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Purpose: To revisit risk factors of major obstetric hemorrhage in a large obstetric center. Study design: A retrospective case control study was conducted based on institutional electronic database and blood bank registry of a single center, 2005-2014. The major obstetric hemorrhage event was defined as transfusion of ≥5 red blood cells units within 48 h of birth and compared to matched group (ratio 1:4) based on the time of birth. Multivariable stepwise backward logistic regression models were fitted to determine risk factors for major obstetric hemorrhage. Odds ratio (OR), further evaluated by standard measures of the predictive accuracy of the logistic regression models, C statistics, and associated neonatal adverse outcome are reported. Results: 113,342 women delivered during the study; 122 (0.1 %) women experienced major obstetric hemorrhage. There was one major obstetric hemorrhage fatality (0.8 %). Compared to the controls, we identified historical as well as significant current modifiable risk factors for major obstetric hemorrhage: multifetal pregnancy (OR 3.92; 95 % CI 1.34-11.52; p = 0.013), induction of labor (OR 2.81; 95 % CI 1.22-7.05; p = 0.027), cesarean section (OR 25.56; 95 % CI 12.88-50.75; p < 0.001), and instrumental delivery (OR 6.58; 95 % CI 2.36-18.3; p < 0.001). C statistics of the model for major obstetric hemorrhage prediction was 0.919 (95 % CI 0.890-0.948, p < 0.001). Conclusion: Major obstetric hemorrhage is a rare event with potentially modifiable risk factors which represent a platform of interventions for lessening obstetric morbidity. [ABSTRACT FROM AUTHOR]

Background: Quantitative sensory testing (QST) measures response to painful stimuli and has been used to predict post-caesarean pain. Pain reported upon intravenous cannulation was shown to predict epidural analgesic use and pain intensity during labour. We hypothesized that pain intensity reported by women upon local anaesthesia injection (ILA) for spinal anaesthesia may predict acute pain after caesarean delivery (CD).Methods: In a prospective observational trial, 229 women undergoing elective CD under spinal anaesthesia were enrolled. Using standardized script before ILA, women received ILA (lidocaine 1% 2.5 mL via 25 G needle), and provided an ILA score after the injection [verbal numeric pain scale (VNPS); 0-100]. Demographic data, average, peak pain (at rest, with movement and uterine cramping) and analgesic requests were recorded for the first 24 h.Results: Fourteen percent of women experienced severe pain (VNPS ≥70) upon ILA. Good correlation was noted between ILA and pain scores at rest and upon mobilization during the 24 h following surgery (average resting pain r = 0.529, p < 0.001, average pain at mobilization r = 0.483, p < 0.0001). Severe acute postoperative pain (VNPS ≥70) was predicted by severe ILA pain with a sensitivity of 91.6% and specificity of 93.3%.Conclusion: This is the first study evaluating a clinical measure to predict post-caesarean pain. Our main findings were that 14% of women experience severe pain upon ILA, which was associated with increased pain during the first 24 h. [ABSTRACT FROM AUTHOR]

Purpose: Delayed childbearing is increasingly common; hence, concerns emerge regarding potential for additional risks of delivery at advanced maternal age (AMA; ≥35 years). In this study, we sought to assess impact of AMA and parity on maternal and perinatal outcomes. Methods: In this retrospective single-center study (July 2005 to October 2011), we compared spontaneously-conceived singleton births of AMA mothers with spontaneously-conceived singletons of mothers aged 24-27 years. Maternal outcomes: incidence of diabetes, hypertension, and emergency cesarean sections (ECS). Neonatal outcomes: prematurity, birth weight, incidence of small or large for gestational age infants (SGA/LGA, respectively), low birth weight (LBW), and 5′-Apgar scores. Sub-groupings of maternal age were 35-38, 39-42, or 43-47 years; prematurity as <34 or <37 weeks; AMA parity as primiparous, 2-5 births, 6-9 births, or ≥10 births. Binary logistic regression was used for multivariate analyses. Results: Of 24,579 eligible women, 11,243 were AMA (14.0 % total singleton births) and 13,336 were aged 24-27 years (16.7 % total singleton births) at delivery. There were no maternal or perinatal deaths. Incidence of maternal hypertension and diabetes was significantly greater in AMA, especially oldest AMA. AMA including primiparous had significantly more ECS than younger including primiparous controls, respectively, and were more likely to deliver LGA neonates. Primiparous AMA women did not have increased incidence of LGA babies but significantly increased incidence of SGA infants. Conclusion: AMA, especially primiparous, has more adverse maternal and neonatal outcomes than younger women; however, these did not include mortality. Consistent antenatal care may explain this. [ABSTRACT FROM AUTHOR]

Objectives: Cervical incompetence complicates approximately 1 in 500 pregnancies and is the most common cause of second-trimester spontaneous abortion and preterm labor. No prospective or large retrospective studies have compared regional and general anesthesia for cervical cerclage. Study design: Following IRB approval, we performed a retrospective study in the two main medical centers over an 8-year period to assess the association of anesthesia choice with anesthetic and obstetric outcomes. Anesthetic and perioperative details were retrospectively collected from fails of all patients undergoing cervical cerclage from 01/01/2005 until 31/12/2012. Details included demographic data, anesthetic technique, PACU data and perioperative complications. Results: We identified 487 cases of cervical cerclage in 327 women during the study period. The most commonly used anesthetic technique was general anesthesia (GA) (402/487; 82.5 %) compared with regional anesthesia (RA) (85/487; 17.5 %). When GA was performed, facemask was the most commonly used technique (275/402; 68.4 %), followed by intravenous deep sedation (61/402; 15.2 %); LMA (51/402; 12.7 %) and tracheal intubation (13/402; 3.2 %). There were no significant differences in demographic characteristics between women receiving general and regional anesthesia. Average duration of suturing the cervix among the GA group was 9.8 ± 1.6 and 10.6 ± 2.1 min in the RA group ( p < 0.001). Average length of stay in the operating room in the GA group was 20.5 ± 3.9 and 23 ± 4.6 min in the RA group ( p < 0.001). Patients receiving GA received in the PACU more opioids (6.2 versus 1.2 %; p < 0.05) and more non-opioids analgesics (36.8 versus 9.4 %; p < 0.001). Duration of PACU stay was shorter after GA (49.5 ± 18 min) than after RA (62.4 ± 28 min; p < 0.001). There were no other differences in anesthetic or perioperative outcome between groups. This study was not designed to provide evidence that RA reduces the risk of pulmonary aspiration, airway complications or adverse fetal neurological effects from maternal anesthetic exposure. Conclusions: Both regional and general anesthesia were safely used for the performance of cerclage. Patients after general anesthesia had a shorter recovery time but a higher demand for opioids and non-opioids analgesia. [ABSTRACT FROM AUTHOR]