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Background: Relaparotomy following a cesarean delivery (CD) is an infrequent complication, with inconsistency regarding risk factors and indications for its occurrence. We therefore aimed to determine risk factors and indications for a relaparotomy following a CD at a single large tertiary center., Methods: A retrospective case-control single-center study (2013-2023). We identified all women who had a relaparotomy up to six weeks following a CD (study group). Maternal characteristics, obstetrical and surgical data were compared to a control group in a 1:2 ratio. Controls were women with a CD before and immediately after each case in the study group, who did not undergo a relaparotomy. Included were CDs occurring after 24 gestational weeks. CD performed at different centers and indications for repeat surgery unrelated to the primary surgery (e.g., appendicitis) were excluded. Logistic regression was used to adjust for potential confounders., Results: During the study period, 131,268 women delivered at our institution. Of them, 28,280 (21.5%) had a CD, and 130 patients (0.46%) underwent a relaparotomy. Relaparotomies following a CD occurred during the first 24 h, the first week, and beyond the first week, in 59.2%, 33.1%, and 7.7% of cases, respectively. In the multivariable logistic regression analysis, relaparotomy was significantly associated with Mullerian anomalies (aOR 3.33, 95%CI 1.08-10.24, p = 0.036); uterine fibroids (aOR 3.17, 95%CI 1.11-9.05,p = 0.031); multiple pregnancy (aOR 4.1, 95%CI 1.43-11.79,p = 0.009); hypertensive disorders of pregnancy (aOR 3.46, 95%CI 1.29-9.3,p = 0.014); CD during the second stage of labor (aOR 2.54, 95%CI 1.15-5.88, p = 0.029); complications during CD (aOR 1.62, 95%CI 1.09-3.21,p = 0.045); and excessive bleeding during CD or implementation of bleeding control measures (use of tranexamic acid, a hemostatic agent, or a surgical drain) (aOR 2.23, 95%CI 1.29-4.12,p = 0.012). Indications for relaparotomy differed depending on the time elapsed from the CD, with suspected intra-abdominal bleeding (36.1%) emerging as the primary indication within the initial 24 h., Conclusion: We detected several pregnancy, intrapartum, and intra-operative risk factors for the need for relaparotomy following a CD. Practitioners may utilize these findings to proactively identify women at risk, thereby potentially reducing their associated morbidity., (© 2024. The Author(s).)

Objective: We aimed to investigate the association of advanced maternal age with intrapartum cesarean delivery and to assess its risk factors and perinatal outcomes., Study Design: A retrospective cohort study of all women with singleton pregnancies who attempted a trial of labor (≥24 + 0 weeks of gestation) in a single center (2011-2017). The study population was stratified by parity (nulliparous or multiparous) and further sub-categorized into three cohorts: (1) women <35 years at birth (reference group), (2) women aged 35-40 years, and (3) women >40 years. Labor and delivery characteristics and neonatal outcomes were compared., Results: Overall, 55,089 women were included: 39, 192 (71.1%) were under 35 years old, 15,90712,892 (28.923.4%) were 35-40 y and 3,015 (5.5%) were >40 y. For nulliparas, the rate of intrapartum Cesarean deliveries increased with maternal age and approached 25.3% in those >40 y as compared to 8.9% for those <35 y. The positive association between Cesarean section rates and maternal age extends beyond nulliparas and is also seen in multiparas, although to a smaller degree. After adjusting for confounders, maternal age was significantly and independently associated with intrapartum cesarean delivery in a dose-dependent manner in nulliparous women, [adjusted Odd Ratio (aOR) 1.56 (95% Confidence Interval (CI) 1.39-1.76) and 2.53 (2.07-3.09)] among women aged 35-40 y and >40 y, respectively. Maternal age was not significantly associated with adverse neonatal outcome., Conclusion: Advanced maternal age is an independent risk factor for intrapartum Cesarean delivery. Yet, the majority of older gravidae who attempt a trial of labor, even if nulliparous, deliver vaginally without an increase in adverse neonatal outcome.

Introduction: A rise in the rate of cesarean delivery (CD) has been found to be associated with a higher length of hospital stay, making it a public health concern. We aimed to evaluate risk factors for prolonged hospitalization following CD., Methods: A retrospective cohort study, in a single tertiary medical center, was conducted (2011-2019). Cesarean deliveries were categorized into three groups according to the postpartum length of stay (a) up to 3 days (the routine post cesarean hospital stay in our center, reference group) (b) 4-9 days, and (c) 10 days or above (prolonged hospitalization). Risk factors were examined using univariate analysis as well as multivariate logistic regression. A specific risk prediction score was developed to predict the need for prolonged hospitalization and ROC curve was assessed utilizing the performance of our model., Results: Overall, 87,424 deliveries occurred during the study period. Of them, 19,732 (22.5%) were cesarean deliveries. Hospitalization period was distributed as follows: 10,971 (55.6%) women were hospitalized for up to 3 days, 7,576 (38.4%) stayed for 4-9 days and 1,185 (6%) had a prolonged hospitalization period (≥10 days). Using multivariate analysis, multiple pregnancy (OR = 1.29, 95%CI 1.05-1.58), preterm delivery < 37 weeks (OR = 8.32, 95%CI 6.7-10.2), Apgar score < 7 (OR = 1.41, 95%CI 1.11-1.78) and non-elective CD (OR = 1.44, 95%CI 1.15-1.8) were identified as independent risk factors for prolonged hospitalization. Antenatal thrombocytopenia (PLT < 100 K) was found to be a protective factor (OR = 0.51, 95%CI 0.28-0.92). Our score model included antenatal risk factors and was found to be predicting the outcome, with an AUC of 0.845 (95%CI 0.83-0.86, p-value < 0.001)., Conclusion: A prediction score model for prolonged hospitalization after CD may be beneficial for risk assessment and post-partum management., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To determine maternal and neonatal complications associated with an intrapartum cesarean delivery (CD) with and without a history of a previous CD., Methods: A retrospective cohort study of all women who underwent an unplanned intrapartum CD following a trial of labor in a university-affiliated tertiary hospital, between 2009 and 2016. Perinatal outcomes of women with and without a history of a previous CD were compared. Composite adverse maternal outcome included one or more of the following: postpartum hemorrhage, need for blood transfusion, or cesarean hysterectomy. Composite adverse neonatal outcome included one or more of the following: 5-min Apgar score <7, neonatal seizure, need for intubation, meconium-aspiration-syndrome, or hypoxic-ischemic encephalopathy., Results: During the study period, 42 275 women attempted vaginal delivery. Of them, 2229 (5.3%) women underwent an unplanned intrapartum CD and met inclusion criteria: 337 (15.1%) with (study group) and 1892 (84.9%) without (control group) a previous CD. Women without a previous CD were younger and were characterized by higher rates of nulliparity and induction of labor compared with women with a previous CD. Other demographic and obstetrical characteristics did not differ between the groups. Indications for CD were also comparable between the groups. Uterine rupture complicated 2.3% of trials of labor among women with a previous CD. Adverse maternal (2.7% vs 2.9%, P = 1.0) and neonatal (3.9% vs 4.3%, P = 0.88) outcomes were comparable between the groups. After adjusting for potential confounders, a previous CD was not associated independently with adverse maternal outcomes (adjusted odds ratio [aOR] 0.86, 95% confidence interval [CI] 0.31-2.38; P = 0.78) or neonatal outcomes (aOR 0.79, 95% CI 0.36-1.75; P = 0.56)., Conclusion: Our study provides evidence that perinatal outcomes of intrapartum CD delivery among women with a previous CD do not differ from those in women without a previous CD. These findings might improve the consultation and informed decision-making process for couples considering a trial of labor after CD., (© 2021 International Federation of Gynecology and Obstetrics.)

Purpose: Thrombocytopenia is the second most common hematological disorder in pregnancy and complicates approximately 10% of all pregnancies. The data regarding the association of mild thrombocytopenia in women undergoing cesarean section and risk of bleeding or bleeding-related complications are scarce. Thus, the aim of the current study was to assess the association of mild thrombocytopenia with hemorrhage-related morbidities, among patients undergoing elective cesarean section., Methods: We performed a retrospective cohort study, in a single tertiary university-affiliated medical center, between 1 January 2012 and 31 May 2019. Medical charts of women who underwent elective cesarean section at term (37 +0/7 -41 +  6/7  weeks of gestations) were retrieved and analyzed. We compared women with mild thrombocytopenia (platelet count of 100-149 × 10 3 /μL) to women with normal platelet count (150-450 × 10 3 /μL). The primary outcome was the need for red blood cell transfusion during the index admission. A secondary outcome was severe bleeding not requiring blood transfusion defined as postpartum hemoglobin decline of  ≥ 3 g/dL as compared to the prepartum levels., Results: During the study period, 1577 women were included in the final analysis, of them 396 (25.11%) had mild thrombocytopenia prior to delivery. As compared to the control group, women with mild thrombocytopenia had higher rates of blood transfusion (3.79 vs. 1.52%, p = 0.01), and had a significant decline in hemoglobin levels. In a multivariable logistic regression model, mild thrombocytopenia was independently associated with blood transfusion with adjusted OR of 2.34 (95% CI 1.10-4.96, p = 0.03)., Conclusion: Preoperative mild thrombocytopenia is associated with an increased risk of blood loss and blood transfusion in women undergoing elective CS. More studies are required to assess those observations in context of urgent cesarean sections and whether any preventive measures can reduce the risk for bleeding., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Purpose: To compare pregnancy outcomes in grand-multiparous (GMP) women with and without one previous cesarean delivery (CD), and to evaluate the number of previous successful vaginal deliveries after a CD needed to reduce the complication rate of trials of labor after a previous CD., Methods: This is a retrospective cohort study of women with singleton pregnancy at term who had a trial of vaginal delivery between 2007 and 2014 at a tertiary medical center. We compared pregnancy outcomes in GMP women with and without one previous cesarean delivery. The primary outcome was mode of delivery and secondary outcomes were uterine rupture and composite maternal and neonatal morbidity. For the secondary objective, we compared pregnancy outcomes in women in TOLAC, stratified by the number of previous vaginal deliveries., Results: Overall, 2815 GMP women met the study criteria, of which 310 (11%) had a previous cesarean delivery. The rate of a successful vaginal deliveries (VBAC) was similar, regardless of the presence of a previous cesarean delivery. No other differences in outcomes were found between the groups. In a secondary analysis, it was found that the presence of a single previous VBAC (compared to no previous VBACs) increased the odds of achieving a vaginal delivery in the next trial of labor after cesarean delivery (TOLAC) (aOR 5.66; 95% CI 3.73-8.60), and decreased the risk of maternal or neonatal adverse outcomes (aOR 0.62; 95% CI 0.39-0.97, and aOR 0.49; 95% CI 0.25-0.97, respectively). Multiple prior VBACs (as compared to a single prior VBAC) did not increase the odds of achieving another VBAC., Conclusion: Grand-multiparous women with and without previous uterine scar have comparable pregnancy outcomes. Additionally, after the first VBAC, additional successful VBACs do not improve the success rate in the next TOLAC., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Purpose: To evaluate whether induction of labor (IOL), as compared with expectant management, in gestational diabetes mellitus (GDM) mothers at term (between 37 0/7 and 40 6/7 ), decreases caesarean section (CS) rate and the rate of adverse composite neonatal outcomes., Methods: A retrospective cohort study, of all women with GDM and a singleton gestation who delivered at term in a single, tertiary, university-affiliated medical center (2007-2014). We compared outcomes of women who underwent IOL at each week of gestation between 37 0/7 and 40 6/7  weeks with women who were managed expectantly. The primary outcome was CS rate., Results: Overall, 2472 GDM patients included in the study, of which 880 women had IOL. CS rate was not found to be significantly different between the groups at any gestational age. IOL at 37 weeks was associated with adverse composite neonatal outcome (aOR 2.2, 95% CI 1.4-3.6) and NICU admission (aOR 2.5, 95% CI 1.4-4.4). At 38 weeks, with NICU admission (aOR 2.0, 95% CI 1.4-2.9), and at 39 weeks with fracture of the clavicle. In a sub-analysis of nulliparous women, IOL at 37 weeks had higher odds of NICU admission and adverse composite neonatal outcomes, at 38 weeks with CS and at 39 weeks with fracture of the clavicle., Conclusions: IOL in GDM mothers at term does not reduce CS rate and may be associated with increased CS rate among nulliparous women at 38 weeks. It is also associated with increased risk for adverse composite neonatal outcome or NICU admission when done prior to 39 0/7  weeks.

Objective: We aimed to evaluate perinatal outcomes of advanced maternal age (AMA) primiparous women seeking scheduled cesarean delivery (CD) versus a trial of labor (TOL)., Materials and Methods: This was a retrospective cohort study of primiparous women ≥40 years of age carrying a single fetus, who delivered at a tertiary, university-affiliated medical center (2007-2014). We compared perinatal outcomes of women who chose a scheduled CD with those who chose TOL. Subsequently, we compared women who had successful TOL (sTOL) with those who had a failed TOL (fTOL)., Results: Out of 62 102 deliveries during the study period, inclusion criteria were met by 374 women. Of them, 83 (22.2%) women had a scheduled CD, and 291 (77.8%) had TOL. Of the TOL group, 118 women (40.5%) had fTOL and 173 (59.5%) had sTOL. Women in the fTOL had higher rates of 1-min Apgar score <7, neonatal asphyxia and adverse neonatal composite outcome compared with women in the sTOL group (p < .05). After adjusting for potential confounders, compared with sTOL, fTOL was not associated with adverse neonatal composite outcome. Compared with scheduled CD, fTOL was associated with an increased risk for adverse neonatal composite outcome (aOR 2.65, 95% CI 1.13-6.19, p = .03)., Conclusion: AMA primiparous women attempting TOL have comparable outcome to those seeking scheduled CD, however, women with fTOL have higher rates of adverse neonatal outcome.

Purpose: The purpose of this study is to compare uterine sonographic characteristics in early puerperium, following vaginal versus cesarean deliveries; and in women with abnormal third stage of labor, compared to uncomplicated vaginal delivery., Materials and Methods: This is a prospective study of women after delivery of singleton, appropriate-for-gestational-age weight, term neonates; 66 women delivered vaginally and 33 delivered by cesarean section. Sonographic uterine dimensions (height, length, and width), intracavitary thickness and its echogenicity (at level of fundus, midcavity and cervix) were recorded at less than and after 24 h from delivery, and compared between women delivered vaginally and by cesarean section. Among women delivered vaginally, data were further analyzed according to whether women underwent manual revision of the uterine cavity., Results: Sonographic evaluations were taken at 15.4 (4.3-24.0) and 39.5 (28.8-108.8) hours after delivery (median, range). We found no clinically significant differences in uterine characteristics according to mode of delivery or according to manual revision of the uterine cavity. The sonographic appearance of the uterus was similar when performed at less than or after 24 h from delivery., Conclusions: Postpartum sonographic evaluation of the uterus appears similar after vaginal and cesarean deliveries.

Purpose: To stratify maternal and neonatal outcomes of trials of labor after previous cesarean delivery (TOLAC) by gestational age., Methods: Retrospective cohort study of all singleton pregnancies with one previous cesarean delivery in TOLAC at term between 2007 and 2014. We compared outcomes of delivery at an index gestational week, with outcomes of women who remained undelivered at this index gestational week (ongoing pregnancy). Odds ratios and 95% confidence intervals were adjusted for maternal age, previous vaginal delivery, induction of labor, epidural use, presence of meconium, and birth weight > 4000 g., Results: Overall, 2849 women were eligible for analysis. Of those, 2584 (90.7%) had a successful TOLAC and 16 women (0.56%) had uterine rupture. Those rates did not differ significantly for any gestational age (GA) group. Following adjustment for possible confounders, GA was not found to be independently associated with adverse maternal or neonatal outcomes., Conclusion: Among women at term with a single previous cesarean delivery, GA at delivery was not found to be an independent risk factor for TOLAC success or uterine rupture. We suggest that GA by itself will not serve as an argument for or against TOLAC.

Objective:  The objective of this study was to assess the hemodynamics of labor, delivery, and 48 hours postpartum in women undergoing vaginal and cesarean deliveries by utilizing a whole body bioimpedance-based device., Materials and Methods:  A prospective longitudinal single-center observational study was performed between September 2014 and September 2015. The hemodynamics of low-risk women undergoing spontaneous vaginal delivery were compared with those undergoing elective cesarean sections. Cardiac index (CI), stroke index, total peripheral resistance index (TPRI), and mean arterial pressure (MAP) were assessed at different time points during delivery and in the immediate postpartum period (1, 24, and 48 hours postpartum)., Results:  Eighty-seven women were evaluated, 63 parturients in the vaginal delivery group and 24 in the cesarean delivery group. Normal vaginal delivery was characterized by a reduction in MAP and CI after epidural anesthesia, whereas elective cesarean sections were characterized by a rise in MAP and CI after spinal anesthesia. As labor progressed, CI increased reaching its peak during the second stage. Immediately following delivery, TPRI declined to its nadir with no significant change in CI. As opposed to vaginal delivery, in cesarean delivery, TPRI peaked within 1-hour postpartum resulting in a significant decline in CI., Conclusion:  Whole body bioimpedance can be used effectively to assess the hemodynamics of vaginal and cesarean deliveries., Competing Interests: Conflict of Interest: S.L. is a consultant for NI Medical, and all other authors report no potential conflict of interest., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

This study describes a retrospective analysis of all women admitted for induction of labour (IoL), carrying a viable singleton foetus, after 34 + 0 weeks of gestation. We aimed to evaluate if foetal sex has an impact on the rate of caesarean delivery following labour induction. Our results demonstrate that among the 1062 women who met the inclusion criteria, 49% (521/1062) were carrying a male foetus. Other than a lower rate of Oxytocin use for the female sex pregnancies, there were no significant differences in pre-labour and labour characteristics between male or female sex pregnancies. There was no difference in caesarean delivery rate between groups (14.4% vs. 14.2%, male vs. female, respectively, p = .505). We concluded conclude that foetal sex does not impact the caesarean delivery rate among women undergoing IoL, regardless of the indication for induction and the indication for the caesarean delivery. Impact statement Male sex foetuses are at increased risk for adverse perinatal outcomes including, among others, an increased risk for caesarean delivery. The possible contribution of male sex to caesarean delivery after labour induction has not been specifically explored. Following induction of labour, there is no difference in failed induction or caesarean delivery rate between male and female sex pregnancies. Induction of labour may be safely employed for both male and female foetuses.

Introduction: To compare perinatal outcomes of interventions for prolonged second stage of labor., Materials and Methods: Retrospective cohort study, in a single, university-affiliate, medical center (2007-2014). Eligibility: singleton gestations at term, diagnosed with prolonged second stage of labor and head station of S + 1 and lower. We compared perinatal outcomes of cesarean deliveries (CD) with vacuum assisted deliveries (VAD)., Results: Of 62 102 deliveries, 3449 (5.6%) were eligible: 356 (10.3%) underwent CD and 3093 (89.7%) underwent VAD. The rate of five-minute Apgar scores <7 was higher in the CD group as well as rates of NICU admission, neonatal asphyxia and composite neonatal adverse outcome. After adjusting for different confounders, CD was associated with adverse neonatal composite outcome (aOR 1.57, 95% CI 1.21-2.05, p = 0.001) and VAD with cephalhematoma (aOR 4.06, 95% CI 2.64-6.25, p < 0.001). No other differences were found between the groups with regards to other traumatic outcomes., Conclusion: Our data suggests that in deliveries complicated by prolonged second stage, CD yield poorer neonatal outcome than VAD, with no apparent major difference in traumatic composite outcome.

Purpose: Labor induction is performed in 20 % of pregnancies. However, the impact of the indications for induction on its failure rate has hardly been investigated. We aimed to evaluate the association of indications for labor induction with failure rate., Methods: Background and delivery-related data were retrospectively collected for all women with a viable term singleton pregnancy, who underwent labor induction with a PGE2 vaginal insert in 2013-2014. Reasons for induction were categorized as maternal indications, hypertensive disorders, premature rupture of membranes, and fetal indications. Induction failure was defined as Bishop score ≤7 at 24 h after PGE2 administration, cesarean delivery due to latent phase dystocia or removal of the insert due to non-reassuring fetal heart rate followed by emergency cesarean delivery. Outcome measures were rate of induction failure (primary) and rate of cesarean delivery (secondary)., Results: The cohort included 1066 women. Those who failed induction (n = 213, 20 %) were more likely to be nulliparous (69.5 vs. 45.7 %, p < 0.0001), older (31 vs. 30 years, p = 0.047), and at an earlier gestational age (39.4 vs. 40.0 weeks, p < 0.0001). Among nulliparous women, maternal indications were significantly associated with induction failure (aOR 2.52, 95 % CI 1.28-4.95, p = 0.007) and cesarean delivery (aOR 2.36, 95 % CI 0.40-2.29, p = 0.019). Among multiparous women, hypertensive disorders (aOR 7.26, 95 % CI 1.89-27.87, p = 0.004) and maternal indications (aOR 4.22, 95 %CI 1.14-15.58, p = 0.031) were significantly associated with induction failure but not cesarean delivery., Conclusions: The indication for induction of labor may impact its failure rate.

Objective: To assess hemoglobin (Hb) decline following elective and non-elective uneventful cesarean section (CS)., Methods: A retrospective cohort study of all women with singleton pregnancy who underwent uneventful CS defined as clinical estimation of intra-operative bleeding < 1000 ml. Hemoglobin decline (pre- and post-CS levels difference) of women with non-elective CS (during labor/delivery process) were compared to those who underwent elective CS (no labor). Cases complicated by placenta previa/abruption were excluded., Results: Overall 2767 women underwent uneventful CS, of them, 954 (34.5%) were non-elective and 1813 (65.5%) were elective. Hemoglobin decline was higher in the non-elective group (1.5 ± 1.3 versus 1.0 ± 1.2 g/dL, p < 0.001). This was also observed in the nulliparous patients as well as in those with previous single CS subgroups. The rate of Hb decline ≥3 g/dL and the rate of post-CS Hb < 7 g/dL were higher in the non-elective group (8.9% versus 3.1%, p < 0.001 and 2.3% versus 0.4%, p = 0.001, respectively). On multivariable analysis, non-elective CS was found to be significantly associated with Hb decline of  ≥3 g/dl after surgery (aOR = 2.10, 95% CI 1.36-3.23, p = 0.001) and need for blood products transfusion (aOR = 2.24, 95% CI 1.04-4.83, p = 0.03)., Conclusion: Non-elective CS was associated with an increased risk of Hb decline and blood product transfusion even in an apparent uneventful operation.

Background: Decreased sensation of fetal movements (DFM) is a common maternal complaint. Thus, we aimed to evaluate the association between DFM and pregnancy outcome in singleton gestation at term according to parity., Methods: A retrospective cohort study of singleton pregnancies at term between 2008 and 2013. Eligibility was limited to women carrying a fetus with no known structural or chromosomal anomalies, at 37+0/7 to 42+0/7 weeks of gestation. Women presenting to the delivery ward with DFM were compared with women without similar complaints., Results: Overall, 12,564 nulliparous women and 25,292 multiparous women gave birth during the study period; of them, 300 nulliparous women (2.4%) and 525 multiparous women (2.1%) complained of DFM. For nulliparous women, after adjusting for potential confounders, DFM was associated with antepartum fetal death (aOR 4.6 [95% CI 1.1-19.8]), cesarean delivery (CD) (aOR 1.3 [95% CI 1.01-1.8]), 1-minute Apgar score less than 7 (aOR 2.3 [95% CI 1.5-3.5]) and neonatal seizures (aOR 3.2 [95% CI 1.3-8.2]). For multiparous women, DFM was associated with unscheduled CD (aOR 2.7 [95% CI 1.6-4.6]) and CD indicated by intermediate/abnormal fetal heart rate tracing (aOR 4.8 [95% CI 2.8-8.4])., Conclusions: DFM carries different outcomes according to parity. Although for nulliparous women, DFM is associated with increased risk of CD and immediate adverse perinatal outcome, for multiparous women it is associated with increased risk for CD, with no immediate increased risk for adverse perinatal outcome., (© 2015 Wiley Periodicals, Inc.)

Purpose: As conflicting data exist concerning the implications of isolated oligohydramnios on pregnancy outcome at term, we aimed to assess this association in low-risk pregnancies., Methods: A retrospective cohort study of term pregnancies with sonographic finding of isolated oligohydramnios (amniotic fluid index (AFI) <5 cm) between 2007 and 2012. Outcome was compared to a control group of pregnancies with normal AFI (5-25 cm). Pregnancies complicated by thrombophilia, hypertension, diabetes, deviant fetal growth or chromosomal/structural abnormalities were excluded. Composite adverse outcome included CS/operative delivery due to non-reassuring heart rate (NRFHR), low Apgar score, umbilical artery pH < 7.10, neonatal intensive care admission, meconium aspiration syndrome, intubation or hypoxic-ischemic encephalopathy., Results: Overall, 987 pregnancies complicated by isolated oligohydramnios were compared to 22,280 low-risk pregnancies with normal AFI. Isolated oligohydramnios was associated with a higher rate of induction of labor (27.7 vs. 3.7 %, p < 0.001), CS due to NRFHR (2.3 vs. 1.1 %, p < 0.01) and composite adverse outcome (9.7 vs. 7.1 %, p < 0.01). However, after adjusting for potential confounders as induction of labor and nulliparity using multivariable logistic regression analysis, isolated oligohydramnios was not found to be independently associated with increased risk for composite adverse outcome (OR 1.01, 95 % CI 0.80-1.27, p = 0.93)., Conclusion: Isolated oligohydramnios at term by itself is not associated with increased obstetrical morbidity.

Objective: To determine risk factors and to quantify the risk of cesarean section (CS) associated with labor induction., Method: A prospective controlled study of women admitted for labor induction with PGE2 in a single tertiary medical center. Outcome was compared with women who presented with spontaneous onset of delivery., Results: The induction group were characterized by a higher body mass index (BMI), lower Bishop score and a higher cervical length at presentation compared with controls. Labor induction with PGE2 was associated with increased risk of CS (14.8% versus 4.5%, p = 0.02). This association persists after adjustment for potential confounders including Bishop score at presentation (OR = 2.9, 95% CI 1.03-11.8). The risk of CS was especially high for nulliparous (24.4% versus 5.1%, p = 0.02), overweight (21.2% versus 3.7%, p = 0.047), induction at <40 weeks of gestation (22.2% versus 2.2%, p = 0.004), in Bishop score <4 (18.2% versus 4.5%, p = 0.03), cervical length >25 mm (19.2% versus 4.5%, p = 0.005), or intact membranes (25.0% versus 4.5%, p = 0.02) at presentation., Conclusions: Labor induction with PGE2 is associated with increased risk of CS. These data should be taken into consideration when deciding on labor induction, especially in the absence of clear medical indication.

Objective: To determine the association between sonographic assessment of fetal biparietal diameter (BPD) and pregnancy outcome.Methods: This was a retrospective cohort study of pregnancies at 37-42 weeks of gestation which had antepartum sonographic measurement of BPD within 7 days before delivery. Eligibility was limited to singleton pregnancies with neither known structural or chromosomal abnormalities nor prelabor Cesarean delivery (CD). The association of BPD with outcome was analyzed using multivariate logistic regression, receiver-operating characteristics curves and stratification according to BPD quartiles.Results: In total, 3229 women were eligible for analysis, of whom 2483 (76.9%) had a spontaneous vaginal delivery (SVD), 418 (12.9%) underwent operative vaginal delivery (OVD) and 328 (10.2%) underwent CD. The mean BPD in the obstetric intervention groups (OVD and CD) was significantly higher than that in the SVD group (P < 0.001). After adjusting for confounders, increased BPD was an independent risk factor such that higher values of BPD were associated with progressively higher risk of obstetric intervention (adjusted odds ratio, 1.05 for each 1-mm increase in BPD (95% CI, 1.02-1.09)), but no clear cut-off value for obstetric intervention was found. The fourth quartile group (BPD ≥ 97 mm) was associated with a significantly lower SVD rate (P < 0.001) and higher OVD rate (P = 0.04), relative to the first (BPD 88-90 mm) and second (BPD 91-93 mm) quartile groups, with no apparent adverse impact on immediate neonatal outcome.Conclusions: Increased BPD within the week prior to delivery is an independent risk factor such that higher values of BPD are associated with progressively higher risk of obstetric intervention; however, in our experience, no adverse neonatal outcome resulted from such intervention. Thus, increased BPD should not discourage a trial of vaginal delivery. [ABSTRACT FROM AUTHOR]