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Introduction: Pregnancy is an incredibly stressful period due to outcome of delivery, anxious about the well-being of the unborn child, added responsibilities once the child is born, financial obligations, adapting to her postpartum body, interpersonal relationships with her spouse and other family members. Aim & Objectives: 1. To determine whether higher anxiety levels in term patients has significant effects on the duration, progress and complications of labour, 2.To assess whether significant maternal anxiety can lead to an increase in caesarean sections or instrumental deliveries, 3.To assess the difference in anxiety levels between term primigravida and term multigravida. Methodology: The study was a descriptive cross-sectional study conducted in the Department of Obstetrics and Gynecology in IGMC&RI. Antenatal women in the low-risk group with gestational age more than or equal to 37 weeks, who gave consent for participation were included in the study. Antenatal women who refused to give consent or those with known co-morbidities complicating labour like gestational diabetes mellitus, pregnancy induced hypertension, multiple gestation, breech presentation, placental abnormalities like placenta previa or abruption, previous history of caesarean section and cephalo - pelvic disproportion were excluded. Results: The demographic details of the participants are shown in Table 1. Out of the 269 participants analysed for the study, Majority of them were housewives, belonged to the age group of 25-30 years (40%). Majority were graduates (49%) and pregnant for the first time (primi) (56.1%). Conclusion: The significance of this study is that maternal anxiety was found positive in about 105 patients, among which 19 participants had severe anxiety. These anxiety scores if known during the antenatal chechups can help in interventions for the betterment of maternal health including guidance and counselling [ABSTRACT FROM AUTHOR]

• This is the first study attempting to provide scientific evidence on the various maneuvers for the insertion of the blades in rotational forceps. • The best results were obtained with the direct maneuver. • Inserting the posterior blade first was the maneuver with the worst results. The Kielland's forceps is the most used forceps for assisting rotational operative births. There are various maneuvers described for blade insertion. Among these, the most used ones are the direct, first posterior, and wandering maneuver. The objective of this study was to compare these three maneuvers using a simulator. In this experimental study, 144 rotational forceps-assisted births were conducted using a simulation model, with 72 starting in a right occiput-transverse position and 72 in a left occiput-transverse position. Each of the three maneuvers (direct, first posterior, or wandering) for blade insertion was performed 48 times by a total of 6 operators, comprising 3 obstetricians with over 10 years of experience and 3 trainees. The assessment of forceps application included evaluating the placement of the blades in terms of asymmetry and the distance from the lock to the posterior fontanelle. Additionally, the study evaluated the number of reinsertions and relocations required, the perceived difficulty of the procedure, and the operator's level of experience. There were no statistically significant differences in terms of asymmetry with the three maneuvers. Regarding the distance from the lock to the posterior fontanelle, the best results were obtained with the direct maneuver. There were no differences in the number of reinsertions, relocations, and the perceived difficulty by the operators among the three maneuvers. Experienced obstetricians had better outcomes in terms of the need for reinsertions. The direct maneuver offer advantages in the insertion of blades for rotational forceps. [ABSTRACT FROM AUTHOR]

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The increasing prevalence of chronic obstructive pulmonary disease (COPD) among the female half of the population is the reason for the increased interest of scientists in the course of COPD and its impact on pregnant women. At the same time, the chronic lung inflammatory process leads to the development of obstetrical and perinatal complications during pregnancy. The aim of our study is to establish the features of changes in the cytokine profile in pregnant women with COPD and their role in the development of obstetrical and perinatal complications. Materials and methods. 77 pregnant women with clinically and instrumentally verified signs of COPD were examined, who were divided into 2 subgroups depending on the degree of bronchial obstruction: IA – 43 pregnant women with FEV1 ≥80 %, IB – 34 pregnant women with FEV1 50–79 %. The control group consisted of 27 healthy pregnant women. The cytokine profile was determined and a correlational interaction with the degree of bronchial obstruction and the frequency of obstetrical and perinatal complications was established. Results. Our analysis of cytokine profile indicators in pregnant women with COPD at the stage of mild and moderate bronchoobstruction has shown a characteristic and significant increase in the level of pro-inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α) and a simultaneous decrease in the level of anti-inflammatory IL-10 (P ≤ 0.05). Dysregulation of the inflammatory response in COPD in pregnant women became the main basis for the development of obstetrical and perinatal complications. We have established that an increase in the degree of bronchoobstruction was also associated with a higher detection frequency of such pregnancy and childbirth complications as anemia by 3.1 times, the threat of preterm birth by 9 times, preeclampsia by 7 times, placental dysfunction by 3.4 times, intrauterine growth restriction by 8 times, premature birth by 3.5 times, premature rupture of membranes during labor by 4 times, and fetal distress by 3 times. Conclusions. In pregnant women with COPD, an increase in the level of pro-inflammatory cytokines – IL-1β (rI = -0.81, rII = -0.67), IL-6 (rI = -0.88, rII = -0.78), IL-8, TNF-α was found to be directly proportional to the degree of bronchial obstruction, and inversely proportional level of anti-inflammatory IL-10 (rI = 0.80, rII = 0.86), which can be an early prognostic criterion for the development of obstetrical and perinatal complications.

Background and Aim: Polyhydramnios is associated with an increased risk of various adverse pregnancy outcomes, yet complications during labor have not been sufficiently studied. We assessed the labor and perinatal outcomes of idiopathic polyhydramnios during term labor. Methods: Retrospective cohort study at a tertiary medical center between 2010 and 2014. Women with idiopathic polyhydramnios defined as an amniotic fluid index (AFI) greater than 24 cm or a deep vertical pocket (DVP) > 8 cm (cases) were compared with women with a normal AFI (5–24 cm) (controls). Statistics: Descriptive, means ± SDs, medians + IQR. Comparisons: chi-square, Fisher's exact test, Mann–Whitney Test, multivariate logistic models. Results: During the study period 11,065 women had ultrasound evaluation completed by a sonographer within two weeks of delivery. After excluding pregnancies complicated by diabetes (pre-gestational or gestational), fetal anomalies, IUFD, multifetal pregnancies, elective cesarean deliveries (CD) or missing data, we included 750 cases and 7000 controls. The degree of polyhydramnios was mild in 559 (75.0%) cases (AFI 24–30 cm or DVP 8–12 cm), moderate in 137 (18.0%) cases (30–35 cm or DVP 12–15 cm) and severe in 54 (7.0%) cases (AFI >35 cm or DVP > 15 cm). Idiopathic polyhydramnios was associated with a higher rate of CD 9.3% vs. 6.2%, p = 0.004; a higher rate of macrosomia 22.8% vs. 7.0%, p < 0.0001; and a higher rate of neonatal respiratory complications 2.0% vs. 0.8%, p = 0.0001. A multivariate regression analysis demonstrated an independent relation between polyhydramnios and higher rates of CD, aOR 1.62 (CI 1.20–2.19 p = 0.002) and composite adverse neonatal outcome aOR 1.28 (CI 1.01–1.63 p = 0.043). Severity of polyhydramnios was significantly associated with higher rates of macrosomia and CD (p for trend <0.01 in both). Conclusions: The term idiopathic polyhydramnios is independently associated with macrosomia, CD and neonatal complications. The severity of polyhydramnios is also associated with macrosomia and CD. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association of vaginal birth complications with first trimester pregnancy associated plasma protein A (PaPP-A) level in LGA vaginal deliveries of non-diabetic mothers. Methods: This is a retrospective study conducted in a tertiary hospital between May 2020 and July 2022. A total of 9,184 singleton pregnancies with normal vaginal delivery between 37 and 42 weeks were reviewed. Non-diabetic patients who gave birth to LGA infants were grouped according to the presence of vaginal birth complications and compared in terms of first trimester aneuploidy screening results. Regression analysis was used to investigate the effect of variables on complications. Receiver operating characteristic (ROC) analysis was performed for the threshold PaPP-A value to predict birth complications. Results: Of the 357 patients, 68 (19.0%) had at least one complication, remaining 289 (81.0%) had no complications. First trimester serum PaPP-A level was significantly higher in complicated group than patients without complications (20.85 ± 19.73 vs 15.18 ± 15.81, p= 0.046). First trimester NT, β-hCG and PaPP-A are significantly associated with perinatal complications in LGA vaginal deliveries. The cut-off value of first trimester PaPP-A level was 10.46 mIU/mL to predict the complications with a sensitivity of 54.4% and a specificity of 54.3%. Conclusions: First trimester PaPP-A level may be associated with vaginal birth complications in LGA infants from non-diabetic mothers. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether pre‐eclampsia is a single clinical entity or whether de novo pre‐eclampsia and superimposed pre‐eclampsia are distinct entities, with respect to baseline maternal characteristics, obstetrical complications, and perinatal outcomes. Methods: A retrospective cohort study comparing singleton pregnancies complicated with de novo pre‐eclampsia (n = 10 979, 93%) and superimposed pre‐eclampsia (n = 804, 7%). Maternal baseline characteristics, pregnancy and labor complications, and neonatal outcomes were evaluated in the univariate analysis. Multivariable logistic regression models were performed for the prediction of different pregnancy outcomes while controlling for confounders. Results: In the multivariate regression models controlling for confounders, superimposed pre‐eclampsia was found to be a significant risk factor for placental dysfunction, a composite outcome composed of severe pre‐eclampsia (rather than mild), placental abruption, oligohydramnios, and small‐for‐gestational‐age neonate (odds ratio [OR] 2.23, 95% confidence interval [CI] 1.90–2.62, P < 0.001), preterm delivery (OR 2.79, 95% CI 2.39–3.26, P < 0.001), and perinatal mortality (OR 1.79, 95% CI 1.11–2.88, P = 0.02). Conclusion: De novo and superimposed pre‐eclampsia demonstrated significant differences in most studied variables, suggesting that these may be two distinct clinical syndromes. In our population, superimposed pre‐eclampsia was found to be significantly associated with adverse pregnancy outcomes such as placental dysfunction, preterm delivery, and perinatal mortality compared with de novo pre‐eclampsia. A retrospective cohort study demonstrating that superimposed pre‐eclampsia is a major risk factor for adverse maternal and perinatal outcomes, when compared with de novo pre‐eclampsia. [ABSTRACT FROM AUTHOR]

Introduction: Obstetric anal sphincter injuries (OASIS) are severe complications to vaginal births with potentially serious long‐term consequences and large impact on quality of life. The aim was to determine risk and protective factors for OASIS. Material and methods: We performed a retrospective register‐based observational study. A cohort of 988 988 singleton term deliveries 2005–2016 in Sweden were included. Data from the Swedish Medical Birth Registry and Statistics Sweden were extracted to identify cases of OASIS and maternal and fetal characteristics. Modified Poisson Regression analyses were performed to assess risk factors. Results: The rate of OASIS was 3.5% (n = 34 583). Primiparity (adjusted risk ratio [aRR] 3.13, 95% CI 3.05–3.21), vacuum extraction (aRR 2.79, 95% CI 2.73–2.86), forceps (aRR 4.27, 95% CI 3.86–4.72), and high birthweight (aRR 2.61, 95% CI 2.50–2.72) were associated with a significantly increased risk of OASIS. Increasing maternal age and decreasing maternal height also increased the risk of OASIS. Obesity increased the risk of OASIS (aRR 1.04, 95% CI 1.04–1.08), if fetal birthweight was not adjusted for. Smoking (aRR 0.74, 95% CI 0.70–0.79) and low maternal education (aRR 0.87, 95% CI 0.83–0.92) were associated with a decreased frequency of reported OASIS. Previous cesarean section increased the risk of OASIS (aRR 1.41, 95% CI 1.36–1.47). Conclusions: Primiparity, instrumental delivery, and high birthweight significantly increased the risk of OASIS. Obesity, low height, increasing age, and previous cesarean section also increased the risk whereas smoking and low maternal educational level were associated with a lower OASIS rate. [ABSTRACT FROM AUTHOR]

Objective: Regardless of the progress made in perinatal medicine, perinatal asphyxia (PNA) remains a major concern in developing countries. A multicenter study conducted in 2014 showed that the overall incidence was about 4‰ live births in Tunisia. The purpose of our research was to establish the occurrence of PNA, identify its causes and evaluate its outcomes based on hypoxic-ischaemic encephalopathy stage, and primary complications resulting from PNA. Methods: A descriptive and analytical multicenter study was carried out from January to December 2020. It enrolled all full-term neonates admitted to six university hospital neonatology departments for management of PNA in Tunisia. Inclusion criteria were sentinel event during antenatal period or abnormalities on fetal heart rate monitoring, APGAR score<7 at fifth minutes or evidence of neurologic signs with or without multi-visceral involvement. Results: Our study enrolled 183 patients, with an incidence of PNA of 5.6‰ live births at term. The mean age of the mothers was 30.6 ± 5 years, and 48.6% were primiparous. Pregnancies were monitored by a private practitioner in 59% of cases and were uneventful in 61.2% of cases. The mean term of delivery was 39 weeks’ amenorrhea, with the majority being inborn (88%). Forceps was recured in 39% of cases, and one in 10 newborns suffered obstetrical trauma. The etiologies of ANP were mainly funicular causes and remained undetermined in 26% of cases. Anoxic-ischemic encephalopathy was classified as stages I, II and III in 60%, 26% and 14% of cases, respectively. Multivisceral failure was observed in 11.5% of cases. Neurological investigations were inadequately performed, with no imaging in 38.3% of cases and no electroencephalogram in 59%. The mortality rate was 14.8% and was correlated with the sarnat and sartnat severity score, the apgar score and the place of delivery . Fifty-five percent of survivors were lost to follow-up. for those followed up, 13.6% had neulogic anomalies at one year of age and 7.6% at two years. Conclusion: PNA remains frequent in our country with limited management. The optimisation of obstetrical management is imperative. The prevention of neurological sequelae by cerebral hypothermia must be established in our country. A follow-up network must also be established to avoid lost to follow-up and to support children with neurological sequelae disorders as well as their parents. [ABSTRACT FROM AUTHOR]

Abstrak Latar Belakang: Menurut UNICEF, setiap lima kelahiran bayi terdapat satu bayi lahir dari ibu dengan usia dibawah 19 tahun. Kehamilan pada remaja usia 15-19 tahun di negara berkembang mencapai angka 21 juta. Kehamilan remaja merupkan masalah yang tersebar di seluruh dunia dan berdampak terhadap kesehatan ibu dan anak. (Mukhopadhyay, 2010), secara luas kematian yang disebabkan oleh kehamilan merupakan penyebab utama kematian anak perempuan usia 15-19 tahun (WHO, 2017). Remaja memiliki risiko komplikasi kehamilan yang tinggi, salah satunya adalah persalinan prematur, IUGR dan pre-eklamsia. (Baker, 2007).Terjadi peningkatan risiko komplikasi sebesar 2 kali lipat pada kehamilan remaja dibandingkan kehamilan pada wanita usia 20-an (Utomo I. D., 2013), Penelitian ini bertujuan untuk mencari hubungan kehamilan remaja dengan komplikasi kehamilan dan persalinan. Metode: Penelitian ini menggunakan metode analitik observasional dengan pendekatan retrospektif cross sectional dengan jumlah sampel 40 dan diambil dengan teknik cosecutive sampling. Hasil: Komplikasi pada kehamilan remaja mencapai 60%. Hasil analisis hubungan kehamilan remaja dengan komplikasi kehamilan (p value= 0,0100 OR = 6), anemia ( p value 0,013 OR=7,364), defisiensi gizi p value=0,400), prekalmisa/eklamsia (p value =0,300), komplikasi persalinan (p value =1,000), persalinan SC (p value=1,000) dan KPD (p value =1,000). Kesimpulan: Pada penelitian ini kehamilan remaja berpengaruh pada komplikasi kehamilan dengan penyulit dominan anemia dan tidak berpengaruh pada komplikasi persalinan. Abstract Backgrounds: According to UNICEF, every five babies born there is one baby born to a mother under the age of 19 years. Pregnancy in adolescents aged 15-19 years in developing countries reaches 21 million. Teenage pregnancy was a problem that spread throughout the world and had an impact on maternal and child health. (Mukhopadhyay, 2010), widely deaths caused by pregnancy are the main cause of death for girls aged 15-19 years (WHO, 2017). Adolescents had a high risk of pregnancy complications, one of which is premature labor, IUGR and pre-eclampsia. (Baker, 2007). There has been a 2-fold increase in the risk of complications in adolescent pregnancies versus pregnancies in women in their 20s (Utomo I. D., 2013). Methods: This study were observational analytic method with a retrospective cross sectional approach with 40 samples and was taken by cosecutive sampling technique. Results: Complications in adolescent pregnancy reach 60%. The results of the analysis of the relationship of adolescent pregnancies with complications of pregnancy showed (p value= 0,0100 OR = 6), anemia ( p value 0,013 OR=7,364), nutritional deficiency (p value=0,400), preeclampsia/eclampsia (p value =0,300), labor complications (p value =1,000), sectio caesaria (p value=1,000) dan premature rupture of membrane (p value =1,000)

Purpose This study investigated the effect of a woman's age at first marriage (AFM) on the incidence of labor complications and babies with low birth weight (LBW). Methods This study used data from the 2017 Indonesian Demographic and Health Survey (IDHS) on women aged 15~49 who gave birth to their first child within the previous 5 years. Data analysis was conducted using binary logistic regression for labor complications and the binomial probit method for the incidence of LBW. Results The analysis showed that AFM affected the likelihood of childbirth complications and LBW babies. An increase in AFM tended to reduce the risk of childbirth complications, although poor economic conditions increased the risk of complications in mothers with a higher AFM. In addition, a low or high AFM increased the chances of delivering a baby with LBW. Conclusion A low AFM was associated with an increased likelihood of women experiencing birth complications when delivering their first child and delivering babies with LBW, underscoring the importance of delaying childbirth until a more mature age.

Relevance. The relevance of improving the treatment of pregnant women with iron deficiency anemia (IDA) is due to an increase in morbidity and adverse effects on the course and outcome of the gestational process, the state of the fetus and newborn.The objective of this study was the comparative assessment of the frequency of complications of labor and the postpartum period in women who received intravenous and oral iron preparations during pregnancy.Material and methods. The study included 140 pregnant women. The mean age of the patients was 31.75 (19; 49) years. Results. Pregnant women with IDA, after a single administration of intravenous preparation of iron carboxymaltosate, had pronounced stable dynamics of hematological and ferrokinetic blood parameters, as well as the low frequency of postpartum complications, compared to the oral preparation of iron (III) hydroxide polymaltosate.

Introduction: To evaluate the effect of antibiotic regimens for chorioamnionitis on maternal and neonatal outcomes. Material and methods: We conducted a systematic review, wherein we searched six bibliographic databases until June 2020 and included randomized clinical trials describing antibiotic regimens for treating chorioamnionitis. Risk of bias was assessed using the Cochrane Risk of Bias tool V2.0. Random‐effects meta‐analysis was performed and results were presented as risk ratio (RR) and mean differences (MD) with 95% CI. Results: Fourteen trials at low‐to‐high risk of bias were included. Three trials (n = 244), comparing different intrapartum antibiotic regimens, showed no difference in outcomes except for lower composite maternal morbidity (endometritis, pneumonia, sepsis, blood transfusion, and ileus) with ampicillin/sulbactam vs ampicillin/gentamicin in one study (0/43 vs 6/49, P =.03). Three trials (n = 295) comparing different doses of intrapartum antibiotics showed no differences in maternal and neonatal outcomes, although one study showed a shorter duration of antibiotic treatment in the experimental arm (4 mg/kg gentamicin q24h + 1200 mg clindamycin q12h) vs conventional arm (1.33 mg/kg gentamicin + 800 mg clindamycin q8h) (48.0 ± 36 hours vs 55.2 ± 48 hours, P =.04). Four trials (n = 484) comparing postpartum antibiotics vs no antibiotics showed no difference in outcomes except for a shorter hospital stay (two studies, MD −7.90 hours, 95% CI −13.52 to −2.27 hours). Three trials (n = 447) comparing single vs multiple doses of postpartum antibiotics showed shorter hospital stay [MD −19.14 hours, 95% CI −29.88 to −8.41 hours), but no differences in treatment failure (RR 1.73, 95% CI 0.69‐4.30) or total antibiotic dose (MD −9.24, 95% CI −19.49 to 1.01). One trial (n = 48) comparing intrapartum vs postpartum initiation of treatment found benefits to intrapartum (vs postpartum) initiation of antibiotics, in terms of postpartum maternal hospital stay (MD −24 hours, 95% CI −45.56 to −1.44 hours), neonatal hospital stay (MD −45.6 hours, −93.84 to −11.76 hours), and neonatal pneumonia or sepsis (RR 0.06, 95% CI 0.00‐0.95). Conclusions: Upon diagnosis of chorioamnionitis, there is limited evidence to recommend the prompt initiation of intrapartum antibiotics, and to consider a single dose of postpartum antibiotics over multiple doses or no treatment. Well‐designed trials using standard definitions of chorioamnionitis, outcome measures, and newer antibiotics are required to inform clinical practice with regard to the preferred antibiotic regimen, dose, and duration to optimize maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the effect of a woman's age at first marriage (AFM) on the incidence of labor complications and babies with low birth weight (LBW). Methods: This study used data from the 2017 Indonesian Demographic and Health Survey (IDHS) on women aged 15~49 who gave birth to their first child within the previous 5 years. Data analysis was conducted using binary logistic regression for labor complications and the binomial probit method for the incidence of LBW. Results: The analysis showed that AFM affected the likelihood of childbirth complications and LBW babies. An increase in AFM tended to reduce the risk of childbirth complications, although poor economic conditions increased the risk of complications in mothers with a higher AFM. In addition, a low or high AFM increased the chances of delivering a baby with LBW. Conclusion: A low AFM was associated with an increased likelihood of women experiencing birth complications when delivering their first child and delivering babies with LBW, underscoring the importance of delaying childbirth until a more mature age. [ABSTRACT FROM AUTHOR]

Aim: To compare fetomaternal outcomes among pregnant patients in COVID and non-COVID period in tertiary centre in eastern Nepal. Methods: All women who delivered at Nobel Medical College Teaching Hospital during non-COVID period between April to June 2019 and COVID period between April to June 2020 were compared. Data were collected from medical records. Results: Significant number of women had cesarean deliveries in COVID period (36.5% vs 32.6%). There were no significant differences in period of gestation at the time of delivery, birth weight of baby, intrauterine fetal death and neonatal intensive care unit admission as well as no difference in obstetric outcomes, labor complications, maternal intensive care unit stay, near miss and peripartum hysterectomy. Conclusion: There were more cesarean sections, vaginal birth after cesarean section and vaginal breech delivery in COVID period and no other significant differences in maternal and fetal outcomes during COVID period and NonCOVID period. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study is to evaluate the therapeutic effect of hyoscine N‐butylbromide (HBB) in active phase of labor and its safety to mother and fetus. Methods: A systematic literature search was conducted on Cochrane Library, Pubmed, EMBASE, CINAHL, ClinicalTrials.gov and three databases in Chinese up to March 31, 2020. Randomized controlled trials (RCTs) of HBB administration during the active phase for shortening of spontaneous labor at term compared with placebo were included. Two reviewers assessed the methodological quality and data extraction independently. We calculated pooled risk ratios (RRs), mean differences (MDs) and 95% confidence intervals (CIs) using Review Manager 5.3 software. Intention‐to‐treat principles and random‐effects model were adopted for analysis and pool results. Results: In total, 1448 women from 9 RCTs were included in the meta‐analysis. The HBB group exhibited significantly decreased durations of active phase (MD −61.1 min; 95% CI: −87.7 to −34.4, I2: 96%), the second stage (MD −2.0 min; 95% CI: −3.4 to −0.5, I2: 62%), and third stage (MD −0.7 min; 95% CI: −1.1 to −0.3, I2: 51%). Intravenous (IV) HBB group and intramuscularly (IM) HBB group were compared to the control group (MD −60.9 min; 95% CI −87.7 to −34.1, I2: 96%). No significant differences were observed in Cesarean section, post‐partum hemorrhage, instrumental labor, Apgar scores or any adverse effects. Conclusion: Hyoscine N‐butylbromide had a significant effect of shortening the duration of the active phase of labor without adverse effects. We recommend a single dose of intravenous administrated HBB when a woman undergoes labor augmentation. [ABSTRACT FROM AUTHOR]

Background: One of the main problems of women during childbirth is fear of labor pain; so far, different ways to reduce it have been recommended. The aim of this study was to compare normal labor indexes in two methods of delivery of labor in water and routine delivery. Methods: In a prospective cohort study, 180 pregnant women were enrolled. The first group (n = 90) from the beginning of the active phase of labor, entered the water of 37°C, and the second group (90 women) gave birth in the usual manner on dry basis. The two groups were evaluated for pain severity, satisfaction, and complications during and after delivery. Findings: The mean of labor pain severity in the two groups of delivery in water and dry was 7.12 ± 1.42 and 7.87 ± 1.33, respectively, and the severity of pain in the group of water was lower (P = 0.001). Moreover, the delivery group in water had higher satisfaction, so that in the delivery group in water, 9.6% were completely satisfied and 45.2% were satisfied, and in the routine delivery group, 1.2% were completely satisfied and 30.6% satisfied (P = 0.007). Conclusion: Natural delivery in water has been accompanied by a reduction in lower birth rates and more satisfaction of the patients. On the other hand, delivery in water has no effect on the increase of postpartum complications. Moreover, delivery in water, in addition to reducing the delivery, has many other advantages, including lower power loss of pelvic floor muscles.

The establishment of interventions to maximize maternal health requires the identification of modifiable risk factors. Toward the identification of modifiable hospital‐based factors, we analyze over 2 million births from 2005 to 2010 in Texas, employing a series of quasi‐experimental tests involving hourly, daily, and monthly circumstances where medical service quality (or clinical capital) is known to vary exogenously. Motivated by a clinician's choice model, we investigate whether maternal delivery complications (1) vary by work shift, (2) increase by the hours worked within shifts, (3) increase on weekends and holidays when hospitals are typically understaffed, and (4) are higher in July when a new cohort of residents enter teaching hospitals. We find consistent evidence of a sizable statistical relationship between deliveries during nonstandard schedules and negative patient outcomes. Delivery complications are higher during night shifts (OR = 1.21, 95% CI: 1.18–1.25), and on weekends (OR = 1.09, 95% CI: 1.04–1.14) and holidays (OR = 1.29, 95% CI: 1.04–1.60), when hospitals are understaffed and less experienced doctors are more likely to work. Within shifts, we show deterioration of occupational performance per additional hour worked (OR = 1.02, 95% CI: 1.01–1.02). We observe substantial additional risk at teaching hospitals in July (OR = 1.28, 95% CI: 1.14–1.43), reflecting a cohort‐turnover effect. All results are robust to the exclusion of noninduced births and intuitively falsified with analyses of chromosomal disorders. Results from our multiple‐test strategy indicate that hospitals can meaningfully attenuate harm to maternal health through strategic scheduling of staff. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risk of adverse maternal outcomes among adolescents experiencing a repeat pregnancy in the Philippines. Methods: Data were analyzed from four waves (1998–2013) of a cross‐sectional nationally representative survey. We included 2518 non‐nulliparous and non‐pregnant women aged 15–44 years with an interpregnancy interval (IPI) of 24 months or less. Multivariate logistic regression was used to measure the association of repeat pregnancy with adverse maternal outcomes by age group (11–19, 20–24, and 25–45 years), accounting for clustering within each respondent. A stratified analysis by IPI (≤24 vs >24 months) was conducted among 11–19 year olds. Results: No association was observed between repeat pregnancy and low birthweight among adolescent mothers. A second pregnancy increased the risk of pregnancy (adjusted odds ratio [OR] 10.49, 95% confidence interval [CI] 4.00–27.49) and labor (adjusted OR 3.61, 95% CI 1.61–8.09) complications among adolescent women (11–19 years). Interaction tests showed there was a significant increase in these risks as compared with older women. Stratified analysis by IPI did not modify the observed effect for either outcome. Conclusion: Repeat pregnancy among Filipino adolescents increased the risk of pregnancy and labor complications irrespective of IPI. A repeat pregnancy, either closely or adequately spaced, increased the likelihood of maternal complications by at least four times among adolescent mothers. [ABSTRACT FROM AUTHOR]

To evaluate the profile and frequency of drug abuse before fatal occupational injuries from cases registered in Vitoria, ES, Brazil. From 2008 to 2012, 302 fatal work accidents were registered in the analyzed area. Epidemiological variables like age, sex, type of drug detected, occupation, cause of death, and location of the accident were studied. Drugs that were routinely searched for and considered in the analysis are alcohol, cocaine, marijuana, barbiturates, benzodiazepines, and amphetamines. Male workers, with a mean age of 40 years old, were affected more frequently than females. In the 302 analyzed cases, there was a loss of 10,717 years of lifetime. Drugs were detected in over 20% of cases. Studies of fatal accidents at work (FOI) in Brazil shows that the records of these accidents are often not properly communicated to the competent bodies. Of all the workers included in the study, 23.9% was positive for the presence of drugs, most frequently detected were alcohol and cocaine. These findings are at least partially explained by the fact that the use of alcohol is not seen as a threat and its use is socially acceptable, even in working situations. Health guidelines and worker safety prevention measures should be applied more rigorously, with the goal of reducing the number of injuries and fatalities. [ABSTRACT FROM AUTHOR]

Objective: To describe our cases of postpartum hemorrhage (PPH) with pelvic arterial embolization (PAE). Material and methods: All patients with PPH who underwent PAE in our center in the interval 2011-1016 were retrospectively studied, evaluating the technical procedure, clinical results, and subsequent fertility. Results: There were 33 cases of PPH with PAE. The majority occurred in primiparous women (N = 22, 66.6%) who delivered vaginally (N = 20, 61%). In addition, most PPH with PAE cases had an early onset (N = 26, 79%) and were caused by uterine atony (N = 14, 42.4%). Success of PAE occurred in 27 (81.8%) cases and a satisfactory clinical follow-up was the rule, with 21 (64%) women recovering their normal menstruation, and six (18.2%) becoming pregnant in the following years. Conclusions: PAE is a safe and efficacious technique with minor complications. Moreover, it allows conservation of the uterus with preservation of fertility. [ABSTRACT FROM AUTHOR]

Introduction: Specific and targeted intervention is needed to reduce the relatively high maternal mortality and morbidity in Indonesia. The apparent rural-urban disparities might require different intervention strategies. Therefore, this study aims to assess patterns and sociodemographic determinants of selfreported maternal morbidity in rural and urban areas. Methods: Data from the Indonesian Demographic and Health Survey 2012 were analyzed. In this cross-sectional survey, maternal morbidity status and sociodemographic factors were obtained through questionnaire-based interviews. Women who completed the maternal morbidity questionnaire were included in the analyses (n=12 679). Descriptive statistics were used to assess differences in proportion; mixed-effects regression was used to evaluate the association between sociodemographic factors and maternal morbidity. Results: Approximately 53.3% of women reported experiencing pregnancy and/or labor complications, with a lower proportion in rural areas (51.3%) than in urban areas (55.1%). The patterns of pregnancy morbidities were similar for rural and urban women. The highest proportion of pregnancy morbidity was classified as 'other', followed by 'bleeding'. There were slight differences in the type of labor morbidities. Compared to urban women, women in rural areas had a higher prevalence of bleeding and infection, but a significantly lower prevalence of pregnancy rupture of membrane. Nulliparity was a dominant factor for self-reported maternal morbidity. Younger urban, but not rural, women represented a higher proportion of maternal morbidity. In urban areas, women with social disadvantage represented a higher proportion of morbidity. However, in rural areas, a higher prevalence of maternal morbidity was seen in women of higher socioeconomic status. These rural-urban disparities might be partially caused by differences in knowledge of maternal morbidities and sociodemographic status between rural and urban women. Conclusions: This study found similar patterns of pregnancy morbidity, but slight differences in labor morbidity patterns. Specific interventions for major maternal complications within rural or urban areas are important. There were also differences in the proportion of self-reported maternal complications by sociodemographic factors, which might be caused by differences in reporting. Intervention to improve knowledge and awareness of maternal complication is needed, specifically for socially disadvantaged women and women living in rural areas. [ABSTRACT FROM AUTHOR]

Objective: To determine if hemodynamic assessment in 'low-risk' pregnant women at term with an appropriate-for-gestational age (AGA) fetus can improve the identification of patients who will suffer maternal or fetal/neonatal complications during labor.Methods: This was a prospective observational study of 77 women with low-risk term pregnancy and AGA fetus, in the early stages of labor. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor (USCOM® ) system. Patients were followed until the end of labor to identify fetal/neonatal and maternal outcomes, and those which developed complications of labor were compared with those delivering without complications.Results: Eleven (14.3%) patients had a complication during labor: in seven there was fetal distress and in four there were maternal complications (postpartum hemorrhage and/or uterine atony). Patients who developed complications during labor had lower cardiac output (5.6 ± 1.0 vs 6.7 ± 1.3 L/min, P = 0.01) and cardiac index (3.1 ± 0.6 vs 3.5 ± 0.7 L/min/m2 , P = 0.04), and higher total vascular resistance (1195.3 ± 205.3 vs 1017.8 ± 225.6 dynes × s/cm5 , P = 0.017) early in labor, compared with those who did not develop complications. Receiver-operating characteristics curve analysis to determine cut-offs showed cardiac output ≤ 5.8 L/min (sensitivity, 81.8%; specificity, 69.7%), cardiac index ≤ 2.9 L/min/m2 (sensitivity, 63.6%; specificity, 76.9%) and total vascular resistance > 1069 dynes × s/cm5 (sensitivity, 81.8%; specificity, 63.6%) to best predict maternal or fetal/neonatal complications.Conclusions: The study of maternal cardiovascular adaptation at the end of pregnancy could help to identify low-risk patients who may develop complications during labor. In particular, low cardiac output and high total vascular resistance are apparently associated with higher risk of fetal distress or maternal complications. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To test the generalizability of previously reported increased risk of reoccurrence of retained placenta in yet another setting.Methods: In this observational retrospective study we longitudinally followed women who had a vaginal delivery complicated by a partial or complete retained placenta at Edith Wolfson Medical Center between 1 January 2009 and 31 December 2012. The study group included parturient women who had a partial or complete retained placenta after a vaginal delivery (n = 90). The control group included parturient women who did not have a partial or complete retained placenta after a vaginal delivery from the same time period using the same inclusion criteria (n = 90).Results: Retained partial or complete placenta at a previous delivery was found to be an independent risk factor for retained partial or complete placenta in a subsequent delivery (adjusted OR 9.8, 95%CI 1.2 to 80.6, p = 0.032) and for retained partial or complete placenta and/or postpartum hemorrhage in a subsequent delivery (adjusted OR 14.1, 95% CI 1.7 to 111.9, p = 0.012), after controlling for gestational age and induction of labor at previous delivery.Conclusion: Retained partial or complete placenta at an index delivery increases the risk of reoccurrence of retained partial or complete placenta in a subsequent delivery. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. METHODS: A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications were adjusted through logistic regression analysis. RESULTS: Obesity was present in 308 (6.9%) patients. Cesarean delivery was performed in 164 (53.2%) obese, 407 (43.1%) pre-obese, 1,045 (35.1%) normal weight and 64 (24.5%) underweight women. The relative risk for cesarean delivery in obese women was 1.8 (95% CI: 1.5-2.0) compared to normal weight women. Greater weight gain was particularly associated with cesarean among the obese (RR 4th vs 2nd weight gain quartile 2.2; 95% CI: 1.4-3.2). Increased weight at the beginning of pregnancy was associated with a significantly higher adjusted risk of meconium with vaginal delivery and perinatal death and infection in women submitted to cesarean section. Similarly, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women submitted to vaginal delivery and for prematurity with cesarean. CONCLUSIONS: Pre-gestational obesity and greater weight gain independently increase the risk of cesarean delivery, as well as of several adverse outcomes with vaginal delivery. These findings provide further evidence of the negative effects of prepregnancy obesity and greater gestational weight gain on pregnancy outcomes.OBJETIVO: Avaliar a associação de obesidade pré-gestacional e ganho de peso excessivo com cesariana e outras complicações do parto. MÉTODOS: Um total de 4.486 mulheres com 20-28 semanas de gravidez do pré-natal geral do Sistema Único de Saúde de seis capitais brasileiras foram arroladas entre 1991-1995 e seguidas até o parto. As categorias do índice de massa corporal e o ganho de peso total foram calculados com base no peso pré-gestacional. Associações entre estas categorias nutricionais e complicações do parto foram ajustadas por regressão logística. RESULTADOS: A obesidade foi observada em 308 (6,9%) pacientes. As cesarianas ocorreram em 164 (53,2%) obesas, 407 (43,1%) pré-obesas, 1.045 (35,1%) normais e em 64 (24,5%) mulheres de baixo peso. O risco relativo para cesariana na comparação de obesas com grávidas de peso normal foi 1,8 (IC 95%: 1.5-2.0). Ganho de peso excessivo mostrou a maior associação com cesariana entre obesas (RR=2,2; IC 95%: 1,4-3,2) para 4º vs 2º quartil. Maior peso pré-gravídico esteve associado com risco ajustado significativamente aumentado para mecônio no parto vaginal e com prematuridade, morte perinatal ou infecção na cesariana. Similarmente, grande ganho de peso aumentou o risco para mecônio e hemorragia materna no parto vaginal e com prematuridade na cesariana. CONCLUSÕES: A obesidade pré-gestacional e o ganho de peso excessivo aumentaram de forma independente o risco de cesariana e vários resultados adversos durante o parto vaginal. Esses achados oferecem evidências adicionais aos efeitos negativos da obesidade pré-gravídica e do ganho de peso excessivo na gravidez e parto.

Introduction: In the Netherlands, low-risk pregnancies are managed by midwives in primary care. Despite strict definitions of low risk, obstetric complications can occur. Midwives seldom encounter uncommon labour complications, but are sufficiently trained to manage these. We assessed neonatal and maternal outcome after management of shoulder dystocia in primary midwifery care. Materials and Methods: In this 2-year prospective cohort study from April 2008 to April 2010, primary-care midwives, who participated in an obstetric emergency course, reported all obstetric complications. Main outcome was neonatal and maternal outcome. Results: In sixty-four cases of shoulder dystocia McRoberts was the first maneuver in 42/64 (65.6%) cases with a success rate of 23.8%. All-fours maneuver was most frequently used as the second maneuver (24/45; 53.3%). No neonatal mortality occurred, none of the infants suffered from hypoxic ischemic injury, two (3.1%) had transient brachial plexus injuries, two (3.1%) had fractured clavicles and one (1.6%) had a fractured humerus. Eight (12.5%) neonates were successfully resuscitated because of birth asphyxia. All infants fully recovered. In neonates with immediate adverse outcome significantly more maneuvers were used compared with those without adverse neonatal outcome (p = 0.02). Postpartum hemorrhage occurred in 2/64 (3.1%) women, deep vaginal lacerations in 2/64 (3.1%), perineal tears in 23/64 (35.9%). No anal sphincter injuries occurred. Conclusions: McRoberts and all-fours maneuvers are widely used by primary-care midwives in the management of shoulder dystocia. Low rates of adverse neonatal and maternal outcomes were observed in cases of shoulder dystocia up to 6 weeks postpartum. [ABSTRACT FROM AUTHOR]

Objective: To analyze the obstetric and gynecologic history of women with uterine rupture during pregnancy, and examine maternal and perinatal morbidity and mortality outcomes after uterine rupture. Materials and Methods: A retrospective review of patients with rupture of the gravid uterus at Mackay Memorial Hospital, for the period between January 1984 and September 2003, was undertaken. The records of these patients were studied with regard to previous cesarean section, the use of uterine stimulants, the use of instruments in delivery, clinical features, treatment modality, and maternal and fetal morbidity and mortality. Results: A total of 21 cases of rupture of the gravid uterus were found. The prevalence of uterine rupture was 1 in 6,056 deliveries. The most common risk factor was previous cesarean section scar (48%). Fetal distress (43%) and postpartum hemorrhage (24%) were the two most common manifestations of ruptured uterus. Fourteen cases were term pregnancies. However, seven cases presented before term, including one in the first trimester, two in the second trimester, and four in the early third trimester. There was only one maternal death (5%), but five cases (24%) presented with intrauterine fetal demise. Conclusion: Physicians should be alert to the possibility of uterine rupture at all stages of pregnancy. The ability to recognize the various signs of a possible rupture event, such as fetal distress, maternal pain, or hypotension, and then to address the situation immediately, is critical to a good outcome.

OBJETIVO: Analisar as complicações maternas associadas ao tipo de parto e comparar o parto cesáreo com o via vaginal. MÉTODOS: Estudo retrospectivo de 1.748 partos realizados em hospital universitário de São Paulo no período de abril a dezembro de 2001, cujos recém-nascidos apresentaram peso superior a 500 gramas. Foram analisadas as complicações maternas ocorridas durante o parto e as diagnosticadas durante o puerpério, necessitando de nova internação da paciente. Para análise estatística, foram utilizados o teste t de Student e o teste Exato de Fisher. Adotou-se como nível de significância o valor de 0,05. RESULTADOS: O parto cesáreo foi realizado em 988 pacientes (56,5%) e o por via vaginal em 760 (43,5%). As complicações hemorrágicas ocorreram em 1,2% dos casos de cesárea e em 0,8% dos casos de parto via vaginal, sem diferença significativa entre esses grupos. A endometrite ocorreu em 0,4% dos casos de cesárea e em 0,1% dos partos por via vaginal, não sendo observada diferença significativa. Dois casos de infecção puerperal evoluíram para histerectomia no grupo cujo parto foi cesáreo. Não foi observado nenhum caso de óbito materno relacionado à cesárea. CONCLUSÕES: Não foram constatadas associações entre as complicações maternas e o tipo de parto no período analisado.OBJECTIVE: To analyze maternal complications associated to type of delivery, comparing cesarean (c-) section with vaginal delivery. METHODS: Retrospective study of 1,748 deliveries carried out at a university hospital in the city of São Paulo, Southeastern Brazil, in which the newborn weighed more than 500 g. Maternal complications occurred during delivery as well as those diagnosed during puerperium that required further hospital admission were analyzed. Statistical analyses included Student's t test and Fisher's Exact test. Significance level was set at 0.05. RESULTS: C-sections were performed on 988 patients (56,5%). Hemorrhagic complications occurred in 1.2% of c-sections and in 0.8% of normal deliveries, with no statistically significant difference between both groups. Endometritis was observed in 0.4% of c-sections and in 0.1% of vaginal deliveries, without statistically significant difference. Two cases of puerperal infection evolved to hysterectomies, in the c-section group. There were no maternal deaths related to c-section. CONCLUSIONS: No associations were found between maternal complications and type of delivery in the period analyzed.

Objective(s): To evaluate the outcomes of pregnancies complicated by umbilical cord entanglement. Material & Methods: We selected pregnant women who referred to Niknafs maternity hospital with singleton, vertex and term pregnancy. Pregnancies with infants with no umbilical cord entanglement served as comparison group. Results: Of the 4 78 deliveries, the frequency of umbilical cord entanglement was 40.17%. The frequency of nuchal cord entanglement was 34.3% and around limbs or trunk was 5%. The frequency of two or more cord entanglements at delivery was 6.49%. Pregnancies with umbilical cord entanglement were more likely to exhibit an abnormal fetal heart rate pattern (P

Objective To evaluate national cesarean section ( CS) rates and other obstetric indicators after a concerted action to reduce CS rates was undertaken in Portugal from 2010 onwards. This action was based on the transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding. Design Retrospective observational population-based study. Setting Portugal. Population Births occurring in Portugal between 2000 and 2014. Methods Governmental sources were used to obtain data on national CS, perinatal and maternal mortality rates. Rates of instrumental vaginal delivery, vaginal birth after cesarean ( VBAC), hypoxia-related complications and perineal lacerations were retrieved for state-owned hospitals. Main outcome measures CS, perinatal and maternal mortality, instrumental vaginal delivery, VBAC, hypoxia-related complications and perineal lacerations. Results After a continuous rise between 2000 and 2009, national CS rates declined significantly over the following 5 years (36.6% vs. 33.1%, time trend p ≤ 0.001). Perinatal mortality maintained a downward trend during this period, while maternal mortality remained unchanged. Rates of instrumental vaginal delivery, VBAC and perineal lacerations increased, while the incidence of hypoxia-related complications decreased. Conclusions A concerted action based on the transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding, was followed by a significant reduction in national CS rates, as well as an improvement in most related obstetric indicators. There may be an association between the reported intervention and the observed changes. [ABSTRACT FROM AUTHOR]

Puerperal uterine inversion is a severe but rare obstetric complication of yet unknown origin. In this two-year study we determine the incidence of this complication and we describe associated risk factors to expose its etiology. All cases of uterine inversion were included from a nationwide cohort study which contained all 98 hospitals with a maternity unit in the Netherlands. We reviewed the medical records of 15 patients, resulting an incidence of approximately 1 in 20 000 vaginal births. Fourteen cases (93.3%) were classified as low-risk pregnancies at booking. Nulliparous women were not overrepresented and the main associated factors were signs of prolonged labor followed by third stage manipulation. This study is the first population-based study for uterine inversion. With the reported associated factors and occurrence in women with a low-risk profile, we show that every birth attendant should be able to detect this rare but severe complication. [ABSTRACT FROM AUTHOR]

Background: Many women suffer from perineal trauma during the normal vaginal delivery. Perineal trauma is mainly associated with pain and complications after the childbirth. Perineal management techniques can play a significant role in perineal trauma reduction. This study aimed to compare the effects of perineal management techniques (hands-off technique, Ritgen maneuver and perineal massage using a lubricant during delivery) on the labor complications.. Materials and Methods: This quasi-experimental clinical trial was conducted on 99 primiparous women who referred to Daran Hospital, Isfahan, Iran for normal vaginal delivery in 2009. The subjects were selected using a convenient method and randomly assigned to three groups of Ritgen maneuver, hands-off technique and perineal massage with lubricant. A questionnaire was used to determine the demographic characteristics of the participants and complications after birth. The short form of McGill Pain Questionnaire and the visual analogue scale for pain were also employed. The incidence and degree of perineal tears were evaluated immediately after delivery. Moreover, the incidence and severity of perineal pain were assessed 24 hours and also 6 weeks after delivery. Findings: In the Ritgen maneuver group, the frequency of tears, the relative frequency of tear degrees, the severity of perineal pain 24 hours after delivery and the frequency of pain and perineal pain severity 6 weeks after delivery were significantly different from the other two methods. Conclusions: Hands-off technique during parturition of the neonate's head was associated with fewer complications after delivery. It was even better than perineal massage during the parturition. [ABSTRACT FROM AUTHOR]

Abstract: Maternal death, in which prolonged labor is the third leading cause, accounts for 20% of deaths among women in Bangladesh. This study describes the process of recognition and response to symptoms during potential prolonged labor among 17 women in three sites in Bangladesh. In October–December 2008, integrated illness history interviews were conducted with women and confirmed and/or supplemented by family and/or birth attendants present during labor. Interviews elicited participants’ recognition of symptoms and care-seeking reactions and recorded responses in time-by-event matrices. Interviews were conducted in Bangla, recorded, transcribed, and translated into English. The most frequent and usually first action was to seek care from untrained attendants at home, then from professional attendants outside the home. Care-seeking outside the home occurred a median of 19 h after perceived labor onset. Delays in care-seeking arose for reasons related to: (1) confusion over the onset of labor, (2) power processes inhibiting women’s disclosure of labor symptoms, (3) the practice of “waiting for delivery,” and (4) preferences for home delivery. Strategies to encourage lay recognition of and response to prolonged labor should consider women’s misinterpretation and non-disclosure of labor pain, health beliefs surrounding the labor process, and fears of medical intervention. [Copyright &y& Elsevier]

To investigate the possible association of obstetric complications and autistic disorder, we performed a review of case-control studies of any obstetric complication in autistic disorder. If the odds ratio = {(Number of cases with autistic disorder with any obstetric complication)/(Number of cases with autistic disorder without any obstetric complication)}/{(Number of controls without autistic disorder with any obstetric complication)/(Number of controls without autistic disorder without any obstetric complication)} <1, then there are more complications in controls; =1, then complications are equal in cases and controls; and >1, then there are more complications in cases. Most publications do not provide the raw data to calculate the odds ratio. Many calculated odds ratios support the hypothesis that cases with autism have more obstetric complications. Further investigation is warranted to clarify the relationships between obstetric complications and autism and related conditions in the general population worldwide. [ABSTRACT FROM AUTHOR]

The latent phase of labor is complex and not completely understood by modern science. Studies often ignore evaluation of this phase of labor because determination of onset is subjective. In this article, the definition and time parameters of latent phase labor are discussed, and generalized distinctions between prelabor and labor are evaluated. Outpatient relief measures for latent phase as well as inpatient medical interventions for prolonged latent phase of labor are reviewed. Recommendations for policy development are included along with a discussion about the need to consider the significance of time limits. For optimal outcomes, clinicians are encouraged to individualize a management plan that is made in collaboration with the laboring woman. [Copyright &y& Elsevier]

Several reports have suggested an association between obstetric complications and autistic disorder. Since conclusions may be drawn from case-control studies, a methodology to identify case-control studies of autistic disorder and obstetric complications for qualitative and quantitative reviews is needed. We sought to establish the feasibility of blinding of reports as a means to remove biases in meta-analyses of case-control studies of autism and obstetric complications. Therefore, we located published reports of case-control studies of autistic disorder and obstetric complications by a literature search and additional articles. The methods or other appropriate portions of the articles were blindly reviewed for the presence or absence of obstetric complications in cases with autistic disorder matched with at least one control without autistic disorder. Good inter-rater reliability was obtained for case-control studies of autistic disorder (74.6% agreement and κ=.451) and for obstetric complications (84.0% agreement and κ=.658). [ABSTRACT FROM AUTHOR]

Background:Rupture of the unscarred uterus is a rare and potentially catastrophic event. We retrospectively reviewed the records of patients with this condition to analyze their obstetric and gynecologic history and evaluate maternal and perinatal morbidity and mortality. Methods:A total of 11 cases of rupture of the unscarred gravid uterus were managed at Mackay Memorial Hospital from January 1984 to September 2003. Data extracted from the records included the use of uterine stimulants, instrumental delivery, and prior abortion by instrumentation, clinical features, treatment, and maternal and fetal morbidity and mortality. Results:The incidence of unscarred uterine rupture is 0.009% during the 20-year study period. The most common contributing factors were prior abortion by instrumentation and the use of uterotonic agents, in three cases respectively. Fetal distress occurred in six cases and postpartum hemorrhage in two. There was no maternal death, but in two cases, there was intrauterine fetal demise or perinatal death. Conclusion:Though unexpected in a woman with an unscarred uterus, rupture should be considered as a possible cause of fetal distress or unusual pain or hypotension in the mother. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Labor and delivery units are often used to provide care for nonlaboring patients requiring intensive medical and nursing care. The utilization of labor beds in this manner, however, can result in a shortage of beds for those patients who are truly in labor. Unfortunately, patient dissatisfaction, use of supplemental staffing, and ill-prepared, overworked nurses can then become the result of this practice. Clearly, an improved, innovative model of providing care for high-risk perinatal patients is needed. The purpose of this article is to describe how one hospital and its interdisciplinary team met the challenge of providing expert care for complex perinatal patients by creating a unique model of patient care delivery, the perinatal special care unit (PSCU). An advanced practice nursing role, the perinatal nurse practitioner (PNNP) was implemented to provide collaborative care for these patients. This article includes a discussion of positive and negative outcomes that occurred after the PSCU became a reality. Overall, housing patients on the PSCU has eliminated inappropriate use of labor and delivery beds and has led to a more satisfying childbearing experience for all involved. [ABSTRACT FROM AUTHOR]

The purpose of this article is to help nurses understand how to quickly and effectively manage the nursing care of patients with perinatal hemorrhage. The etiology, symptoms, medical management, and nursing care of the patient experiencing a perinatal hemorrhage are discussed. Hemorrhage during the antepartum, intrapartum, or post-partum period is a life-threatening emergency for the mother and/or fetus. Early antepartum hemorrhage (before 20 weeks gestation) can be related to abortion/miscarriage, ectopic pregnancy, or gestational trophoblastic disease; late antepartum hemorrhage (after 20 weeks gestation) may result from placental abruption and placenta previa. Intrapartum hemorrhage is most commonly due to placental abruption, or to uterine rupture, uterine inversion, invasive conditions of the placenta, or complications of Cesarean birth. Postpartum hemorrhage is defined as blood loss greater than 500 ml in a vaginal delivery or 1000 ml in a Cesarean birth; early postpartum hemorrhage occurs during the first 24 hours after delivery; late postpartum hemorrhage occurs after the first 24 hours after delivery. The most common cause of postpartum hemorrhage is uterine atony; however, lacerations, hematomas, and subinvolution of the uterus can also cause postpartum hemorrhage. Nurses who understand how to assess, plan, intervene, and evaluate outcomes for perinatal hemorrhage are in the position to prevent the major tragedies that can accompany hemorrhage in pregnancy and shortly afterward. [ABSTRACT FROM AUTHOR]