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Objective: To compare labor progression in twin vs singleton gestations. Study Design: Retrospective review of electronic database created by Consortium on Safe Labor, reflecting labor and delivery information from 12 clinical centers 2002-2008. Women with twin gestations, cephalic presentation of presenting twin, gestational age ≥34 weeks, with ≥2 cervical examinations were included. Exclusion criteria were fetal anomalies or demise. Singleton controls were selected by the same criteria. Categorical variables were analyzed by χ2; continuous by Student t test. Interval censored regression was used to determine distribution for time of cervical dilation in centimeters, or “traverse times,” and controlled for confounding factors. Repeated-measures analysis constructed mean labor curves by parity and number of fetuses. Results: A total of 891 twin gestations were compared with 100,513 singleton controls. Twin gestations were more often older, white or African American, earlier gestational age, increased prepregnancy body mass index, and with lower birthweight. There was no difference in number of prior cesarean deliveries, induction, or augmentation, or epidural use. Median traverse times increased at every centimeter interval in nulliparous twins, in both unadjusted and adjusted analysis (P < .01). A similar pattern was noted for multiparas in both analyses. Labor curves demonstrated a delayed inflection point in the labor pattern for nulliparous and multiparous twin gestations. Conclusion: Both nulliparous and multiparous women have slower progression of active phase labor with twins even when controlling for confounding factors. [Copyright &y& Elsevier]

Objective: We sought to assess body mass index (BMI) effect on cesarean risk during labor. Study Design: The Consortium on Safe Labor collected electronic data from 228,668 deliveries. Women with singletons ≥37 weeks and known BMI at labor admission were analyzed in this cohort study. Regression analysis generated relative risks for cesarean stratifying for parity and prior cesarean while controlling for covariates. Results: Of the 124,389 women, 14.0% had cesareans. Cesareans increased with increasing BMI for nulliparas and multiparas with and without a prior cesarean. Repeat cesareans were performed in >50% of laboring women with a BMI >40 kg/m2. The risk for cesarean increased as BMI increased for all subgroups, P < .001. The risk for cesarean increased by 5%, 2%, and 5% for nulliparas and multiparas with and without a prior cesarean, respectively, for each 1-kg/m2 increase in BMI. Conclusion: Admission BMI is significantly associated with delivery route in term laboring women. Parity and prior cesarean are other important predictors. [ABSTRACT FROM AUTHOR]

The article presents research which analyzed the efficacy of obstetric maneuvers for the acute management of shoulder dystocia. The researchers used an electronic database to identify women who suffered from a vertex fetus beyond 34 0/7 weeks of gestation and who incurred the medical condition during delivery. They found that the highest rate of delivery is associated with the occurrence of posterior shoulder.

The article presents information about a study on perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice. Researchers looked at the electronic medical records collected by the Consortium on Safe Labor from 19 hospitals within 12 institutions, including information on patient characteristics, prenatal complications, labor and delivery data, and maternal and neonatal outcomes. It was found that nulliparity and episiotomy are important risk factors for their- or fourth-degree lacerations.