Search

Introduction Material and Methods Results Conclusions Occiput posterior (OP) position rates at birth are 5%–8% in studies mainly comprising white European women. The anthropoid pelvis is common in black African women. This pelvic shape has a narrow anterior segment and an ample room posteriorly. The fetal head is wider posteriorly, and the OP position may be favorable in women with an anthropoid pelvic shape. We aimed to examine the fetal rotation with ultrasound longitudinally during the active phase of labor in a sub‐Saharan population. We also aimed to examine associations between fetal position, delivery mode, and duration of labor.The study was conducted at Kilimanjaro Christian Medical Centre in Moshi, Tanzania from the 19th of November 2023 to 13th of April 2024. Women with a single fetus in cephalic presentation, gestational age >37 weeks, without previous or pre‐labor cesarean section were eligible. Fetal position was classified as occiput anterior (OA) from 10 to 2 o'clock, occiput transverse (OT) at 3 or 9 o'clock, and OP position from 4 to 8 o'clock.The study participants comprised 215 women. Fetal positions at admission, in the first and second stage of labor and at birth are presented in the graphical figure. In all, 65/215 (30.2%) fetuses were in OP position at admission, 59/204 (28.9%) in the first stage, 38/210 (18.1%) in the second stage and 35/215 (16.3%) were delivered in OP position. The OP rates at birth were 25/92 (27.2%) in nulliparous and 10/123 (8.1%) in parous women. The operative delivery rate was 10/157 (6.4%) in women with ultrasound assessed fetal position as OA in the second stage (six cesarean section and four vacuum extractions), and 28/48 (58.3%) in the non‐OA group (27 cesarean section and one vacuum extraction) (p < 0.01). The hazard ratio for delivery in the second stage was 0.26 (95% CI 0.13–0.52) for the non‐OA versus the OA group in nulliparous women and 0.25 (95% CI 0.12–0.52) in parous women.The persistent OP position rate at birth was higher than previously reported, and the operative intervention rate was nine time higher in women with the fetus in non‐OA versus OA position in the second stage. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have indicated the association between smooth endoplasmic reticulum aggregates (SERa+) and poorer medically assisted reproduction outcomes. However, the link between SERa+ and neonatal outcomes remains controversial and open for debate. A comprehensive meta‐analysis on the relation between SERa+ and the risk of birth defects is needed. Material and Methods: The literature search was conducted using the following databases: PubMed, Embase, Cochrane Libraries, Web of Science, and Chinese databases including China National Knowledge Infrastructure (CNKI) and Wan Fang from inception until July 2023. Risk ratio (RR) and 95% confidence interval (CI) were calculated by a fixed‐effected model, while heterogeneity was assessed by forest plots and I2 statistic. Funnel plot was produced to assess publication bias. This meta‐analysis has been registered on PROSPERO (CRD42022313387). Results: The search resulted in 122 studies, 14 of which met the inclusion criteria. The analysis of birth defects revealed a higher risk (RR = 2.17, 95%CI 1.24 to 3.81, p = 0.007) in children derived from SERa+ cycle compared to SERa‐ cycles (711 vs. 4633). Meanwhile, in a subgroup analysis, the risk of birth defects was significantly increased in the SERa+ oocytes group as compared with the sibling SERa‐ oocytes group (RR = 3.53, 95%CI 1.21 to 10.24, p = 0.02). Conclusions: To conclude, our analysis indicated that SERa+ cycles/oocytes may have a potential risk of increased additional major birth defects comparing with SERa‐ cycles/oocytes. This conclusion may provide evidence‐based support for clinicians in IVF clinical guidance and embryologists in prudent embryo selection strategy. [ABSTRACT FROM AUTHOR]

Introduction: Labor induction rates have increased over the last decades, and in many high‐income countries, more than one in four labors are induced. Outpatient management of labor induction has been suggested in low‐risk pregnancies to improve women's birth experiences while also promoting a more efficient use of healthcare resources. The primary aim of this paper was to assess the proportion of women in a historical cohort that would have been eligible for outpatient labor induction with oral misoprostol. Second, we wanted to report safety outcomes and assess efficacy outcomes for mothers and infants in pregnancies that met the criteria for outpatient care. Material and methods: Criteria for outpatient labor induction with oral misoprostol were applied to a historical cohort of women with induction of labor at two Norwegian tertiary hospitals in the period January 1, through July 31, 2021. The criteria included low‐risk women with an unscarred uterus expecting a healthy, singleton baby in cephalic position at term. The primary outcome was the proportion of women eligible for outpatient labor induction. Secondary outcomes included reasons for ineligibility and, for eligible women, safety and efficacy outcomes. Results: Overall, 29.7% of the 1320 women who underwent labor induction in a singleton term pregnancy met the criteria for outpatient labor induction. We identified two serious adverse events that potentially could have occurred outside the hospital if the women had received outpatient care. The mean duration from initiation of labor induction to administration of the last misoprostol was 22.4 h. One in 14 multiparous women gave birth within 3 h after the last misoprostol dose. Conclusions: In this historical cohort, three in ten women met the criteria for outpatient management of labor induction with oral misoprostol. Serious adverse events were rare. The average time span from the initiation of labor induction to the last misoprostol was nearly 24 h. This suggests a potential for low‐risk women with an induced labor to spend a substantial period of time at home before labor onset. However, larger studies testing or evaluating labor induction with oral misoprostol as an outpatient procedure are needed to draw conclusions. [ABSTRACT FROM AUTHOR]

Introduction: There has been increased use of both induction of labor (IOL) and cesarean section for women with term pregnancies in many high‐income countries, and a trend toward birth at earlier gestational ages. Existing evidence regarding the association between IOL and cesarean section for term pregnancies is mixed and conflicting, and little evidence is available on the differential effect at each week of gestation, stratified by parity. Material and methods: To explore the association between IOL and primary cesarean section for singleton cephalic pregnancies at term, compared with two definitions of expectant management (first: at or beyond the week of gestation at birth following IOL; and secondary: only beyond the week of gestation at birth following IOL), we performed analyses of population‐based historical cohort data on women who gave birth in one Australian state (Queensland), between July 1, 2012 and June 30, 2018. Women who gave birth before 37+0 or after 41+6 weeks of gestation, had stillbirths, no‐labor, multiple births (twins or triplets), non‐cephalic presentation at birth, a previous cesarean section, or missing data on included variables were excluded. Four sub‐datasets were created for each week at birth (37–40). Unadjusted relative risk, adjusted relative risk using modified Poisson regression, and their 95% confidence intervals were calculated in each sub‐dataset. Analyses were stratified by parity (nulliparas vs. parous women with a previous vaginal birth). Sensitivity analyses were conducted by limiting to women with low‐risk pregnancies. Results: A total of 239 094 women were included in the analysis, 36.7% of whom gave birth following IOL. The likelihood of primary cesarean section following IOL in a Queensland population‐based cohort was significantly higher at 38 and 39 weeks, compared with expectant management up to 41+6 weeks, for both nulliparas and paras with singleton cephalic pregnancies, regardless of risk status of pregnancy and definition of expectant management. No significant difference was found for nulliparas at 37 and 40 weeks; and for paras at 40 weeks. Conclusions: Future studies are suggested to investigate further the association between IOL and other maternal and neonatal outcomes at each week of gestation in different maternal populations, before making any recommendation. [ABSTRACT FROM AUTHOR]

Introduction: Birth at early term (37+0–38+6 completed gestational weeks [GW] and additional days) is associated with adverse neonatal outcomes compared with waiting to ≥39 GW. Most studies report outcomes after elective cesarean section or a mix of all modes of births; it is unclear whether these adverse outcomes apply to early‐term babies born after induction of labor (IOL). We aimed to determine, in women with a non‐urgent induction indication (elective/planned >48 h in advance), if IOL at early and late term was associated with adverse neonatal and maternal outcomes compared with IOL at full term. Material and methods: An observational cohort study as a secondary analysis of a multicenter randomized controlled trial of 1087 New Zealand women with a planned IOL ≥37+0 GW. Multivariable logistic regression was used to analyze neonatal and maternal outcomes in relation to gestational age; 37+0–38+6 (early term), 39+0–40+6 (full term) and ≥41+0 (late term) GW. Neonatal outcome analyses were adjusted for sex, birthweight, mode of birth and induction indication, and maternal outcome analyses for parity, age, body mass index and induction method. The primary neonatal outcome was admission to neonatal intensive care unit (NICU) for >4 hours; the primary maternal outcome was cesarean section. Results: Among the 1087 participants, 266 had IOL at early term, 480 at full term, and 341 at late term. Babies born following IOL at early term had increased odds for NICU admission for >4 hours (adjusted odds ratio [aOR] 2.16, 95% confidence intervals (CI) 1.16–4.05), compared with full term. Women having IOL at early term had no difference in emergency cesarean rates but had an increased need for a second induction method (aOR 1.70, 95% CI 1.15–2.51) and spent 4 h longer from start of IOL to birth (Hodges–Lehmann estimator 4.10, 95% CI 1.33–6.95) compared with those with IOL at full term. Conclusions: IOL for a non‐urgent indication at early term was associated with adverse neonatal and maternal outcomes and no benefits compared with IOL at full term. These findings support international guidelines to avoid IOL before 39 GW unless there is an evidence‐based indication for earlier planned birth and will help inform women and clinicians in their decision‐making about timing of IOL. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to compare placental size and placental size relative to fetal size (ratio) in ongoing pregnancies examined by magnetic resonance imaging (MRI) at gestational week 36 with placental size among all deliveries at gestational week 36 during the same time period. Material and methods: Ongoing unselected singleton pregnancies (n = 89) were examined by MRI at median gestational week 36+5 days during 2017–2018, and placental and fetal volumes (cm3) were calculated. The placental size and ratio in ongoing pregnancies were compared with placental size and ratio among all deliveries in Norway at gestational week 36 (median gestational week 36+4 days) during 2016–2019 (n = 5582). For comparison of size, we converted volume (cm3) in ongoing pregnancies into grams as: cm3 × 1.05 (density of placental and fetal tissue). Results: In ongoing pregnancies, median placental size was 873 (interquartile range [IQR] 265) grams and median size of all delivered placentas was 613 (IQR 290) grams. Placental size was smaller among the delivered placentas independent of delivery mode: 760 (IQR 387) grams among elective cesarean deliveries (n = 465) and 590 (IQR 189) grams among vaginal deliveries after spontaneous onset of labor (n = 2478). Median ratio in ongoing pregnancies was higher than among deliveries: 0.31 (IQR 0.08) vs 0.21 (IQR 0.08). The ratio was higher in ongoing pregnancies independent of delivery mode: 0.24 (IQR 0.17) among elective cesarean deliveries vs 0.21 (IQR 0.05) among vaginal deliveries after spontaneous onset of labor. Conclusions: The placenta is larger in ongoing pregnancies than among deliveries. This finding suggests that placental size decreases during labor and delivery, possibly by transfer of blood to the fetus. Our finding also suggests that reference values of placental size based on delivered placentas are not valid for ongoing pregnancies. [ABSTRACT FROM AUTHOR]

Introduction: There is limited evidence about changes in the pelvic floor during active labor. We aimed to investigate changes in hiatal dimensions during the active first stage of labor and associations with fetal descent and head position. Material and methods: We conducted a longitudinal, prospective cohort study at the National University Hospital of Iceland, from 2016 to 2018. Nulliparous women with spontaneous onset of labor, a single fetus in cephalic presentation, and gestational age ≥37 weeks were eligible. Fetal position was assessed with transabdominal ultrasound and fetal descent was measured with transperineal ultrasound. Three‐dimensional volumes were acquired from transperineal scanning at the start of the active phase of labor and in late first stage or early second stage. The largest transverse hiatal diameter was measured in the plane of minimal hiatal dimensions. The levator urethral gap was measured as the distance between the center of the urethra and the levator insertion using tomographic ultrasound imaging. Measurements of the levator urethral gap were made in the plane of minimal hiatal dimensions and 2.5 and 5 mm cranial to this. Results: The final study population comprised 78 women. The mean transverse hiatal diameter increased 12.4% between the two examinations, from 39.4 ± 4.1 mm (±standard deviation) at the first examination to 44.3 ± 5.8 mm at the last examination (p < 0.01). We found a moderate correlation between the transverse hiatal diameter and fetal station at the last examination (r = 0.44, r2 = 0.19; p < 0.01; regression equation y = 2.71 + 0.014x), and a weak correlation between the change in transverse hiatal diameter and change in fetal station (r = 0.29; r2 = 0.08; p = 0.01; regression equation y = 0.24 + 0.012x). Levator urethral gap increased significantly in all three planes on both the left and right sides. Head position was not associated with hiatal measurements after adjusting for fetal station. Conclusions: We found a significant, but only modest, increase of the hiatal dimensions during the first stage of labor. The risk of levator ani trauma will therefore be low during this stage. The change in transverse hiatal diameter was associated with fetal descent but not with head position. [ABSTRACT FROM AUTHOR]

Introduction: Umbilical cord blood gas analysis provides information about intrapartum hypoxia and is considered an important measure of quality in maternity care. Universal measurement of umbilical cord pH (UC‐pH), as part of umbilical cord blood gas analysis, has been recommended in Denmark since 2009. The recommendation is that UC‐pH is measured from the umbilical cord artery (pHUA) and vein (pHUV). The aim of this study was to evaluate the national implementation of universal measurement of UC‐pH. Material and methods: The study consisted of two parts. First, an evaluation of the implementation, that is, the proportion of births with measured UC‐pH since the recommendation was introduced. Second, an evaluation of the cases in which UC‐pH was missing. This analysis only involved births with gestational age ≥35 + 0 weeks. Results: In the period 2009 to 2018 there were 560 889 singleton, live births with registered gestational age in Denmark. The proportion of births with measured pHUA and pHUV increased from 12.4% in 2009 to 82.8% in 2015 and then declined to 76.9% in 2018 (p < 0.001). When comparing the group with missing pH from one or both vessels to the group with both pHUA and pHUV we found lower occurrence of pregnancy and births complications in the first group, body mass index ≥35 (unadjusted RR: 0.89, 95% CI: 0.85–0.93), pregnancy induced medical conditions (RR: 0.86, 95% CI: 0.84–0.89), fetal distress during birth (RR: 0.77, 95% CI: 0.76–0.79), emergency cesarean section (RR: 0.80, 95% CI: 0.78–0.83) and serious births events (RR: 0.80, 95% CI: 0.74–0.86). In contrast, the occurrence of placental insufficiency (RR: 1.07, 95% CI: 1.03–1.11), small for gestational age (RR: 1.36, 95% CI: 1.30–1.43, for <2.3th percentile), hypothermia treatment (RR: 1.60, 95% CI: 1.21–2.14) and neonatal death (RR: 1.96, 95% CI: 1.40–2.74) were higher in the group without measured pHUA and pHUV. Conclusions: The use of UC‐pH measurement has increased markedly in Denmark since universal measurement was recommended in 2009. Missing UC‐pH from one or both vessels was associated with less complicated pregnancies and with small for gestational age, hypothermia treatment and neonatal death. [ABSTRACT FROM AUTHOR]

Introduction: The etiology of lower‐limb neurological deficit after vaginal delivery remains poorly understood. The objective herein was to identify factors associated with this maternal nerve injury after vaginal delivery. Material and methods: A single‐center, case–control (matching 1:4) study. Cases were women with a lower‐limb neurological deficit that appeared immediately after vaginal delivery. Controls were randomly selected women who gave birth vaginally during the same period, without any deficit. Finally, to assess the rates of factors associated with these deficits, we studied them using a randomly selected 5% sample of the population with vaginal deliveries. Results: During the 30‐month study period, 31 cases were identified among 10 333 women who gave birth vaginally (0.3%, 95% CI 0.20–0.43); 124 controls were also included. After logistic regression, the presence of a neurological deficit after delivery was associated with second‐stage labor duration (per hour odds ratio [OR] 3.67, 95% CI 2.09–6.44; OR per standard deviation increase 2.73, 95% CI 1.75–4.25, p < 0.001) and instrumental delivery (OR = 3.24, 95% CI 1.29–8.14, p = 0.012), with no interaction effect (p = 0.56). Extrapolation of these factors to a 5% sample of the overall population of women with vaginal births showed that the rate of these deficits would be very low for women with second‐stage labor lasting up to 90 min without instrumental delivery (0.05%) but increased to 1.52% when these factors were combined (OR 33.1, 95% CI 9.4–116.9). Conclusions: Following vaginal delivery, the onset of a neurological deficit is principally associated with the duration of second‐stage labor and instrumental delivery. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to describe and compare changes in the reproductive pattern of women in their 40s observed over a decade in Scandinavia. Material and Methods: Cross‐sectional study using the total population of women aged 40–49 years between 2008–2018 in Denmark, Norway and Sweden (on average n = 1.5 million). Aggregated data concerning birth and induced abortion rate were collected and analyzed from national health registers. National data on redeemed prescriptions of hormonal contraceptives in the three countries were collected from prescription registers. Births after spontaneous and assisted conceptions were identified by using cross‐linked data on deliveries from the Medical Birth Registers and National Registers of Assisted Reproduction in the three countries. Results: Use of hormonal contraception increased among women aged 40–44 years in Denmark from 24% to 31%, in Sweden from 27% to 30%, and in Norway from 22% to 24%. The levonorgestrel‐releasing intrauterine device was the most frequently used method in all countries. Birth rates among women 40–44 years increased continuously from 9.5 to 12/1000 women in Denmark and from 11.7 to 14.3/1000 in Sweden, but remained stable in Norway at ~11/1000 women. There was a doubling of assisted conceptions in Denmark from 0.71 to 1.71/1000 women, Sweden from 0.43 to 0.81/1000 and Norway from 0.25 to 0.53/1000 women 40–49 years of age. Sweden had the highest induced abortion rate (7.7 to 8.1/1000 women) in women aged 40–49 years during the study period. Conclusions: From 2008 to 2018, birth rates continuously increased among women aged 40–49 years in Denmark and Sweden and births resulting from assisted reproductive technology doubled in all three countries. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the optimal simulation-based team training in obstetric emergencies. We aimed to review how simulation-based team training affects patient outcomes in obstetric emergencies.Material and Methods: Search Strategy: MEDLINE, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were searched up to and including May 15, 2021.Selection Criteria: randomized controlled trials (RCTs) and cohort studies on obstetric teams in high-resource settings comparing the effect of simulation-based obstetric emergency team training with no training on the risk of Apgar scores less than 7 at 5 min, neonatal hypoxic ischemic encephalopathy, severe postpartum hemorrhage, blood transfusion of four or more units, and delay of emergency cesarean section by more than 30 min.Data Collection and Analysis: The included studies were assessed using PRISMA, EPCO, and GRADE.Results: We found 21 studies, four RCTs and 17 cohort studies, evaluating patient outcomes after obstetric team training compared with no training. Annual obstetric emergency team training may reduce brachial plexus injury (six cohort studies: odds ratio [OR] 0.47, 95% CI 0.33-0.68; one RCT: OR 1.30, 95 CI% 0.39-4.33, low certainty evidence) and suggest a positive effect; but it was not significant on Apgar score below 7 at 5 min (three cohort studies: OR 0.77, 95% CI 0.51-1.19; two RCT: OR 0.87, 95% CI 0.72-1.05, moderate certainty evidence). The effect was unclear for hypoxic ischemic encephalopathy, umbilical prolapse, decision to birth interval in emergency cesarean section, and for severe postpartum hemorrhage. Studies with in situ multi-professional simulation-based training demonstrated the best effect.Conclusions: Emerging evidence suggests an effect of obstetric team training on obstetric outcomes, but conflicting results call for controlled trials targeted to identify the optimal methodology for effective team training. [ABSTRACT FROM AUTHOR]

Introduction: Some women keep on recalling intense labor pain experienced at childbirth to a degree that may negatively affect their life during the postpartum period or lead them to request a cesarean section (CS) in the subsequent delivery. This longitudinal study aimed to assess the impact of severe recalled labor pain from the previous birth on the preference for and delivery by an elective CS in the subsequent delivery. Furthermore, we investigated whether co‐occurring maternal demographic, somatic and mental health factors related to the previous and subsequent delivery, explain parts of a potential association. Material and methods: The study sample comprised 1135 parous women from the Akershus Birth Cohort. Severe recalled labor pain was assessed on a numeric rating scale at pregnancy week 17, and at pregnancy week 32, the preference for an elective CS for the subsequent delivery was assessed. Information on actual delivery by elective CS in the subsequent delivery was retrieved from the electronic birth record. Logistic regression analyses were conducted to examine the impact of severe recalled labor pain on elective CS. Results: Severe recalled labor pain at the previous birth was associated with a preference for an elective CS (odds ratio [OR] 3.57, 95% confidence interval [CI] 2.25–5.67) and actual delivery by elective CS (OR 4.71, 95% CI 2.32–9.59). This association remained statistically significant for the preference for an elective CS (adjusted OR [aOR] 2.12, 95% CI 1.24–3.62) but diminished for delivery by elective CS (aOR 2.30, 95% CI 0.99‐5.35) when adjusting for a variety of covariates. Factors related to previous childbirth such as number of years since previous birth, assisted vaginal delivery, anal sphincter lesions, overall birth experience and fear of childbirth were also linked to preference for and delivery by an elective CS. Conclusions: Women with severe recalled labor pain were about twice as likely to prefer an elective CS compared with women without severe recalled pain. For actual delivery, the significant association with severe recalled pain diminished after adjustment for covariates. However, sample size was small and, irrespective of severe recalled labor pain, preference for an elective CS was statistically significantly associated with actual delivery by elective CS. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to compare childbirth experiences and experience of labor pain in primiparous women who had received high‐ vs low‐dose oxytocin for augmentation of delayed labor. Material and methods: A multicenter, parallel, double‐blind randomized controlled trial took place in six Swedish labor wards. Inclusion criteria were healthy primiparous women at term with uncomplicated singleton pregnancies, cephalic fetal presentation, spontaneous onset of labor, confirmed delayed labor progress and ruptured membranes. The randomized controlled trial compared high‐ vs low‐dose oxytocin used for augmentation of a delayed labor progress. The Childbirth Experience Questionnaire version 2 (CEQ2) was sent to the women 1 month after birth. The CEQ2 consists of 22 items in four domains: Own capacity, Perceived safety, Professional support and Participation. In addition, labor pain was reported with a visual analog scale (VAS) 2 hours postpartum and 1 month after birth. The main outcome was the childbirth experience measured with the four domains of the CEQ2. The clinical trial number is NCT01587625. Results: The CEQ2 was sent to 1203 women, and a total of 1008 women (83.8%) answered the questionnaire. The four domains of childbirth experience were scored similarly in the high‐ and low‐dose oxytocin groups of women: Own capacity (P =.36), Perceived safety (P =.44), Professional support (P =.84), Participation (P =.49). VAS scores of labor pain were reported as similar in both oxytocin dosage groups. Labor pain was scored higher 1 month after birth compared with 2 hours postpartum. There was an association between childbirth experiences and mode of birth in both the high‐ and low‐dose oxytocin groups. Conclusions: Different dosage of oxytocin for augmentation of delayed labor did not affect women's childbirth experiences assessed through CEQ2 1 month after birth, or pain assessment 2 hours or 1 month after birth. [ABSTRACT FROM AUTHOR]

Introduction: Intramuscular or intravenous oxytocin is used in out-of-hospital emergency care in Finland to prevent postpartum hemorrhage after unplanned out-of-hospital deliveries. However, the use of oxytocin by emergency medical services is based on in-hospital studies. The aim of this study was to determine whether the use of oxytocin is associated with diminished postpartum hemorrhage after unplanned out-of-hospital deliveries.Material and Methods: We studied patient records covering all unplanned out-of-hospital deliveries in the Helsinki University Hospital area between 1 January 2013 and 31 December 2017 inclusive. Oxytocin was available in ambulances responsible for half of the population of the study area and was not available in ambulances responsible for the other half. The study area corresponded to 25% of all deliveries in Finland. The primary outcome was the estimated total bleeding (mL). Secondary outcomes were (1) the first blood hemoglobin value measured in hospital (g/L), (2) whether blood hemoglobin was measured during the first 24 hours after delivery, (3) the need for red blood cell concentrate, (4) the need for uterotonic or prothrombotic medication in-hospital during the first 24 hours, (5) the need for any postpartum operation during the first 24 hours and (6) composite outcome combining the secondary outcomes 2-5.Results: Of all ambulance responses in the study area, .04% concerned out-of-hospital deliveries. There were 216 analyzed out-of-hospital deliveries. Altogether, 111 of these occurred in the area with oxytocin available in ambulances and 105 in the area without. Oxytocin was administered in 57 of the 111 deliveries (51%) where it was available. No differences in the primary outcome (P = .548 for oxytocin available vs not available and P = .381 for oxytocin used vs not used) or secondary outcomes were detected between those deliveries where oxytocin was available vs not available or between those where it was used vs not used.Conclusions: Out-of-hospital oxytocin was not associated with diminished postpartum hemorrhage in this study setting. Oxytocin does not seem to be an essential drug for all ambulance units. The in-hospital use of oxytocin was not evaluated and thus is not disputed by this study. [ABSTRACT FROM AUTHOR]

Introduction: The objective was to evaluate the quality of life of pregnant women with a full-term birth from the first trimester to the 9th month using the EQ5D-3L questionnaire, comparing physiological, simple pathological, or complex pathological pregnancies.Material and Methods: A prospective cohort of 500 pregnant women over the age of 18 was monitored between 2015 and 2017 at the Toulouse University Hospital (France). The data were collected monthly with an online report. Given that the decrease in quality of life was not linear during pregnancy, unadjusted and adjusted piecewise linear regression models were performed, considering 3 periods of time during pregnancy: 3-4, 4-8, and 8-9 months. The 5 dimensions of the EQ5D-Index and perceived health status were also analyzed.Results: In total, 1847 questionnaires were collected. Between the 4th and 8th months, the quality of life was lower for pathological pregnancies (P < 0.001) than for physiological ones and decreased over time for each type of pregnancy (physiological: -0.08 points per month, P < 0.001; simple pathological: -0.12 points per month, P < 0.001; complex pathological: -0.11 points per month, P < 0.001). Interestingly, the perceived health status was lower at the 9th month than at the 3rd month of pregnancy, for physiological pregnancies (mean difference = -10.5 points, P < 0.001), pathological pregnancies (mean difference = -10.0 points, P < 0.002), and for complex pathological pregnancies (mean difference = -7.8 points, P = 0.058).Conclusions: In our population, the quality of life decreased between the 4th and 8th months, and decreased to a greater degree in a pathological pregnancy. [ABSTRACT FROM AUTHOR]

The term "cryopreservation" refers to the process of cooling cells and tissues and storing them at subzero temperatures in order to stop all biological activity and preserve their viability and physiological competences for future use. Cooling to subzero temperatures is not a physiological condition for human cells; this is probably due to the high content of water in the living matter, whose conversion to ice crystals may be associated with severe and irreversible damage. Among reproductive cells and tissues, metaphase II oocytes are notably vulnerable to cryopreservation, mainly because of their large size, low surface area to volume ratio, relatively high water content and presence of the meiotic spindle. As human biological systems lack efficient internal defense mechanisms against chilling injuries, it is of the utmost importance to supply adequate external support, in terms of cryoprotectant additives, appropriate cooling/warming rates, and suitable long-term storage. Over the years, scientists have proposed different cryopreservation strategies in the effort to achieve an optimized recipe ensuring cell survival and, at the same time, maintenance of the physiological functions and abilities necessary to continue life. However, despite the first success obtained in the 1980s with frozen oocytes, it was not until recently that notable improvements in the cryopreservation technique, thanks to the advent of vitrification, allowed a breakthrough of this fine procedure. [ABSTRACT FROM AUTHOR]

Introduction: The literature describes advantages for mothers giving birth in water, but waterbirth is controversial in Sweden and has not been offered at hospitals until recently. This study aimed to describe and compare the characteristics and outcome of waterbirths with those of spontaneous vaginal births at the same clinics.Material and Methods: A retrospective cohort study was conducted on all waterbirths at two maternity units in Sweden from March 2014 to November 2015 (n = 306), and a consecutively selected comparison group of 306 women having conventional spontaneous vaginal births. Logistic regression was used to analyze the primary outcome; second-degree perineal tears.Results: Women giving birth in water had a lower risk of second-degree perineal tears [adjusted odds ratio (aOR) 0.6, 95% confidence interval (CI) 0.4-0.9]). Their labor was shorter (6 h 3 min vs. 7 h 52 min) and there were significantly fewer interventions than in the comparison group; amniotomy (13.7 vs. 35.3%), internal cardiotocography (11.1 vs. 56.8%), and augmentation with oxytocin (5.2 vs. 31.3%). There were no differences in Apgar scores or admissions to neonatal intensive care unit. The experience of childbirth, measured with a numeric rating scale, was higher in the waterbirth group indicating a more positive birth experience. Three newborns born in water had an umbilical cord avulsion.Conclusions: In this low-risk population, waterbirth is associated with positive effects on perineal tears, the frequency of interventions, the duration of labor and women's birth experience. Midwives handling waterbirth should be aware of the risk of umbilical cord avulsion. [ABSTRACT FROM AUTHOR]

Introduction: The influence of levator-ani muscles on second-stage labor is poorly understood. The ability of these muscles to stretch without damage may affect birth outcomes, but little is known about material properties, effects of pregnancy and/or ethnicity on levator-ani stiffness. There are strong associations between muscle damage and subsequent pelvic floor disorders. This study aimed to quantify levator-ani muscle stiffness during the third trimester of pregnancy and postpartum in European and Polynesian women. Associations between stiffness, obstetric variables, and the risk of intrapartum levator-ani injury (avulsion) were investigated.Material and Methods: This was a prospective observational pilot study. A total of 167 (106 European and 61 Polynesian) nulliparous women were recruited antenatally; 129 returned postnatally. Participants were assessed between 36 and 38 weeks' gestation and three to five months postpartum. Assessments included pelvic floor ultrasound, elastometry testing, and validated questionnaires on pelvic floor function. Logistic regression, Student t-, Chi-square and Mann-Whitney tests were used as appropriate.Results: There are significant differences between antenatal and postnatal muscle stiffness measurements (p < 0.01). Stiffness was significantly higher in the European cohort (p = 0.03). There were more avulsion injuries in European (20%) than in Polynesian (9%) women. There were no significant differences in antenatal stiffness between women with and without avulsion, but change in stiffness (antenatal to postnatal) was significantly less in the avulsion group. There were no associations between stiffness, and other obstetric variables, epidural anesthesia seemed protective (p = 0.03).Conclusions: Quantification of levator-ani muscle stiffness is feasible. Muscle stiffness is significantly different before and after birth. [ABSTRACT FROM AUTHOR]

The author comments on the uterus transplantation project (UTx) in Sweden. Topics discussed include the developments and improvements in the country's reproductive medicine, insights on ways on how the UTx was initiated, and the author's experience in taking part in the UTx project during his genecologic-oncology surgery fellowship in Adelaide, Australia.

Cesarean section rates have become a political issue, attracting the attention of governments, health bureaucrats and professional organizations. In some instances this has led to a renewed interest in forceps delivery, even Kielland's rotational forceps. It is suggested that calls for a greater use of forceps, especially rotational forceps, are ill-advised and commonly based on ignorance of recent urogynecological and imaging literature. Forceps use is associated with a much higher likelihood of major maternal trauma, especially to the anal sphincter and levator ani muscles, which may result in substantial future morbidity. Hence, its use should be avoided whenever possible. This is particularly obvious for rotational forceps. [ABSTRACT FROM AUTHOR]

Objective To explore the views of a multidisciplinary group of experts and achieve consensus on the importance of perineal support in preventing obstetric anal sphincter injuries ( OASIS). Design A three-generational Delphi survey. Setting A UK-wide survey of experts. Population A panel of 20 members consisting of obstetricians, midwives and urogynecologists recommended by UK professional bodies. Methods A 58-item web-based questionnaire was sent to all participants who were asked to anonymously rate the importance of each item on a six-point Likert scale. They were asked to rate their level of agreement on statements related to hands-on/hands-poised techniques, the association of hands-poised/hands-off approach with OASIS, the need to implement perineal support and the need to improve the evidence to support it. Systematic feedback of responses from previous rounds was provided to participants. Main outcome measures To achieve consensus on key areas related to perineal support. Results The response rate was 100% in all three iterations. There was consensus that current UK practice regarding perineal protection was not based on robust evidence. The respondents agreed that hands-poised/hands-off and OASIS are causally related and that hands-poised was misinterpreted by clinicians as hands-off. Although 90% of experts agreed that some form of randomized trial was required and that all would be prepared to take part, there was also consensus (75%) that in the meantime, hands-on should be the recommended technique. Conclusions Our results highlight the current lack of evidence to support policies of perineal support at time of birth and the need to address this controversial issue. [ABSTRACT FROM AUTHOR]

Objective To assess the reproductive long-term prognosis of women with and without endometriosis, to explore changes over time, and to quantify the contribution of artificial reproductive techniques. Design Cohort study. Setting Denmark 1977-2009. Sample Data retrieved from four national registries. Among 15-49-year-old women during the period 1977-82, 24 667 were diagnosed with endometriosis and 98 668 (1:4) women without endometriosis were age-matched. Methods To assess long-term reproductive prognosis, all pregnancy outcomes were identified among the women with and without endometriosis until the end of 2009. To explore changes over time, the endometriosis cohorts were followed for 15 years from the years 1980, 1986, 1992 and 1998, with the corresponding control cohorts. All pregnancy outcomes were categorized into naturally or artificially conceived pregnancies. Main outcome measures Births, miscarriages, induced abortions, ectopic pregnancies and hydatidiform moles. Results Compared with women without endometriosis, women with endometriosis had a lowered relative risk for childbirth of 0.93 (95% confidence interval 0.92-0.95), for miscarriages the relative risk was 1.2 (95% confidence interval 1.2-1.3), ectopic pregnancies were almost twice as many (relative risk 1.9, 95% confidence interval 1.8-2.1), while frequencies of induced abortions were equivalent. The chances for childbirth increased over time from 0.82 to 0.92 ( p < 0.001) with successive cohorts, but this was restricted to pregnancies from assisted reproduction. Conclusion Women with endometriosis have slightly fewer children, but this lessened over time due to artificially conceived pregnancies. The risk for miscarriages and ectopic pregnancies was increased compared with women without the disease. [ABSTRACT FROM AUTHOR]

Objective To compare obstetric morbidity of midwife-performed instrumental vaginal deliveries with those performed by doctors. Design Retrospective cohort study. Setting University Hospital, UK. Population Women undergoing an instrumental vaginal delivery of a singleton infant outside of the operating theater in Aberdeen Maternity Hospital, between June 2005 and June 2010. Methods Prospectively entered data were obtained from the hospital data management system. Obstetric outcomes of deliveries by midwives were compared with those performed by any doctor and, in a secondary analysis, with those by junior doctors (fewer than two years at 'registrar' level). Sociodemographic characteristics and clinical outcomes were compared using the chi-squared test, Mann-Whitney U-test and independent sample t-test. Main outcome measures Third- or fourth-degree tears. Results Among 2540 women identified, 330 (13%) were delivered by midwives. Maternal and clinical characteristics were comparable in each group. Midwives were more likely to use ventouse as their instrument of choice. Women delivered by midwives were less likely to suffer a third- or fourth-degree tears than those delivered by doctors and junior doctors. This difference did not reach statistical significance once adjusted for instrument used: odds ratio 0.6 (95% confidence interval: 0.3-1.2) and odds ratio 0.6 (95% confidence interval: 0.3-1.1), respectively. Conclusions Instrumental vaginal deliveries performed by trained midwives are associated with equivalent maternal morbidity to those performed by doctors once adjusted for midwives' preference for the ventouse. This study highlights the potential contribution of an advanced role for midwives in the labor ward. [ABSTRACT FROM AUTHOR]

Potential problems with breast implants have been widely discussed, but few data exist on the childbearing and offspring of women with implants. The purpose of this study was to investigate the occurrence and conditions of pregnancies of women who have had cosmetic breast implantation (exposed women), and the health of their newborns.Women who had breast implants for cosmetic reasons in the period 1967–1999 (n = 2236) were identified from hospital surgical records. The births of the exposed women were identified through record linkage to the Population Register. The perinatal health of the infants was studied by the data in the Medical Birth Register in 1987–1999. For each birth to an exposed woman, 20 control mothers who gave birth in the same year were chosen randomly from the Medical Birth Register. Differences in mothers' background characteristics were adjusted by logistic regression.The women had received their first cosmetic breast implants at young ages (mean 31 years). By year 2000, 26% of the exposed women had one or more children. Half of these women had not had a liveborn child before getting implants. Of the 1661 exposed women who had not (yet) had children, 32% were less than 35 years of age at the end of follow-up. The women had children at a mean of 4.7 years after the implants. Some of the perinatal health indicators suggested poorer health and others better health for infants of exposed women, but only transfers to other hospitals and lower birthweight among infants of exposed multipara were statistically significant.The study shows that pregnancy and infant health are relevant considerations with regard to breast implants; further studies on implants are needed. [ABSTRACT FROM AUTHOR]

Objective. To investigate the views and experiences of Swedish women regarding antenatal, delivery and postpartum care. Study design. A random sample of women from the birth cohorts 1955, 1959, 1963, 1967 and 1971 resident in the city of Göteborg (n=2880) was invited by letter to complete a questionnaire regarding antenatal, delivery and postpartum care. Results. The overall response rate was 73% and 1130 (54%) of the 2109 responders had given birth to at least one child. Eighty-one percent of parous women answered that checking blood and urine samples, fetal heart rate, and the measurement of fundal height were the most important procedures in antenatal care. A majority had a positive attitude towards the use of electronic fetal heart rate monitoring (parous 85%; nulliparous 84%). Sixty percent of parous women were aware that ultrasound examination was voluntary and a majority (90%) had a positive attitude towards ultrasound scanning. Forty-three percent of parous women wanted antenatal clinics to be open until 8.00 p.m. A minority of both parous (4%) and nulliparous (4%) women were interested in home delivery. There were more parous (33%) than nulliparous (12%) women who expressed no anxiety at all about the next delivery. Seventy-nine percent of the parous women reported that they would like to have a planned visit with a delivery ward midwife before the next delivery. About 80% reported that they would feel very safe if their partners were present at the delivery (nulliparous 79%; parous 84%). Eighty-five percent preferred a single room or a room together with only one other woman in the postnatal ward. Seventy-two percent of the women wanted to stay 72 hours or less in the postpartum ward and 24% thought there had been too many visitors during the postnatal period. Over 80% were very positive towards breast-feeding. Approximately 80% of all women considered regular contractions up to twelve hours to be acceptable before delivery. Conclusions. This study has provided some useful information about women’s opinion regarding antenatal, delivery and postpartum care which may be taken into account when instigating changes in the maternity care system. [ABSTRACT FROM AUTHOR]

Introduction: Optimal mode of delivery in breech presentation has been widely examined and debated. The aim of this study was to compare perinatal and maternal outcomes with either a policy of planned vaginal delivery or planned cesarean section in breech presentation.Material and Methods: This was a registry-based retrospective cohort study from Turku University Hospital, Finland with 1418 singleton breech deliveries at term over a period of 11 years (January 2002 to December 2012). Data were collected from the mothers' medical records.Results: Apgar scores at 5 min as well as umbilical artery pH values were significantly lower in the planned vaginal breech delivery group compared with the planned cesarean section group, suggesting a short-lasting delayed recovery after birth. There were more puerperal infections in planned cesarean section group compared with the planned vaginal delivery group.Conclusions: The results confirm that planned vaginal breech delivery results in short-lasting delayed recovery after birth compared with planned cesarean section. [ABSTRACT FROM AUTHOR]

Background. Increasing cesarean section (CS) rates over the last 3 decades may, in part, be explained by improved obstetric procedures, but socio-economic factors also play a major role. Much attention has been given to professionals' attitudes to operative delivery, and several studies have been performed to clarify the issue. The present study explored CS rates among Norwegian doctors and midwives, compared to other professionals with an education of 17-18 years (doctors) and 15-16 years (midwives). Methods. Data on mode of delivery notified to the Medical Birth Registry of Norway for 1969-1998 (n=1,733,665) were linked with data on formal education from Statistics Norway. CS rates and crude and adjusted odds ratios (ORs) were calculated for the observation period. Results. Female doctors and midwives had higher CS rates; the crude ORs were 1.18 (95% CI: 1.12-1.28) for doctors, and 1.35 (95% CI: 1.21-1.49) for midwives. Adjusted for age and birth order, the ORs were 1.22 (95% CI: 1.12-1.33) for doctors and 1.14 (95% CI: 1.03-1.27) for midwives. Conclusion. From 1969 to 1998, Norwegian female doctors and midwives had higher CS rates than other professionals with an education of comparable duration. [ABSTRACT FROM AUTHOR]