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Objectives: Abnormal fetal tongue size is a phenotypic feature of various syndromes including Beckwith‐Wiedemann, Pierre‐Robin, oromandibular limb hypoplasia, chromosomal aberrations, etc. Current data regarding normal fetal tongue size are limited. Hence, micro/macroglossia are subjectively determined. The aim of the study was to construct a contemporary fetal tongue nomogram and to assess its clinical contribution. Methods: A prospective cross‐sectional study was performed in well dated, low risk, singleton pregnancies. Fetal tongues were measured by 5 trained sonographers. Highest quality images were selected. Intra‐ and interobserver variability was assessed. Tongue length, width, area, and circumference 1st to 99th centiles were calculated for each gestational week. Based on the normal tongue size charts, we created a Tongue Centile Calculator. Results: Over 18 months, 664 tongue measurements were performed. A cubic polynomial regression model best described the correlation between tongue size and gestational age. The correlation coefficient (r2) was 0.934, 0.932, 0.925, and 0.953 for tongue length, width, area, and circumference, respectively (P <.001). Intra‐ and interobserver variability had high interclass correlation coefficients (>0.9). Using the new charts, we were able to identify 2 cases of macroglossia, subsequently diagnosed with Beckwith‐Wiedemann, and 4 cases of microglossia, 3 associated with Pierre‐Robin sequence, and 1 associated with persistent buccopharyngeal membrane. Conclusions: We present novel fetal tongue size charts from 13 to 40 weeks of gestation. Clinical application of these nomograms may be beneficial in the prenatal diagnosis of syndromes or malformations associated with abnormal fetal tongue size. [ABSTRACT FROM AUTHOR]

Background: Currently, the use of FE is decreasing and neonatal adverse outcomes following FE are underreported. We aimed to evaluate the rate of neonatal adverse outcomes in current obstetric practice at two university hospitals with a low FE volume. Methods: A multicentre retrospective study. All singleton pregnancies delivered by forceps extraction between 2011 and 2020 were analyzed. The characteristics of the deliveries with a composite neonatal adverse outcome (CNAO) were analyzed and compared with those without. Results: The study cohort included 861 neonates delivered by FE. The CNAO was recorded in 131 (15.2%). Women in the CNAO group gained less weight during pregnancy (mean 13 kg vs. 15 kg, p = .014). Factors found to be associated with CNAO were preterm delivery (gestational age < 37°7) (26 (19.8%) vs. 44 (6.0%), OR [95% CI]: 3.86 (2.28–6.52), p < .001), low birth weight (23 (17.6%) vs. 44 (6.0%), OR [95% CI] 3.32 (1.92–5.71), p < .001), and smaller head circumference (329 vs. 331 mm, OR [95% CI] 0.79 (0.67–0.93), p = .035). In a multivariate analysis, gestational age (adjusted OR [95% CI] 0.672 (0.546–0.826), p < .001) and maternal weight gain during pregnancy (adjusted OR [95% CI]: 0.950 (0.904–0.998), p = .042), were both negatively associated with CNAO. Among term deliveries, the only factor found to be independently associated with CNAO was maternal weight gain during pregnancy (adjusted OR [95% CI]: 0.951 (0.910–0.994), p = .025). Conclusions: In the setting of low volume FE, this mode of delivery is associated with a relatively low rate of neonatal morbidity. Synopsis: Performance of forceps extraction in the setting of low volume practice is associated with a relatively low rate of neonatal morbidity. [ABSTRACT FROM AUTHOR]

Objective: Among deliveries <34 weeks, there is inconclusive evidence regarding the preferred route of delivery when there is a need to expedite delivery during the second stage of labor. As it is unreasonable that future randomized controlled trials will be conducted to settle this query, every clinical data concerning this topic, may be helpful. We aim to compare neonatal outcomes among women undergoing emergent cesarean delivery (ECD) versus vacuum-assisted delivery (VAD) during the second stage of labor among singleton gestations <34 weeks. Methods: A retrospective cohort study including all women who underwent either ECD or VAD at the second stage of labor between 30°/7 and 336/7 weeks, during 2011-2019. The primary outcome was the rate of adverse neonatal outcomes, defined as intrapartum death, mechanical ventilation, asphyxia, respiratory distress syndrome, subgaleal hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis, and phototherapy. Results: Of the 153,672 live singleton deliveries during the study period, 2871 (1.9%) delivered before 34°/7. Of those 1674 (58.3%) delivered vaginally unassisted and 1137 (39.6%) delivered by a CD during the first stage of labor. A total of 60 deliveries were analyzed, with a median gestational age of 32 weeks, interquartile range (IQR) 31-33. Median birth weight at delivery was 1845 g, IQR 1574-2095. Overall 25 (42%) of women were delivered by VAD and 35 by CD (58%). Indications for expeditious delivery did not differ between the study groups. Neonates delivered by VAD had a higher median birth weight (1940 vs. 1620 g, p = .02). Second stage of labor was longer in the ECD group as compared to the VAD group (median 200 vs. 52 min, p = .01). The rate of Apgar score at 1 min <7 was higher among the CD group (10 (40%) vs. 5 (14%), OR [95% CI]: 4.0 (1.1-13.8), p = .03). Longer length of stay was evident in the CD group as compared to the VAD group (median 30 vs. 21 days, p = .001). The rate of composite neonatal adverse outcome was comparable between the study groups. Adverse outcomes were associated with lower body mass index (median 27.7 vs. 34.9, p = .04), higher rate of premature preterm rupture of membranes (40 (91%) vs. 5 (31%), OR [95% CI]: 22.0 (5.0-91.1), p < .001) and labor dystocia as the indication for expedited delivery (38 (86%) vs. 7 (44%), OR [95% CI]: 8.1 (2.1-30.1), p = .001). Conclusions: Cesarean delivery during the second stage of labor of gestations <34 weeks was associated with a higher rate of lower Apgar scores and longer length of stay. [ABSTRACT FROM AUTHOR]

Objective: Isolated oligohydramnios (IO) - oligohydramnios in the absence of maternal or gestational comorbidity is debated as an indication for induction of labor. Previous meta-analyses regarding perinatal outcomes of IO at term have yielded conflicting results. We aimed to investigate the neonatal outcomes among gestations with IO delivered at 36°/7-396/7. Methods: The study cohort included all women undergoing a trial of labor between during 2011 and 2019 of a singleton gestation with cephalic presentation between 36°/7 and 40°/7. We allocated the study groups into women with IO and those with normal amniotic fluid volume. Neonatal outcomes were compared between the groups and in relation to gestational age and induction of labor. Results: Overall, there were 529/17,709 (3.0%) IO cases. IO was associated with maternal age <25 years (OR [95% CI] 1.62 (1.20-2.20), p = .001). Induction of labor was more common with IO (OR [95% CI] 1.33 (1.05-1.69) p = .01. IO was associated with preterm delivery (OR [95% CI] 1.81 (1.36-2.40), p < .001). The rate of neonatal adverse outcome did not differ between study groups. Overall composite adverse neonatal outcome occurred among 1,399/17,709 (7.9%) deliveries. Adverse neonatal outcome was associated with induction of labor (OR [95% CI] 1.61 (1.40-1.86), p < .001) and low birth weight (OR [95% CI] 7.41 (6.27-8.75), p < .001). When Stratified by gestational age, neonatal adverse outcome did not differ between IO and no IO groups. When examining cases of induction of labor per gestational age, induction of labor at 36 weeks among IO gestations, was associated with adverse neonatal outcome as compared to no IO group (OR [95% CI] 5.7 (1.23-26.3), p = .04). Conclusions: Induction of labor in gestations complicated by IO at 36 weeks gestational age is associated with an increased risk for adverse neonatal outcome. Our study results adds to the current literature regarding outcomes of IO and time of delivery. [ABSTRACT FROM AUTHOR]

Objective: The assessment of sonographic estimated fetal weight (EFW) enables identification of fetuses in the extremes of weight, thus aiding in the planning and management of peripartum care. There are conflicting reports regarding the accuracy of EFW in diabetic mothers. We aimed to study the factors associated with the accuracy of EFW at term, specifically the role of gestational and pre-gestational diabetes in this setting.Methods: A retrospective study including all women carrying singleton term gestations who delivered within a week following a sonographic fetal weight estimation between 2011 and 2019. Accurate EFW was defined as within 10% of the actual birthweight. We allocated the study cohort into two groups: (1) Accurate EFW (2) inaccurate EFW. Both groups were compared in order to identify factors associated with the inaccuracy of EFW.Results: Overall, 41,263 deliveries were available for evaluation, including 412 (1.0%) deliveries among women with pre-gestational diabetes and 4,735 (11.5%) among women with gestational diabetes. Of them, 7,280 (17.6%) had inaccurate EFW. Inaccurate EFW was associated with nulliparity, OR 0.82 [95% CI] (0.78-0.87), oligohydramnios, OR 0.81 [95% CI] (0.71-0.93), pregestational diabetes, OR [95% CI] 0.61 (0.50-0.79), and extremity of fetal weight; <2,500 grams-OR [95% CI] 0.37 (0.33-0.41) and >4,000 grams OR [95% CI] 0.52 (0.48-0.57). On multiple regression analysis, the following factors were independently associated with inaccurate EFW: pregestational diabetes, OR [95% CI] 0.58 (0.46-0.73), p < .001, nulliparity, OR [95% CI] 0.86 (0.82-0.91), p < .001 and higher fetal weight (for each 500 grams), OR [95% CI [1.25 (1.21-1.30), p < .001. On analysis of different weight categories, pregestational diabetes was associated with inaccurate EFW only in those with birthweight >3,500 grams, OR [95% CI] 0.37 (0.24-0.56) (p < .001).Conclusion: Among pregestational diabetic women, the accuracy of sonographic EFW when assessed to be >3,500 grams is questionable. This should be taken into consideration when consulting women and planning delivery management.Synopsis: Among pregestational diabetic women, the accuracy of estimated sonographic fetal weight higher than 3,500 grams is of limited accuracy. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that women admitted for delivery should have universal PCR testing for SARS‐CoV‐2. Yet, the considerable difference in the incidence of COVID‐19 between different geographic regions may affect screening strategies. Therefore, we aimed to compare questionnaire‐based testing versus universal PCR testing for SARS‐CoV‐2 in women admitted for delivery. Methods: A prospective cohort study of women admitted for delivery at a single center during a four‐week period (April 22‐May 25, 2020). All women completed a questionnaire about COVID‐19 signs, symptoms, or risk factors, and a nasopharyngeal swab for PCR for SARS‐CoV‐2. Women who were flagged as suspected COVID‐19 by the questionnaire (questionnaire‐positive) were compared with women who were not flagged by the questionnaire (questionnaire‐negative). Results: Overall, 446 women were eligible for analysis, of which 54 (12.1%) were questionnaire‐positive. PCR swab detected SARS‐CoV‐2 in four (0.9%) women: 3 of 392 (0.8%) in the questionnaire‐negative group, and 1 of 54 (1.9%) in the questionnaire‐positive group (P =.43), yielding a number needed to screen of 92 (95% CI 62‐177). In 96% of the cases, the PCR results were obtained only in the postpartum period. No positive PCR results were obtained from neonatal testing for SARS‐CoV‐2. The sensitivity of the questionnaire was 75.0%, and the negative predictive value was 99.7%. Conclusions: Although the rate of positive PCR results was not significantly different between the groups, the number needed to screen is considerably high. The use of questionnaire‐based PCR testing in areas with low incidence of COVID‐19 allows for a reasonable allocation of resources and is easy to implement. [ABSTRACT FROM AUTHOR]

While the immediate effects of pregnancy on aortic dimension in patients with Marfan syndrome (MFS) have been evaluated, the late effects of subsequent pregnancies in these patients are less known. For this purpose, we evaluated 2 groups of women with MFS who were under specialized care in our institution. Group A included 23 women with MFS who experienced 55 pregnancies; group B included 12 nulliparous MFS patients. Patients in group A were similar in age (36.13 ± 5.6 years vs. 34.25 ± 6.54 years, p = 0.41) and follow-up time (group A 6.05 ± 3.56 years and group B 4.92 ± 3.37 years, p = 0.37). Baseline aortic root diameters as well as the aortic root diameters at follow-up visits were similar between groups (35.60 ± 4.42 vs. 35.08 ± 3.82 mm, p = 0.73, and 37.57 ± 4.66 vs. 37.33 ± 4.83 mm, p = 0.89, respectively). The aortic root diameter increased by 0.5 (0, 2) mm in group A and 1 (0, 4.5) mm in group B (p = 0.54). The rate of aortic dilation per year of follow-up was similar between the groups (0.34 ± 0.52 mm/year in group A vs. 0.55 ± 0.75 mm/year in group B [p = 0.52]). Chronic medical treatment was similar in both groups. Patients in both groups were treated similarly with β-blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers. In summary, subsequent pregnancies in patients with MFS were not associated with an increase in the rate of aortic root dilation in these patients. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that women admitted for delivery should have universal PCR testing for SARS-CoV-2. Yet, the considerable difference in the incidence of COVID-19 between different geographic regions may affect screening strategies. Therefore, we aimed to compare questionnaire-based testing versus universal PCR testing for SARS-CoV-2 in women admitted for delivery., Methods: A prospective cohort study of women admitted for delivery at a single center during a four-week period (April 22-May 25, 2020). All women completed a questionnaire about COVID-19 signs, symptoms, or risk factors, and a nasopharyngeal swab for PCR for SARS-CoV-2. Women who were flagged as suspected COVID-19 by the questionnaire (questionnaire-positive) were compared with women who were not flagged by the questionnaire (questionnaire-negative)., Results: Overall, 446 women were eligible for analysis, of which 54 (12.1%) were questionnaire-positive. PCR swab detected SARS-CoV-2 in four (0.9%) women: 3 of 392 (0.8%) in the questionnaire-negative group, and 1 of 54 (1.9%) in the questionnaire-positive group (P = .43), yielding a number needed to screen of 92 (95% CI 62-177). In 96% of the cases, the PCR results were obtained only in the postpartum period. No positive PCR results were obtained from neonatal testing for SARS-CoV-2. The sensitivity of the questionnaire was 75.0%, and the negative predictive value was 99.7%., Conclusions: Although the rate of positive PCR results was not significantly different between the groups, the number needed to screen is considerably high. The use of questionnaire-based PCR testing in areas with low incidence of COVID-19 allows for a reasonable allocation of resources and is easy to implement., (© 2020 Wiley Periodicals LLC.)