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Introduction: There is an increase in women delivering ≥35 years of age. We analyzed the association between advanced maternal age and pregnancy outcomes in late- and postterm pregnancies., Material and Methods: A national cohort study was performed on obstetrical low-risk women using data from the Netherlands Perinatal Registry from 1999 to 2010. We included women ≥18 years of age with a singleton pregnancy at term. Women with a pregnancy complicated by congenital anomalies, hypertensive disorders or diabetes mellitus were excluded. Composite adverse perinatal outcome was defined as stillbirth, neonatal death, meconium aspiration syndrome, 5-minute Apgar score <7, neonatal intensive care unit admittance and sepsis. Composite adverse maternal outcome was defined as maternal death, placental abruption and postpartum hemorrhage of >1000 mL., Results: We stratified the women into three age groups: 18-34 (n = 1 321 366 [reference]); 35-39 (n = 286 717) and ≥40 (n = 40 909). Composite adverse perinatal outcome occurred in 1.6% in women aged 18-34, 1.7% in women aged 35-39 (relative risk [RR] 1.06, 95% confidence interval [95% CI] 1.03-1.08) and 2.2% in women aged ≥40 (RR 1.38, 95% CI 1.29-1.47), with 5-minute Apgar score <7 as the factor contributing most to the outcome. Composite adverse maternal outcome occurred in 4.6% in women aged 18-34, 5.0% in women aged 35-39 (RR 1.08, 95% CI 1.06-1.10) and 5.2% in women aged ≥40 (RR 1.14, 95% CI 1.09-1.19), with postpartum hemorrhage >1000 mL as the factor contributing most to the outcome. In all age categories, the risk of adverse pregnancy outcomes was higher for nulliparous than for multiparous women. The risk of adverse outcomes increased in both nulliparous and parous women with advancing gestational age. When adjusted for parity, onset of labor and gestational age, advanced maternal age is associated with an increase in both composite adverse perinatal and maternal outcomes., Conclusions: The risk of adverse pregnancy outcome increases with advancing maternal age. Women aged ≥40 have an increased risk of adverse perinatal and maternal outcome when pregnancy goes beyond 41 weeks., (© 2020 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Introduction: Vaginismus is a severe dysfunction and a problem which can interfere with woman's and couple's sex life. It may influence the obstetric outcome. This study aims to determine if the clinical features of vaginismus can impact childbirth experience., Methods: We conducted a retrospective multicenter study involving patients affected by primary vaginismus, having given birth to their first child (who had reached term), between 2005 and 2015., Results: Out of 19 patients included in the study, 9 had prolonged pregnancies, 14 had spontaneous labor (including 8 at term), 3 had cesarean section before going into labor and 2 had labor induction. Among the 16 women who experienced labor, 4 had cesarean section, 5 had vaginal delivery with the help of forceps and 7 had spontaneous vaginal delivery. Among the 12 women who had vaginal delivery, 9 underwent episiotomy, 7 had spontaneous perineal tear alone or in combination with episiotomy. No 3 rd and 4 th degree perineal injury or intact perineum were found. The average birth weight for babies was 3380 g ± 332 (2870 g-3970g, 47 th percentile)., Conclusion: The rates of labour dystocia and perineal morbidity were significantly high. These data were comparable to most of the data in the literature. It is likely that the psychological and behavioral aspects of vaginismus (fear-avoidance and anxiety-inducing mechanism) have favoured prolonged pregnancies, cesarean sections, mechanical dystocias and perineal injuries. Additional studies are necessary to better identify vaginismus and its obstetrical implications., Competing Interests: Les auteurs ne déclarent aucun conflits d’intérêts.

Objective: To investigate whether new national guidelines of routine induction of labour and increased surveillance in low risk pregnancies at 41 +2-5 weeks of gestation as an alternative to expectant management until 42 +0 weeks of gestation has improved perinatal outcome., Methods: A questionnaire-based study regarding local induction practices among all Danish delivery units and a cross-sectional population-based registry study based on data from the Danish Medical Birth Registry (DMBR) in the years 2009-2012., Outcome Measures: Primary outcomes were frequencies of induced labour and perinatal mortality; secondary outcomes were indicators of perinatal morbidity and instrumental delivery rates., Results: The questionnaire data showed that 22 of the 24 Danish delivery units complied with the new guidelines in 2012. The study population retrieved from the DMBR included 36,845 low-risk pregnancies at or beyond 41 +2 weeks of gestation. The number of labour inductions within the study population had doubled after implementation of the new guideline. The increased proportion of induced labour did not appear to influence perinatal morbidity or instrumental delivery rates. Perinatal mortality remained steady in the years 2009, 2010 and 2011 whereas a reduction of 60 % was seen in 2012. However, this change was not statistically significant (P = 0.10)., Conclusion: This population-based study with a high reported adherence to the new national guideline found no changes in instrumental deliveries or perinatal outcomes after implementation of earlier routine induction of labour and increased surveillance in low risk pregnancies., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: To assess the recurrence rate of postterm delivery (gestational age at or beyond 42+0 weeks or 294 days) and to describe maternal and perinatal outcomes after previous postterm delivery., Study Design: From the longitudinal linked Netherlands Perinatal Registry database, we selected all singleton primiparous women who delivered between 37+0 and 42+6 weeks with a subsequent singleton pregnancy from 1999 to 2007. We excluded congenital abnormalities. We compared the recurrence rate of postterm delivery and risk of antenatal fetal death in women with and without a postterm delivery in their first pregnancy. We compared perinatal outcome (composite of perinatal mortality, Apgar score <7 and birth injury) and adverse maternal outcome (composite of maternal death, abruptio placentae, PPH>1000ml and blood transfusions) between women with a recurrent and a de novo postterm second pregnancy., Results: Our study population consisted of 233,327 women of whom 17,874 (7.7%) delivered postterm in the first pregnancy. In the second pregnancy, 2678 (15%) women had a recurrent postterm delivery compared to 8698 (4%) women with a de novo postterm delivery (odds ratio (OR) 4.2 95% confidence interval (CI) 4.0-4.4). Subgroup analysis in recurrent and de novo postterm delivery showed no differences in composite perinatal and composite maternal outcome (OR 1.0; CI 0.7-1.5, p=0.90 and OR 1.1, CI 0.9-1.4, p=0.16), adjusted for fetal position and mode of delivery)., Conclusions: Women with a postterm delivery in the first pregnancy have a higher risk of recurrent postterm delivery. Our data suggest that there is no difference in the composite adverse perinatal outcome between recurrent and de novo postterm delivery., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: To estimate the frequency of prolonged pregnancy and study its associated maternal morbidity., Methods: Abstracts and articles were searched using Pubmed and Cochrane Library., Results: Nearly 15% of pregnant women in France are concerned by prolonged pregnancy (≥41(+0) weeks), whereas post-term pregnancy (≥42(+0) SA) only concern 1% of them. The post-term pregnancy frequency is heterogeneous between Europe and United States. It varies between 0.5% and 10% (EL2). In Europe, Scandinavian countries present discrepancies with high proportions of post-term pregnancies between 5 and 7%. These observations identified time variations and variations between countries. They can be explained by two factors: pregnancy datation by ultrasound and the evolution of labor induction practices. Moreover, post-term pregnancy constitute a risk factor of maternal complications as: cesarean section, postpartum haemorrhages, infections and perineum lacerations (EL2). On the contrary, limited conclusions about associations between prolonged pregnancies and labor inductions are due to insufficient data and the lack of high quality studies. Nowadays, we still ignore if labor inductions in the particular context of prolonged pregnancies are associated or not to an increase of maternal morbidities., Conclusion: Prolonged pregnancy is associated with an excess of maternal morbidity., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: Laboratory workers are commonly exposed to chemical, biological and physical agents. They also may adopt poor postures for long periods and be engaged in moving and handling. These factors may increase the risk of adverse pregnancy outcome in female laboratory workers., Aims: To assess whether laboratory work during pregnancy increases the risk of adverse pregnancy outcomes., Methods: The 1990-2006 Finnish Medical Birth Registry was used to identify all singleton newborns of all Finnish laboratory workers (n = 5425) and those of teachers (n = 21,438) as the reference population. The main outcomes were sexual differentiation (female gender), low birth weight, high birth weight, preterm delivery, post-term delivery, small-for-gestational age (SGA), large-for-gestational age and perinatal death. The generalized estimating equation (GEE) analysis was used to estimate odds ratios (ORs) adjusted for maternal age, parity, marital status and maternal smoking during pregnancy., Results: In the GEE analysis, the risk of low birth weight (adjusted OR: 1.27, 95% CI: 1.08-1.45) and SGA (adjusted OR: 1.27, 95% CI: 1.02-1.52) was higher in laboratory workers than in teachers. Correspondingly the prevalence of high birth weight (> or = 4000 g) was lower in newborns of laboratory workers (adjusted OR: 0.90, 95% CI: 0.83-0.98). The prevalence of post-term deliveries was close to being significantly higher among newborns of laboratory workers (adjusted OR: 1.16, 95% CI: 1.00-1.31)., Conclusions: This large population-based study provides evidence that laboratory work may be associated with reduced foetal growth.

Objective: We sought to estimate when rates of maternal pregnancy complications increase beyond 37 weeks of gestation., Study Design: We designed a retrospective cohort study of all low-risk women delivered beyond 37 weeks' gestational age from 1995 to 1999 within a mature managed care organization. Rates of mode of delivery and maternal complications of labor and delivery were examined by gestational age with both bivariate and multivariable analyses., Results: We found that, among the 119,254 women who delivered at 37 completed weeks and beyond, the rates of operative vaginal delivery (OR 1.15, 95% CI 1.09, 1.22), 3rd- or 4th-degree perineal laceration (OR 1.15, 95% CI 1.06, 1.24), and chorioamnionitis (OR 1.32, 95% CI 1.21, 1.44) all increased at 40 weeks as compared to 39 weeks of gestation (P < .001), and rates of postpartum hemorrhage (OR 1.21, 95% CI (1.10, 1.32), endomyometritis (OR 1.46, 95% CI 1.14, 1.87), and primary cesarean delivery (1.28, 95% CI 1.20, 1.36) increased at 41 weeks of gestation (P < .001). The cesarean indications of nonreassuring fetal heart rate (OR 1.81, 95% CI 1.49, 2.19) and cephalo-pelvic disproportion (OR 1.64, 95% CI 1.40, 1.94) increased at 40 weeks of gestation (P < .001)., Conclusion: We found that the risk of maternal peripartum complications increase as pregnancy progresses beyond 40 weeks of gestation. Management of pregnancies that progress past their EDC should include counseling regarding the risks of increasing gestational age.

Background: The objective of this study was to determine the outcome of pregnancy in post-term cases compared with term cases in a well defined population receiving modern obstetric care., Methods: We utilized the population-based birth registry data of the Kuopio University Hospital (1990-2000) to investigate pregnancy outcome in 1,678 post-term singleton pregnancies. The general obstetric population (n=22,712) was used as a reference group in logistic regression analysis., Results: The overall frequency of post-term pregnancies was 6.9% and the incidence of post-term pregnancies was found to be increased in obese, primiparous, and smoking women, whereas in women with chronic diseases and obstetric risks deliveries were induced earlier. The risks of macrosomia, maternal complications, and operative deliveries were increased in post-term pregnancies. Post-term infants experienced meconium passage (21.2% versus 12.8%) (p<0.01) and intrapartum asphyxia (3.4% versus 2.1%) (p<0.01) significantly more often than the controls. However, the stillbirth rate was low, probably due to careful monitoring of these pregnancies., Conclusions: Although high-risk pregnancies were not allowed to come post-term, postmaturity per se is a moderate risk state compromising fetal well-being with regard to meconium passage and acid-base status at birth. We conclude that simple antenatal monitoring beyond 42 weeks reduces perinatal mortality but is inefficient in reducing meconium-stained liquor seen with increasing gestation.

To compare labour and delivery outcomes in women undergoing induction and those having spontaneous onset for pregnancies past the estimated date of delivery, a prospective study of 395 singleton, uncomplicated pregnancies was performed. Labour was induced in 175 women. Overall caesarean section rate was 9.4%, with no significant difference between the 2 groups. Overall rate of assisted vaginal deliveries was 7%, higher in the induction group than the spontaneous onset group but the difference was not significant. There was no significant difference in occurrence of intrapartum meconium, nor for maternal morbidity. No neonate needed intubation. No perinatal deaths occurred. Perinatal mortality and morbidity are preventable, and induction of labour before 42 weeks is justifiable to prevent adverse outcomes.