Hôpital Couple Enfant in Grenoble. Two groups were formed: a group “before” (2015) the publication of national recommendations, and a group “after” (2019). Eligible patients were primiparous, giving birth at term with a spontaneous labor; fetus head presentations and patients with intact membrane when arrived at the maternity were included. Results – The oxytocin administration rate decreased significantly, from 72,2 % in the "before" group to 45,2 % in the "after" group. This decrease comes with a moderate increase of the active phase duration, without variation of the rate of cesarean section and with a constant rate of immediate postpartum hemorrhage between the two groups. No significant difference were found for the Apgar score at 5 min, the transfer rate and the pH < 7.10 rate in neonates. Regarding the oxytocin administration methods, the initial rate is significantly lower, without the total dose significantly decreasing, and with a total infusion duration constant between the two groups. Conclusion – In 23 % of cases, oxytocin is used in accordance with the recommendations. Improvement proposals arising from this study could be the drafting of service protocols on normal labor management, and the establishment of training within the service.; Objectifs – L’objectif principal de cette étude était de réaliser un état des lieux des pratiques avant et après la publication des recommandations nationales de 2016 pour l’administration d’oxytocine au cours du travail spontané, afin d’évaluer l’impact de celles-ci sur le travail, l’accouchement et l’état néonatal. L’objectif secondaire était d’évaluer l’application de ses nouvelles recommandations. Méthodes – Etude comparative de type avant-après, rétrospective, mono-centrique menée à l’Hôpital Couple Enfant de Grenoble. Deux groupes ont été constitués : un groupe « avant » (2015) la publication des recommandations et un groupe « après » (2019). Les patientes éligibles étaient des primipares accouchant à terme à la suite d’un travail spontané ; ont été inclues les patientes avec un foetus en présentation céphalique à membranes intactes à leur arrivée à la maternité. Résultats – Le taux d’administration d’oxytocine diminue significativement, passant de 72,2 % dans le groupe « avant » à 45,2 % dans le groupe « après ». Cette diminution de l’administration d’oxytocine s’accompagne d’une augmentation modérée de la durée de la phase active, sans que le taux de césarienne ne varie et avec un taux d’hémorragie du post-partum immédiat constant entre les deux groupes. Il n’a pas été retrouvé de différence significative concernant le score d’Apgar à 5 min, le taux de transfert et le pH < 7,10 des nouveau-nés. Concernant les modalités d’administration d’oxytocine, le débit initial est significativement plus faible, sans que la dose totale ne diminue de manière significative, et avec une durée totale de la perfusion constante entre les deux groupes. Conclusion – On constate une utilisation de l’oxytocine conforme aux recommandations dans 23 % des cas. Des propositions d’améliorations découlant de ce travail pourraient être la rédaction de protocoles de service sur la prise en charge du travail normal et la mise en place de formation au sein du service.

Background: Caesarean delivery is defined as an operative procedure to deliver the fetus or foetuses after the period of viaility through an incision on the adominal wall and uterine wall in an intact uterus. The World Health Organization (WHO) has identified an ideal caesarean section (CS) rate for a nation of around 10-15%1. The objective of the present study was to find the rate of primary caesarean deliveries in and its contribution to total caesarean rate and to analyze the indications of the caesarean sections. Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at Regional hospital,Bilaspur. A total of 90 primary caesarean deliveries were studied. Results: The total deliveries during the study period were 809 and the total caesarean section rate observed was 14.96%. The caesarean section rate among primigravidae was 74.38%. Out of the total number of primicaesarean deliveries, 92.22% were performed in emergency and 7.78% were performed electively. Among the emergency caesarean sections performed, 60.24% of patients had induced labor and 39.76% had spontaneous labor. The most common indication of caesarean section was fetal distress (43.33%) followed by failed induction(18.89%) and malpresentations (16.67%). Conclusions: Caesarean audit should be performed routinely and every case should be scrutinised. Reducing the primary caesarean rate not only decreases total caesarean rate but also many long-term complications associated with previous caesarean sections like adherent placenta ,rupture uterus

Background: Induction of labor is the stimulation of the uterus to initiate the labor process whether by administering oxytocin, prostaglandin or reputing the membrane [1]. It was realized that the number of induction of labor patients was thought to be increasing in comparison with the spontaneous labor patients. Therefore, the complications of induced labor were higher. A detailed analysis was needed to confirm that. Objective: The aim of the study is to analyze the outcomes between spontaneous versus induced labor. Materials and Methods: A retrospective analysis was conducted at our tertiary care university hospital, in the period from December 2015 to December 2016 when 311 women were divided into two groups: group 1, women who had spontaneous labor (n = 106) compared with group 2, women who were labor induced (n = 205). Complications of pregnancy, delivery type, tear, episiotomy, blood transfusion and instruments used were analyzed retrospectively. Results: The mean ± SD of baseline characteristics, like age, height, weight, BMI and hemoglobin level for all study samples was 28.59 ± 5.95 years, 1.58 ± 0.06 m, 71.77 ± 13.42 kg, 28.59 ± 5.89 kg/m2 and 11.08 ± 1.45 g/dl respectively. A statistically significant difference was noticed in the duration of labor between spontaneous and induced labor (95% CI: 9.194 - 152.130; p-value 0.004 and OR: 0.239). There was no significant difference in complications, delivery type (Spontaneous Vaginal Delivery (SVD) or other), blood transfusion, and instrument used between women who had spontaneous labor versus induced labor. However, significant differences in tear (95% CI: 4.354 - 0.996; p-value 0.035) and episiotomy (95% CI: 0.928 - 0.224; p-value 0.028) were found between the two groups. In conclusion, the induced labor was found to be associated with high incidence of duration of labor, tear and episiotomy. Patients should always be counseled when there it is an option between the two delivery types.

Background Oxidative stress has been implicated in numerous birth outcomes, including spontaneous preterm birth. However, the relationship with presentation at delivery has been less well studied. We assessed the relationship between oxidative stress biomarkers and gestational duration with a focus on spontaneous presentation for delivery. Methods Our sample included 740 women from a multi-center prospective cohort study, recruited from 2010 to 2012. Resultant measures of oxidative stress in pregnancy prostaglandin F2α (PGF2α), 8-iso-prostaglandin F2α (8-iso-PGF2α), and the primary 8-iso-PGF2α metabolite were measured in third trimester urine samples. Information on presentation for delivery was abstracted from medical records. We examined associations with preterm birth using adjusted logistic models. Time to event (overall delivery and spontaneous delivery) was examined using adjusted accelerated failure time models. Results The 8-iso-PGF2α metabolite was associated with increased odds of overall preterm birth (OR: 1.44 [95% CI: 1.00, 2.06]), and the association with spontaneous preterm birth was similar in magnitude but not statistically significant (OR: 1.45 [95% CI: 0.96, 2.20]). We did not detect associations between other biomarkers and preterm birth, or between biomarkers and timing of overall or spontaneous delivery in accelerated failure time models. Conclusions Our data suggest that increased oxidative stress, as indicated by the 8-iso-PGF2α metabolite, may be associated with preterm birth. In contrast to previous studies, associations were similar among individuals with spontaneous versus non-spontaneous presentation for delivery.

Objective Prostaglandins (PGs) are considered universal mediators for the process of physiological parturition. This is based on observations that amniotic fluid concentrations of PGs are elevated prior to and during the onset of labor (mostly utilizing immunoassays). Distinguishing PGs from similarly structured molecules (i.e. prostamides; PG-EA) is difficult given the cross-reactivity of available antibodies and the chemical similarity between these compounds. Herein, this limitation was overcome by utilizing mass spectrometry to determine PG and PG-EA concentrations in amniotic fluid of women with spontaneous labor at term and in those with clinical chorioamnionitis (CHAM), the most common infection-related diagnosis made in labor and delivery units worldwide. Study Design Liquid chromatography-tandem mass spectrometry (LC MS/MS) was used to determine the PG and PG-EA content in amniotic fluid samples of women with spontaneous labor at term with (n = 14) or without (n = 28) CHAM. Controls included women who delivered at term without labor (n = 10). Results PGE2, PGF2α, and 13,14-dihydro-15-keto-PGF2α (PGFM) were higher in amniotic fluid of women with spontaneous labor at term than in those without labor. PGE2, PGF2α, and PGFM were also higher in amniotic fluid of women with CHAM than in those without labor. However, PGE2-EA and PGF2α-EA were lower in amniotic fluid of women with CHAM than in those without CHAM. The ratios of PGE2 to PGE2-EA and PGF2α to PGF2α-EA were higher in amniotic fluid of women with spontaneous labor at term with or without CHAM than in those without labor; yet, the ratio of PGF2α to PGF2α-EA was greater in women with CHAM than in those without this clinical condition. Conclusions Spontaneous labor at term with or without CHAM is characterized by elevated amniotic fluid concentrations of prostaglandins (PGE2, PGF2α, and PGFM) but not prostamides. Quantification of these products by LC MS/MSlc==may potentially be of utility in identifying their physiological functions relevant to parturition. Summary Prostaglandins (PGs) are critical for the onset and progression of labor. Structural similarities of PGs and prostamides (PG-EA) prevents their specific identification by immunoassay. We utilized LC MS/MS to determine PG and PG-EA content in amniotic fluid (AF) of women with spontaneous labor at term with or without CHAM and women who delivered at term without labor. Higher aamniotic ffluid PG levels were observed in women with spontaneous labor with and without CHAM compared to women delivering without labor. PG-EA levels in amniotic fluid of women with spontaneous labor and CHAM were lower than in women with spontaneous labor without CHAM but not those without labor. Ratios of PGs to PG-EAs were higher in AF of women with labor and CHAM compared to those without labor. Delineation of these products by LC MS/MS may potentially be of utility in identifying their physiological functions relevant to parturition

Physical exercise at term is empirically used as a method of enhancing the spontaneous labor onset. The objective of this study was to evaluate the effect of controlled maternal physical exercise at term as a method of enhancing the spontaneous labor onset.At 38 weeks low-risk pregnant women, with a singleton cephalic fetus and no previous cesarean deliveries were randomly allocated to one of two arms: the experimental group performed 30 min of walking 3 times a week at 4 km/h, and the control group maintained their usual work and household activities. The primary outcome measure was the rate of labor induction. A sample size of 60 per group was planned to detect a 10% difference in labor induction rate, at a significance level of 0.05 and a power of 0.80.The exercise group had a lower rate of labor induction (17.5 versus 33.3%, adjusted odds ratio [OR] = 0.28, 95% confidence interval [CI]; 0.14-0.87) and fewer operative vaginal deliveries (20.6 versus 38.1%, adjusted OR = 0.42, 95% CI; 0.17-0.92). No differences were found in gestational age at onset of spontaneous labor, duration of the active phase of labor, interval between induction and the active phase of labor, cesarean section rates, birth weight, and Apgar scores. No maternal or fetal heart rate abnormalities were recorded during the exercise sessions.For low-risk women at term walking for 30 min 3 times a week at 4 km/h from 38-week onwards is safe, enhances the spontaneous onset of labor and reduces operative vaginal delivery rates.Physical exercise at term is empirically used as a method of enhancing the spontaneous labor onset. In finding that for low-risk women walking for 30 min 3 times a week at 4 km/h from 38-week onwards enhances spontaneous labor onset of and reduces operative vaginal delivery.ClinicalTrials.gov. www.clinicaltrials.gov NCT02460185.

Specific causes of preterm birth remain unclear. Several recent studies have suggested that immune changes during pregnancy are associated with the timing of delivery, yet few studies have been performed in low-income country settings where the rates of preterm birth are the highest. We conducted a retrospective nested case-control evaluation within a longitudinal study among HIV-uninfected pregnant Kenyan women. To characterize immune function in these women, we evaluated unstimulated and stimulated peripheral blood mononuclear cells in vitro with the A/California/2009 strain of influenza to understand the influenza-induced immune response. We then evaluated transcript expression profiles using the Affymetrix Human GeneChip Transcriptome Array 2.0. Transcriptional profiles of sufficient quality for analysis were obtained from 54 women; 19 of these women delivered 37 weeks. The median time to birth from sample collection was 13 weeks. No transcripts were significantly associated with preterm birth in a case-control study of matched term and preterm birth (n = 42 women). In the influenza-stimulated samples, expression of IFNL1 was associated with longer time to delivery-the amount of time between sample collection and delivery (n = 54 women). A qPCR analysis confirmed that influenza-induced IFNL expression was associated with longer time to delivery. These data indicate that during pregnancy, ex vivo influenza stimulation results in altered transcriptional response and is associated with time to delivery in cohort of women residing in an area with high preterm birth prevalence.

AIM Cesarean section rates are increasing worldwide and Robson's classification system allows a practical approach to study this phenomenon. C-section in Chile has been indicated as unexpectedly high, with important variability within the country and payment systems. The aim was to report our data using Robson's system and the evolution of local C-section rate in a public hospital during a 9-year period. METHODS Retrospective analysis (2005-April 2014), in a metropolitan hospital in Santiago. All deliveries were classified into Robson groups. Time changes were analyzed with Pearson's correlation. P value

Uterine tachysystole (TS) is a potentially significant intrapartum complication seen most commonly in induced or augmented labors but may also occur in women with spontaneous labor. When it occurs, maternal and perinatal complications can arise if not identified and managed promptly by obstetric care providers. Over recent years, new definitions of the condition have facilitated further research into the field, which has been synthesized to inform clinical management guidelines and protocols. We propose a set of recommendations pertaining to TS in line with contemporary evidence and obstetric practice.

Background The Twin Birth Study, a multicenter randomized controlled trial, found no differences in neonatal outcomes in women with twins randomized to planned cesarean or vaginal delivery. Nevertheless, women who present in spontaneous labor might expect a better outcome following a trial of vaginal delivery than undergoing cesarean delivery. In this secondary analysis, we aimed to compare neonatal outcomes of women who presented in spontaneous labor in the two arms of the Twin Birth Study. Methods Women in whom the first twin was in the cephalic presentation were randomized between 32 + 0 and 38 + 6 weeks to planned vaginal delivery or cesarean. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Results Of the 2804 women included in the Twin Birth Study, 823 women in the planned vaginal delivery arm and 612 in the planned cesarean arm presented in spontaneous labor. Although the odds ratio favored planned vaginal delivery, there was no statistically significant difference in the rate of primary outcome between the vaginal delivery and cesarean arms (1.8% vs 2.7%, respectively; P = 0.16; OR 1.49; 95% CI, 0.87-2.55). Similarly, the rates of the individual components of the primary outcome and of maternal adverse outcome were similar between the two arms. Conclusion In women with twins who present in spontaneous labor between 32 + 0 and 38 + 6 weeks' gestation, where the first twin is cephalic, a policy of planned vaginal delivery or cesarean is not associated with significant differences in neonatal or maternal outcomes.

Objective To investigate whether the predicted chance of success is associated with the choice to undergo trial of labor after cesarean (TOLAC). Study Design Retrospective cohort study of women with a single prior nonelective cesarean delivering a term singleton in 2012 at a tertiary care hospital. A vaginal birth after cesarean (VBAC) score (likelihood of success) was estimated for each patient. The primary outcome was percentage of women choosing TOLAC among women with favorable (> 70% likelihood) and unfavorable VBAC scores. Other factors such as desired sterilization, provider type, and spontaneous labor were included in the analysis. Results In 2012, 434 women were eligible: 73 with VBAC score >70%, and 361 with score ≤70%. Of those with score >70%, 63% chose TOLAC, compared with 21% with score ≤70% (p Conclusion Almost four in ten women with a history of nonelective primary cesarean and a very high predicted likelihood of VBAC choose elective repeat cesarean. Spontaneous labor was strongly associated with the choice to undergo TOLAC.

We report a case of a 30-year-old woman who was first found to have a persistently low serum potassium level at 26 years of age during her first pregnancy. Genetic test of SLC12A3 confirmed Gitelman syndrome. The patient remained asymptomatic and had two deliveries following spontaneous labor. The first neonate died of heart failure due to cardiac abnormalities. The obstetric and neonatal outcome of the second pregnancy was good.

Background: Elective induction of labor is defined as an initiation of labor, either by mechanical or pharmacological means at a time earlier than nature regardless of a medical or obstetric indication. Objectives were to estimate the proportion of caesarean sections and vaginal deliveries and magnitude of maternal complications following elective induction and spontaneous labor.Methods: The study entitled “comparison of caesarean section rate and maternal complications in elective induction versus spontaneous labor in LD Hospital, Kashmir” was a hospital based observational study, conducted in the Postgraduate Department of Obstetrics and Gynaecology, LallaDed Hospital of Government Medical College, Srinagar over a period of one and a half years.Results: Women in induced labor group had slightly increased risk of caesarean section than those in spontaneous group. Fetal distress was the most common indication for caesarean section in both the groups. There was no difference in both groups regarding maternal complications such as perineal lacerations; postpartum hemorrhage (PPH); need for blood transfusions and post partum hospital stay.Conclusions: Though induction of labor is associated with a slight increased risk of caesarean delivery, it is not related to other maternal complications. Therefore inductions are safe in hands of safe obstetricians.