Emergent cesarean section during active labor-does cervical dilatation matter?

Purpose: To compare the immediate and late complications associated with emergent cesarean sections (CS) performed during the first and second stages of active labor.

Methods: We conducted a retrospective analysis of electronic medical records from a single academic center, including data from 577 patients who underwent emergent cesarean sections at 4 cm or more of cervical dilatation. Patients were divided into two groups: those who had CS during the first stage of labor (4-9 cm dilatation) and those who had CS at complete dilatation (10 cm).

Cesarean Delivery Complicated by Peripartum Infection and Risk of Uterine Rupture During Subsequent Trial of Labor.

Uterine rupture is a rare, but dangerous obstetric complication that can occur during trial of vaginal birth. The aim of this study was to evaluate the relationship between peripartum infection at the first caesarean delivery to uterine dehiscence or rupture at the subsequent delivery. We conducted a retrospective case-control study from March 2014 to October 2020 at a single academic medical center.

Does decreased fetal growth estimation in the appropriate for gestational age range affect delivery outcomes?

Purpose: To study the effect of decreased estimated fetal weight (EFW) percentiles in appropriate for gestational age fetuses.

Methods: This retrospective cohort study included women who had second and third trimester ultrasound examinations. Delivery and neonatal outcomes of pregnancies with decreased EFW of ≥  30 percentiles in EFW between ultrasound examinations (decreased growth group) and those without such a decrease (control group) were compared.

Are reduced fetal movements "merely" a maternal perception or truly a reflection of umbilical cord complications? A clinical trial.

Objective: To characterize obstetric outcomes and the association with umbilical cord (UC) complications among women complaining of reduced fetal movements (RFMs).

Methods: This retrospective cohort compared women with a perception of RFMs within 2 weeks prior to delivery with women who reported no changes in fetal movements in terms of maternal characteristics and neonatal outcomes. A primary outcome of UC complications at delivery was defined.

Low lying placenta: natural course, clinical data, complications and a new model for early prediction of persistency.

Objective: To define the natural course and complications, and develop a model for predicting persistency when low-lying placenta (LLP) is detected early in pregnancy.

Methods: This retrospective cohort study included women with LLP detected during an early anatomic scan performed at 13-16 weeks gestation. Additional transvaginal ultrasound exams were assessed for resolution at 22-24 weeks and 36-39 weeks.

Head Injuries Related to Birth Trauma in Low Birthweight Neonates During Vacuum Extraction.

Preterm delivery (gestational age < 34 w) is a relative contraindication to vacuum extraction. Current data do not differentiate clearly between preterm delivery and low birthweight. We aimed to evaluate the impact of non-metal vacuum cup extraction on neonatal head injuries related to birth trauma in newborns with low birthweights (< 2500 g).

Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?

Vacuum extraction (VE) is an important modality in modern obstetrics, yet sometimes results in maternal or neonatal adverse outcomes, which can cause a lifetime disability. We aimed to characterize potential risk factors for adverse outcomes that in retrospect would have led the physician to avoid the procedure. Retrospective cohort of 3331 singleton pregnancies, ≥ 34 w delivered by VE.

Head position and vacuum-assisted delivery using the Kiwi Omnicup.

Objective: To evaluate the association between fetal head position during prevacuum assessment and adverse outcomes.

Method: This retrospective cohort study included all vacuum-assisted deliveries using the Kiwi Omnicup over 5 years. Primary outcomes were third- or fourth-degree perineal tear, pH < 7.

Vacuum-Assisted Delivery Complication Rates Based on Ultrasound-Estimated Fetal Weight.

This retrospective cohort study investigated the association between ultrasonographic estimated fetal weight (EFW) and adverse maternal and neonatal outcomes after vacuum-assisted delivery (VAD). It included women with singleton pregnancies at 34−41 weeks gestation, who underwent ultrasonographic pre-labor EFW and VAD in an academic institution, over 6 years. Adverse neonatal and maternal outcomes included shoulder dystocia, clavicular fracture, or third- and fourth-degree perineal tears.

Spontaneous Preterm Birth: Elevated Galectin-3 and Telomere Shortening May Reflect a Common Pathway of Enhanced Inflammation and Senescence.

Preterm delivery complicates 5-12% of pregnancies and is the primary cause of neonatal morbidity and mortality. The pathophysiology of preterm labor and parturition is not fully known, although it is probably related to inflammation and placental senescence. Telomere shortening is related to senescence and galectin-3 (Gal-3) protein is involved in cell growth, differentiation, inflammation, and fibrosis.

Can 17 hydroxyprogesterone caproate (17P) decrease preterm deliveries in patients with a history of PMC or pPROM?

Background: A history of spontaneous preterm birth (sPTB) is a significant risk factor for recurrence. Intra-muscular-7α-hydroxyprogesterone caproate (17P) has been the preventive treatment of choice until the recent "Prolong study" that reported no benefit.

Objective: To determine the benefit of (17P) treatment in preventing reoccurrence of sPTB, by evaluating two presenting symptoms of the first sPTB: premature contractions (PMC) and preterm premature rupture of membranes (pPROM).

Elevated expression of galectin-3, thioredoxin and thioredoxin interacting protein in preeclampsia.

Objectives: Preeclampsia (PE) is a pregnancy-related syndrome characterized by the onset of hypertension and proteinuria that can lead to end-organ dysfunction. Galectin-3 (Gal-3) is involved in cell growth, differentiation, inflammation and fibrosis. Thioredoxin (TXN) acts as antioxidant enzyme in several cellular processes, regulating inflammation and inhibiting apoptosis.

Adverse outcomes in vacuum-assisted delivery after detachment of non-metal cup: a retrospective cohort study.

Purpose: To evaluate neonatal and maternal outcomes associated with detachment of non-metal vacuum cup during delivery and to identify risk factors for these detachments.

Methods: This retrospective cohort study included women with singleton pregnancy, who underwent vacuum-assisted vaginal delivery with a non-metal vacuum cup in a single academic institution, January 2014-August 2019. Failed vacuum deliveries were excluded.

Differences in obstetric healthcare utilization and delivery complications before and after the COVID-19 pandemic - a retrospective study.

Purpose: To investigate the effect of the COVID-19 pandemic on healthcare utilization related to labor and delivery and to assess the effect of the COVID-19 pandemic on intra-partum and delivery complications.

Methods: This retrospective study was performed at a university-affiliated, tertiary medical center. It included women admitted to the delivery room from 1 March 2020 to 23 July 2020 during the first wave of the COVID-19 pandemic.

Can we improve our ability to interpret category II fetal heart rate tracings using additional clinical parameters?

Objectives: This study examined predictive factors, in addition to Category II Fetal Herat Rate (FHR) monitoring that might imply fetal acidosis and risk of asphyxia.

Methods: This retrospective cohort study compared three groups of patients with Category II FHR monitoring indicating need for imminent delivery. Groups were divided based on fetal cord blood pH: pH≤7.

The role of mediolateral episiotomy during vacuum-assisted vaginal delivery with soft cup devices.

Purpose: This study evaluated whether episiotomy during vacuum-assisted delivery leads to fewer third- and fourth-degree tears.

Methods: This was a retrospective cohort study of all nulliparas who underwent a singleton, soft cup, vacuum-assisted vaginal delivery in one institution, from January 2014 to August 2019. Failed vacuum deliveries were excluded.

Prevalence, risk factors and pregnancy outcomes of women with vascular brain lesions in pregnancy.

Background: Vascular brain lesions (VBL) occur in up to 4.0% of the general population. With the increasing availability and use of sophisticated imaging techniques, there are more patients being diagnosed with asymptomatic intracranial AVMs and cavernous hemangiomas.

The yield of chromosomal microarray analysis among pregnancies terminated due to fetal malformations.

Background: Chromosomal microarray analysis (CMA) is preferred for genetic work-up when fetal malformations are detected prenatally.

Objectives: To assess the detection rate of CMA after pregnancy termination due to abnormal ultrasound findings.

Methods: CMA was successfully performed in 71 pregnancies using fetal DNA (mainly from skin) or placenta.

Does parity affect pregnancy outcomes in the elderly gravida?

Purpose: To identify whether older primiparas have more complications than do women who continue to deliver children into their late reproductive age. Patients of at least 35 years of age at delivery were included. Within this cohort, data from primiparous and multiparous women were compared.

Neonatal outcomes of pregnancy-associated breast cancer: Population-based study on 11 million births.

Background: As the age at first pregnancy continues to rise in the United States so does the incidence of breast cancer diagnosed during pregnancy. Our objective was to evaluate temporal trends in the incidence of pregnancy-associated breast cancer (PABC) and to measure neonatal outcomes associated with PABC.

Methods: We conducted a population-based cohort study using the 1999-2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from the United States.