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Objective: The aim of this study was to assess the usefulness of routine hemoglobin testing following elective and urgent cesarean section (CS) in patients without primary postpartum hemorrhage (PPH). Methods: This retrospective cohort study included women who underwent vaginal delivery (VD), elective CS, and urgent CS at Carmel Medical Center from 2015 to 2020. Data were extracted from the obstetric database, excluding deliveries with PPH. Demographic and obstetric variables were recorded. Primary outcomes were the need for packed red blood cell transfusion. Results: A total of 19 446 women were included, with five (0.3%) requiring a blood transfusion in the elective CS group, 27 (0.17%) in the VD group, and eight (0.4%) in the urgent CS group. Urgent CS was associated with a higher risk of blood transfusion, but there was no significant difference between elective CS and VD. Elective CS showed the lowest rates of post‐delivery hemoglobin below 7 g/dL 1 (0.1%) compared to VD 16 (0.6%) and urgent CS 13 (0.7%). Conclusion: Routine postoperative hemoglobin testing following elective CS in asymptomatic patients without PPH appears unnecessary. This study supports reconsidering routine hemoglobin testing following elective CS, aligning with the goal of optimizing resource utilization while maintaining patient quality. Synopsis: We found that routine postoperative hemoglobin testing following elective cesarean section in asymptomatic patients without postpartum hemorrhage appears unnecessary. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate the optimal timing for fetal weight estimation during the third trimester.This retrospective cohort study involved fetal weight estimations from both early (28+0–36+6 weeks) and late (37+0 weeks and beyond) third trimester. These estimations were converted to predicted birth weights using the gestation‐adjusted projection formula. Birth weight predictions were compared with actual birth weights, to identify the most effective timing for weight prediction.The study included 3549 cases, revealing mean percentage errors (MPE) of −3.69% for early sonographic assessments, −2.5% for late sonographic assessments, and −1.9% for late clinical assessments. A significant difference was found between early and late sonographic estimations (P < 0.001), whereas late sonographic and clinical assessments did not differ significantly (P = 0.771). Weight predictions for fetuses below the 10th and above the 90th centiles were less accurate than for those within the 10th–90th centiles (P < 0.001). In women with obesity, late clinical estimations were less precise (MPE of −5.85) compared with non‐obese women (MPE of −1.66, P < 0.001). For women with diabetes, early sonographic estimations were more accurate (MPE of −1.31) compared with non‐diabetic patients (MPE of −3.94, P < 0.001) though this difference did not persist later in pregnancy.Sonographic and clinical weight predictions in the late third trimester were more accurate than earlier third‐trimester sonographic assessments, hence continuous follow up and assessments closer to term are important. In women with diabetes, no adjustments in weight prediction methods are necessary. Accurately predicting birth weights for abnormally small or large fetuses remains challenging, indicating the need for improved screening and diagnostic strategies. [ABSTRACT FROM AUTHOR]

To evaluate the effect of overweight (body mass index; BMI 25.0–29.9 kg/m2), and obesity (BMI>30 kg/m2), on the success of trial of labor after cesarean delivery (TOLAC), with consideration of successful past vaginal birth. This retrospective cohort study was performed using electronic database of obstetrics department at a university-affiliated tertiary medical center. All women admitted for TOLAC at 37–42 weeks of gestational age, carrying a singleton live fetus at cephalic presentation, with a single previous low segment transverse cesarean delivery between 1/2015 and 5/2021 were included. Primary outcome was the rate of cesarean delivery during labor, and subgroup analysis was performed for the presence of past vaginal birth. Of the 1200 TOLAC deliveries meeting the inclusion criteria, 61.9 % had BMI in the normal range, 24.6 % were overweight (BMI 25.0–29.9 kg/m2), and 13.4 % were obese (BMI of 30 kg/m2 and over). Using a multivariate analysis, BMI≥30 kg/m2 was associated with increased risk of cesarean delivery compared to normal weight. However, in the subgroup of 292 women with a history of successful vaginal birth BMI did not affect TOLAC success. BMI does not affect the success of TOLAC in women with previous vaginal birth. This information should be considered during patients counselling, in order to achieve a better selection of mode of delivery and higher patients' satisfaction. [ABSTRACT FROM AUTHOR]

The COVID-19 outbreak caused persons to be reluctant to seek medical care due to fear of contracting the infection. To evaluate the effect of the COVID-19 pandemic on admission rates to the delivery room and the feto-maternal unit, and to assess the effect on the nature of presenting obstetrical complaints to the emergency department. A retrospective cohort study in one medical center. The population was women > 20 weeks pregnant who presented to the obstetrical emergency department with self-complaints during 29 days at the peak of the pandemic outbreak, and a matched group during the exact period in the previous year. We compared between the groups: clinical, obstetrical, and demographic data, including age, area of residence, gravidity, parity, previous cesarean deliveries, high-risk pregnancy follow-up, the last 30 days admissions to the obstetrical emergency department, gestational age, chief complaints, cervical dilatation, cervical effacement, admissions to the delivery room or feto-maternal unit, time from admissions to the delivery room to birth, if applicable, and acute obstetrical complications diagnosed at the emergency department. During the pandemic outbreak, 398 women met study inclusion criteria, compared to 544 women in the matched period of the previous year. During the COVID-19 period, women visited the obstetrical emergency department at a more advanced mean gestational age (37.6 ± 3.7 vs. 36.7 ± 4.6, p =.001). Higher proportions of women in the COVID-19 cohort presented in active labor, defined by cervical dilation of at least 5 cm on admission to the labor ward [37 (9.3%) vs 28 (5.1%), p =.013)] and with premature rupture of membranes [82 (20.6%) vs 60 (11.0%), p <.001)], and consequently with more admissions to the delivery room [198 (49.7%) vs 189 (34.7%), p <.001)]. We also recorded a significant increase in urgent obstetrical events in the emergency department during the recorded COVID-19 pandemic [23 (5.8%) vs 12 (2.2%)), p =.004]. However, the rates of neonatal and maternal morbidity did not change. During the outbreak the proportion of visits during the night was higher than during the matched period of the previous year: [138 (34.7%) vs 145 (26.6%)), p =.008]. In a multivariate logistic regression, the higher rates of admission to the delivery room during active labor and of urgent events during the pandemic outbreak compared to the matched period in the previous year remained statistically significant. The pandemic outbreak of COVID-19 caused a behavioral change among women who presented to the obstetrical emergency department. This was characterized by delayed arrival to the obstetrical emergency department and the delivery room, which led to a significant increase in urgent and acute interventions. The change in behavior did not affect the rates of maternal and neonatal morbidity. [ABSTRACT FROM AUTHOR]

Background: Protocols for preventing early‐onset group B streptococcal (GBS) neonatal infection may result in unnecessary antibiotics administration. Real‐time polymerase chain reaction (PCR) can provide a result within 30–60 min and has been found to be specific and sensitive for defining intrapartum GBS status. Objective: To evaluate whether implementation of GBS fast real‐time PCR to all women who require GBS prophylaxis may reduce the use of maternal prophylactic antibiotics. Methods: This prospective cohort study included women admitted to a single delivery ward who required prophylactic antibiotics either due to a positive antepartum GBS culture screening performed at 35–37 weeks or due to an unknown GBS status with an intrapartum risk factor. All the women were tested by a double vaginal swab (real‐time PCR and culture) as soon as it became apparent, they required antibiotic prophylaxis and prior to its administration. Results: Between May 2019 and August 2020, 303 women met eligibility criteria and were enrolled, but four were excluded from the analysis due to failed culture or PCR tests. Of 299 women included in the study, 208 (69.5%) and 180 (60.2%) women, showed no evidence of GBS on intrapartum culture or PCR, respectively. Of 89 GBS antepartum carriers, 43 (48.3%) and 32 (35.9%) had negative intrapartum culture and PCR results, respectively. Of the 210 women with risk factors, 165 (78.5%) were culture negative and 148 (70.4%) had a negative PCR. Using intrapartum culture as the gold standard, intrapartum GBS real‐time PCR was found to have a sensitivity of 97.8% (95% confidence interval [CI] 92.3, 99.7) and a specificity of 85.6% (95% CI 80.1, 90.1). Conclusions: Compared with antepartum universal culture screening or intrapartum risk‐factor assessment, the need for maternal antibiotic treatment may be substantially reduced by implementation of intrapartum GBS real‐time PCR, without compromising the sensitivity of GBS detection. [ABSTRACT FROM AUTHOR]