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In 2014, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) published an Obstetric Care Consensus for safe prevention of primary cesarean delivery. We aimed to assess whether these guidelines decreased the primary CD rate during the second stage of labor, in our department.A retrospective cohort study of all women reaching the second stage of labor, at term, in a single university-affiliated medical center between2010 and 2017.We compared maternal and neonatal outcomes over three year's periods:-pre-guidelines (2010-2013) vs. 2nd period - post-guidelines (2014-2017).CD rate at 2ndstage of labor.The study included 11,464 women. The CD rate in the 2nd stage of labor has increased significantly from 4% to 5.9% in the post-guidelines period (OR 1.48, 95% CI 1.16-1.89,The implementation of the new ACOG and SMFM guidelines was not associated with a change in the CD rate performed at the 2nd stage of labor in the whole study population. However, there was a rise in the CD rate performed at the 2nd stage in nulliparous women. Furthermore, there was an increase in operative deliveries in the whole study population, especially in multiparous women, without an apparent increase in other immediate adverse neonatal or maternal outcomes.

Background: The macrosomic fetus predisposes a variety of adverse maternal and perinatal outcomes. Although older studies have shown no benefit in inducing women of suspected macrosomic fetuses, mo...

The optimal gestational age for a planned high-order cesarean delivery (CD) reflects the balance between the risk of neonatal morbidity and the risk of unscheduled cesarean delivery prior to the scheduled date.A retrospective cohort study of 656 women with ≥2 previous CDs were divided in two groups of women based on the gestational age at which the CD was scheduled: "38 group" and "39 group". Medical records were reviewed for demographic, medical and obstetrical history, and for adverse maternal and neonatal outcomes.The rate of unscheduled CDs was significantly higher among the 39 group (23.2% vs. 12.7%). There were no significant differences in the rate of maternal or neonatal composite adverse outcome between the two groups. The rate of neonatal respiratory morbidity, however, was higher among the 38 group (5.8% vs. 2.1%).Compared with planned CD, unscheduled CD was associated with a similar rate of maternal composite adverse outcome, but with increased rate of neonatal composite adverse outcome (23.3% vs. 8%, respectively). In a multivariable logistic regression analysis we found that this latter association was due to the earlier actual gestational age at delivery in cases of unscheduled versus planned CD.Planned CD at 39 weeks, rather than at 38 weeks, is associated with more unscheduled CDs, a similar rate of maternal and neonatal composite morbidity, but a decreased rate of neonatal respiratory morbidity.

Our objective was to assess the reported reasons for episiotomy performance in Israel and to review the relevant professional literature. Using anonymous questionnaires, a survey was conducted among obstetricians and midwives in four northern Israel hospitals, and the accoucheurs were asked to score their agreement with 13 proposed indications for episiotomy. Overall, 84 doctors and 32 midwives completed the questionnaires. 86.1% of the responders reported performing episiotomy in all or most cases of shoulder dystocia, and more than half reported performing it in most cases of vacuum deliveries, fetal macrosomia and advanced perineal tear in previous delivery. Subjective assessment of perineal characteristics constituted a justified reason for episiotomy for 15.8-43.9% of the accoucheurs. In conclusion, there is a wide variation in reported reasons for episiotomy between the obstetricians, and many of these indications are not congruent with international practice guidelines. Uniform protocols and educational programmes are needed to guide episiotomy practice.