Search

Purpose: Women diagnosed with mid-trimester cervical insufficiency and dilatation are offered interventions to salvage and support the cervix, where the mainstay of therapy is emergency cervical cerclage. However, considering the significant morbidity associated with delivery in the extreme prematurity period, some women may opt for pregnancy termination. In addition, it is expected that elective cerclage in a subsequent pregnancy may yield better obstetrical results. The objective of this study was, therefore, to compare the obstetrical outcomes of emergency cerclage versus elective cerclage. Methods: This is a retrospective cohort study of the pregnancy outcomes of women with a singleton pregnancy who underwent cervical cerclage at our institution between December 2008 and November 2021. Women who underwent emergency cervical cerclage due to painless dilatation in the second trimester were compared with women who underwent elective cerclage. Results: Overall, 32 women who underwent emergency cerclage and 183 women who underwent elective cerclage were included. No cases of iatrogenic membrane rupture were noted during the cerclage procedure. There was no statistical difference between the emergency cerclage group and the elective cerclage group in the primary outcomes: gestational age at delivery (35.8 + 4.7 vs 36.3 + 4.9, p = 0.58, respectively), delivery in the extreme prematurity period (between 24 and 28 gestational weeks, 6.5% vs 2.3%, p = 0.21, respectively), and fetal or neonatal death (6.9% vs 6.3%, p = 0.91, respectively). Conclusion: Although there are much less favourable circumstances, emergency cerclage is a safe procedure with comparable obstetrical outcomes to elective cerclage. Patient selection and experienced medical team may play a significant role in those cases. [ABSTRACT FROM AUTHOR]

Objectives: To analyze in a retrospective cohort study the outcomes of pregnancies with isolated oligohydramnios at the late preterm period (34-36.6 weeks of gestation). Study design: This retrospective cohort study included three groups of women: (1) Women with isolated oligohydramnios whose pregnancy was managed conservatively (n = 33 births); (2) women with isolated oligohydramnios who were managed actively (i.e. induction of labor) (n = 111 births); and (3) a control group including women with normal amount of amniotic fluid who had a spontaneous late preterm delivery (n = 10,445 births). Maternal and fetal characteristics and obstetrics outcomes were collected from a computerized database of all deliveries at Soroka University Medical Center during the study period. Results: Our cohort included 10,589 births. The rate of inducing labor was higher in the oligohydramnios groups compared to the controls (p < .001). There was an increase in the rate of cesarean section (CS) in the conservative treatment group (p < .001), compared with the other groups. Conservative management was associated with higher rates of maternal infection (p = .026), chorioamnionitis (p = .01), and transitory tachypnea of the newborn (p = .02). After controlling for confounding factors, mal presentation (OR = 19.9), and a prior CS (OR = 2.4) were independently associated with an increased risk for CS, while induction of labor was associated with a reduced risk for CS (OR = 0.28). Conclusions: Women with late preterm isolated oligohydramnios had a higher rate of induction of labor than women with a normal amount of amniotic fluid. Induction of labor seems to be beneficial to both the neonate and the mother as seen by a lower rate of CS conducted in this group, as well as lower maternal and neonatal morbidity in comparison to the conservative group. Therefore, women with oligohydramnios at late preterm may benefit from induction of labor. [ABSTRACT FROM AUTHOR]

Purpose: (1) Compare fetal and neonatal morbidity and mortality associated with induction of labor (IOL) versus expectant management (EM) in women with isolated fetal growth restriction (FGR) between 340/7 and 386/7 weeks; (2) Determine optimal gestational age for delivery of such fetuses.Materials and Methods: A retrospective population based cohort study of 2232 parturients with isolated FGR, including two groups: (1) IOL (n = 1428); 2) EM (n = 804).Results: IOL group had a lower stillbirth and neonatal death rates (p = .042, p < .001), higher 1 and 5 min Apgar scores and a higher vaginal delivery rate compared to the EM group. In the late preterm period, EM was associated with increased rate of low 1 and 5 min Apgar scores, nonreassuring fetal heart rate tracing (NRFHR), stillbirth and neonatal death rate (p = .001, p = .039). In the early term cohort, EM was associated with a higher rate of NRFHR and low 1 min Apgar scores (p = .003, p = .002). IOL at 37 weeks protected from stillbirth but not from adverse composite neonatal outcomes.Conclusions: IOL of FGR fetuses at 37 weeks had a protective effect against stillbirth. In addition, at late preterm, it is associated with lower rates of stillbirth, neonatal death, and NRFHR. [ABSTRACT FROM AUTHOR]