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Aims: To assess clinical outcomes and complications in women with ≥1 prior caesarean delivery (CS) during mid‐pregnancy medical abortion with misoprostol following mifepristone priming. Materials and Methods: Retrospective analysis of abortions at 13–28 weeks gestation using sequential mifepristone and misoprostol at a single centre from 1/2008–12/2018. Procedural outcomes were compared between cases with no prior CS, one prior and ≥2 prior CS. Results: There were 1399 consecutive women who underwent a medical abortion, with 304 (21.7%) having ≥1 prior lower segment CS (241 one, 49 two, 12 three, one four) and one a prior classical CS. Median gestation was 19 weeks (interquartile range (IQR) 17–21) among nulliparas, multiparas with no prior CS and multiparas with prior CS, P = 0.505. Compared with nulliparas (median procedural duration 10.8 h, IQR 7.5–16.5; adjusted hazards ratio (aHR) = 1.20 95%CI 1.04–1.40, P = 0.015), multiparas with prior CS had a shorter procedural duration (9.5 h, IQR 6.5–13.5) while multiparas with no CS had the shortest duration (7.0 h, IQR 5.0–9.8; aHR = 2.28 95%CI 2.01–2.58, P < 0.001). Complications were more frequent with prior CS: estimated blood loss (medians: 100 cc no CS vs 150 cc ≥1 CS, P = 0.002), blood loss >1000 cc (3.6% no CS vs 7.2% ≥1 CS; odds ratio (OR) = 2.11 95%CI 1.23–3.62, P = 0.007) and placental retention (17.3% no CS vs 25.3% ≥1 CS; adjusted OR = 1.44 95%CI 1.05–1.99, P = 0.024). Uterine rupture occurred in 4/304 women with ≥1 prior CS (1.3%). Conclusions: Mifepristone‐misoprostol abortion in women with prior CS is generally safe but associated with an increased risk of procedural complications. Lowering of the misoprostol dosage with prior CS may reduce uterine rupture, although this hypothesis requires ongoing research. [ABSTRACT FROM AUTHOR]

Background: Intrapartum fetal blood sampling (FBS) is a fetal well‐being diagnostic test for cardiotocogram abnormalities. Aim: The aim of this study was to determine whether women who had their first FBS at <4 cm cervical dilation had an increased risk of operative delivery (caesarean section, instrumental delivery) compared to those women who had their first FBS ≥ 4 cm dilation. Materials and methods: Retrospective cohort study involving labouring women who underwent FBS in a tertiary centre between 2015 and 2017. Women who had their first FBS at <4 cm dilation were compared to those who had their first FBS at ≥4 cm. The primary outcome was operative delivery (caesarean, instrumental delivery); secondary outcomes were neonatal complications. Univariate logistic regression was used to assess the association between degree of cervical dilation at first FBS and study outcomes. Results: Among 591 women, 39 (6.6%) had their first FBS at <4 cm cervical dilation. Women in the ≥4 cm group were less likely to have a total of ≥2 FBS (P = 0.003). There was no difference in the primary outcome between the two groups. Women who had the first FBS at <4 cm dilation were twice as likely to have a caesarean section delivery (odds ratio 2.06, 95% confidence interval 1.06–3.98), although 41% had a vaginal birth (instrumental and spontaneous). There were no differences in rates of resuscitation or admission to nursery between groups. Conclusion: Women who had their first FBS < 4cm cervical dilation were twice as likely to have a caesarean section compared to women who had their first FBS ≥ 4 cm. However, 41% had a vaginal birth, and there were no differences in fetal outcomes. [ABSTRACT FROM AUTHOR]

Background: Amniotomy is a commonly used, inexpensive method of labour induction; however, the optimal timing of amniotomy during labour induction is debated. Aims: To investigate whether artificial rupture of membranes <4 cm dilation is associated with caesarean, severe maternal and neonatal morbidity, and labour induction duration. Materials and Methods: Retrospective cohort study of 228 438 deliveries at 19 US hospitals. Women with a viable, singleton gestation undergoing induction ≥37 weeks with cervical dilation <4 cm were included. Women were excluded if membranes spontaneously ruptured <4 cm. Women were compared by early amniotomy (<4 cm dilation) versus not early. The primary outcome was caesarean. Secondary outcomes included severe maternal and neonatal morbidity, and labour duration. Logistic and Cox proportional hazard regression estimated the association between early amniotomy and study outcomes. Results: Of 15 525 eligible women, 10 421 (67%) had early amniotomy. Early amniotomy was associated with higher adjusted odds of caesarean and severe maternal morbidity, but not neonatal morbidity. After accounting for interaction, early amniotomy was associated with increasingly higher odds of caesarean as body mass index increased. Early amniotomy was associated with lower odds of severe maternal morbidity among multiparas with mechanical ripening. Median labour induction was 2.5 h shorter with early amniotomy, significant in hazard regression. Conclusions: Early amniotomy was associated with increased odds of caesarean among obese women. The association between early amniotomy and severe maternal morbidity varied by maternal characteristics, but early amniotomy was not associated with neonatal morbidity. Early amniotomy in labour induction may be advantageous in certain populations, particularly non‐obese women requiring mechanical ripening. [ABSTRACT FROM AUTHOR]

Background: Maternal smoking is associated with a number of adverse outcomes with a dose‐dependent increase in risk. The aim of this study was to evaluate the obstetric and perinatal outcomes in women who smoked during pregnancy. Methods: This was a retrospective cohort study of women who smoked during pregnancy and birthed at a major perinatal centre in Australia between January 2000 and April 2017. The study cohort was compared to a cohort of women who did not smoke in pregnancy. Smoking status was ascertained on history and included all types of smoking. Demographic characteristics and obstetric, intrapartum and perinatal outcomes were compared between the two groups. Results: The study cohort included 20 477 (14.6%) women who smoked during pregnancy and 119 396 controls. Women who smoked tended to be younger, of higher body mass index (BMI), Caucasian and Indigenous ethnicity. Smokers were less likely to be nulliparous, but more likely to be hypertensive and have a lower socioeconomic status compared to non‐smokers. Women who smoked were more likely to have a caesarean section for non‐reassuring fetal status (adjusted odds ratio (aOR) 1.16, 95%CI 1.07–1.26, P < 0.001). The infants of women who smoked were more likely to be born preterm, have a lower median birth weight and birth weights <10th (aOR 1.76, 95%CI 1.66–1.86, P < 0.001) and <5th centile (aOR 2.00, 95%CI 1.86–2.16, P < 0.001). Neonatal outcomes in the smoking cohort were worse with an increase in neonatal intensive care unit admission (aOR 1.34, 95%CI 1.27–1.43, P < 0.001), severe acidosis (aOR 1.41, 95%CI 1.27–1.43, P < 0.001) and a composite of severe neonatal outcomes (18.0% vs 12.0%, aOR 1.35, 95%CI 1.28–1.43, P < 0.001). Conclusion: Women who smoke in pregnancy have worse obstetric and perinatal outcomes compared to controls and should be managed as high risk. [ABSTRACT FROM AUTHOR]