The Rate of Intrapartum Cesarean Delivery Based on Estimated Fetal Weight in Comparison to Previous Child's Birth Weight.

Objective: The aim of the study is to examine whether an estimated fetal weight of the current pregnancy greater than previous birth weight is associated with increased odds of intrapartum cesarean delivery.

Study Design: We conducted a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks' gestation or greater at a single labor and delivery unit. We only analyzed the second pregnancy in the dataset.

Expectant Management of Severe COVID-19 Pneumonia in Late Preterm Pregnancy and Subsequent Cholecystitis: Lessons Learned.

 Since the emergence of coronavirus disease 2019 (COVID-19) as a pandemic in March 2020, research and guidance have been published with regard to the management of infection and considerations in pregnancy, but much is still unknown. Pregnant women with COVID-19 infection are more likely to be hospitalized and are at increased risk for intensive care unit admissions and intubation than nonpregnant women with COVID-19 infection. The optimal timing of delivery among pregnant women with COVID-19 infection has not been established at this time, especially when the infection arises in late preterm and early term gestation.

Interpregnancy Body Mass Index Change and Risk of Intrapartum Cesarean Delivery.

Objective: This study aimed to examine the association between interpregnancy body mass index (BMI, kg/m) change and intrapartum cesarean delivery in multiparous women without a history of cesarean delivery.

Study Design: We conducted a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks' gestation or greater at MedStar Washington Hospital Center from January 2009 to June 2018. We excluded women who had a history of cesarean delivery, prelabor cesarean delivery, and contraindications for vaginal delivery.

Association between long interpregnancy intervals and cesarean delivery due to arrest disorders.

Background: It is hypothesized that pregnancy causes time-limited physiologic adaptations of the reproductive system, such as increased blood flow to the uterus. With long interpregnancy intervals, those adaptations may regress, and maternal physiologic characteristics may revert to those of primigravid women. Therefore, it is plausible that long interpregnancy interval is associated with cesarean delivery, especially due to arrest disorders (failed induction of labor, arrest of dilation, or arrest of descent).

Evaluation of the Emergency Severity Index (Version 4) in Postpartum Women after Cesarean Delivery.

Objective: The Emergency Severity Index (ESI) version 4 is a 5-level triage system (1 being the highest acuity and 5 being the lowest acuity) used in the emergency department (ED). Our goal of the study was to compare rates of readmission according to ESI in postpartum women.

Study Design: This was a secondary analysis of a retrospective cohort study of all women who presented to the ED within 6 weeks after cesarean delivery.

Association between surgical complications and early academic period in women undergoing cesarean delivery.

Objective: To compare rates of operative complications between the earlier and later academic periods.

Study Design: This was a retrospective cohort study of women undergoing cesarean delivery at 23 weeks' gestation or greater during the academic calendar between 2012 and 2017. Our primary outcome was a composite of surgical complications including hemorrhage (4 or more red blood cell transfusion), bladder injury, bowel injury, neonatal injury, cellulitis, wound complications, intensive care unit admission, and readmission.

Evaluation of Risk-Assessment Tools for Severe Postpartum Hemorrhage in Women Undergoing Cesarean Delivery.

Objective: To examine and compare the validity of three known risk-assessment tools (CMQCC [California Maternal Quality Care Collaborative], AWHONN [Association of Women's Health, Obstetric and Neonatal Nurses], and NYSBOH [New York Safety Bundle for Obstetric Hemorrhage]) in women undergoing cesarean delivery.

Methods: We conducted a retrospective cohort study that evaluated all women undergoing cesarean delivery at 23 weeks of gestation or longer from 2012 to 2017 at an urban hospital with average of 1,200 cesarean deliveries per year. Data were obtained by chart review.

Maternal morbidity by attempted route of delivery in periviable birth.

Objective: Much of the literature on clinical decision-making regarding the optimal route of delivery for periviable birth, 23 0/7-25 6/7 weeks gestation, has focused on neonatal risks. In fact, routine cesarean delivery at these early gestational ages has not been shown to improve neonatal mortality or neurological outcomes. Neonatal risks associated with the route of delivery are well known.

Reducing Cesarean Delivery Surgical Site Infections: A Resident-Driven Quality Initiative.

Objective: To examine the association of a resident-driven quality initiative with cesarean delivery surgical site infections.

Methods: This was a quasi-experimental, preintervention and postintervention study of women undergoing cesarean delivery at 23 weeks of gestation or greater between January 2015 and June 2018 at a single tertiary care center. We implemented a resident-driven, evidence-based surgical bundle, excluding women who underwent emergency cesarean or had chorioamnionitis.

Prevalence and Location of Obstetric Lacerations in Adolescent Mothers.

Study Objective: The objective of this study was to describe prevalence and location of obstetric lacerations in adolescents.

Design: Retrospective cohort study.

Setting: We performed an analysis of the Consortium on Safe Labor database including tertiary care university-affiliated urban hospitals.

Early preterm preeclampsia outcomes by intended mode of delivery.

Background: The optimal route of delivery in early-onset preeclampsia before 34 weeks is debated because many clinicians are reluctant to proceed with induction for perceived high risk of failure.

Objective: Our objective was to investigate labor induction success rates and compare maternal and neonatal outcomes by intended mode of delivery in women with early preterm preeclampsia.

Study Design: We identified 914 singleton pregnancies with preeclampsia in the Consortium on Safe Labor study for analysis who delivered between 24 0/7 and 33 6/7 weeks.

Choice of Prophylactic Antibiotics and Surgical Site Infections After Cesarean Delivery.

Objective: To examine the rate of surgical site infection according to the choice of antibiotics in women undergoing cesarean delivery.

Methods: We conducted a retrospective cohort study of women undergoing cesarean delivery (labored, unlabored, and scheduled) from 2012 to 2017. Women with chorioamnionitis and those who did not receive any antibiotics were excluded.

Risk Factors for Umbilical Cord Prolapse at the Time of Artificial Rupture of Membranes.

 The aim of the study was to examine the association between cervical exam at the time of artificial rupture of membranes (AROM) and cord prolapse.  We conducted a retrospective cohort study using the data from the Consortium on Safe Labor. We included women with cephalic presentation and singleton pregnancies at ≥ 23 weeks' gestation who underwent AROM during the course of labor.

Outcomes after periviable ultrasound-indicated cerclage.

Background: Cerclage placed for a sonographically short cervix has been shown to reduce the risk of preterm delivery in women with a history of prior preterm birth. While short cervix is traditionally placed before viability, the threshold gestational age at which viability is achieved continues to decrease, and, as a result, a larger subset of women may be ineligible to receive this potentially beneficial procedure.

Objective: To evaluate the association between obstetric outcomes and perioperative complications after placement of an ultrasound-indicated cerclage at periviability compared to placement in the previable period.

Racial/Ethnic Differences in Labor Induction in a Contemporary US Cohort: A Retrospective Cohort Study.

Objective: To examine labor induction by race/ethnicity and factors associated with disparity in induction.

Study Design: This is a retrospective cohort study of 143,634 women eligible for induction ≥24 weeks' gestation from 12 clinical centers (2002-2008). Rates of labor induction for each racial/ethnic group were calculated and stratified by gestational age intervals: early preterm (24-33), late preterm (34-36), and term (37-41 weeks).

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment.

Cesarean delivery (CD) is one of the most common procedures performed in the United States, accounting for 32% of all deliveries. Postpartum surgical site infection (SSI), wound infection and endometritis is a major cause of prolonged hospital stay and poses a burden to the health care system. SSIs complicate a significant number of patients who undergo CD - 2-7% will experience sound infections and 2-16% will develop endometritis.

Neonatal outcomes in fetuses with cardiac anomalies and the impact of delivery route.

Background: Congenital fetal cardiac anomalies compromise the most common group of fetal structural anomalies. Several previous reports analyzed all types of fetal cardiac anomalies together without individualized neonatal morbidity outcomes based on cardiac defect. Mode of delivery in cases of fetal cardiac anomalies varies greatly as optimal mode of delivery in these complex cases is unknown.

Maternal outcomes associated with early preterm cesarean delivery.

Background: Data on complications associated with classic cesarean delivery are conflicting. In extremely preterm cesarean delivery (22 0/7-27 6/7 weeks' gestation), the lower uterine segment is thicker. It is plausible that the rates of maternal complications may not differ between classic and low transverse cesarean.

Duration of Oxytocin and Rupture of the Membranes Before Diagnosing a Failed Induction of Labor.

Objective: To compare maternal and neonatal outcomes based on length of the latent phase during induction with rupture of membranes before 6 cm dilation.

Methods: This is a retrospective cohort study using data from the Consortium of Safe Labor study, including 9,763 nulliparous and 8,379 multiparous women with singleton, term pregnancies undergoing induction at 2 cm dilation or less with rupture of membranes before 6 cm dilation after which the latent phase ended. Outcomes were evaluated according to duration of oxytocin and rupture of membranes.

Induction of Labor in Women with Oligohydramnios: Misoprostol Compared with Prostaglandin E2.

 To compare perinatal outcomes in women with oligohydramnios and an unfavorable cervix undergoing labor induction with misoprostol to prostaglandin E2.  We conducted a secondary analysis of women with oligohydramnios undergoing labor induction in the Consortium on Safe Labor study (2002-2008). Oligohydramnios was recorded in the medical chart.

Indications for primary cesarean delivery relative to body mass index.

Background: Obesity is a known risk factor for cesarean delivery. Limited data are available regarding the reasons for the increased rate of primary cesarean in obese women. It is important to identify the factors leading to an increased risk of cesarean to identify opportunities to reduce the primary cesarean rate.

Maternal and Neonatal Outcomes by Attempted Mode of Operative Delivery From a Low Station in the Second Stage of Labor.

Objective: To evaluate maternal and neonatal outcomes by attempted mode of operative delivery from a low station in the second stage of labor.

Methods: Retrospective study of 2,518 women carrying singleton fetuses at 37 weeks of gestation or greater who underwent attempted forceps-assisted delivery, attempted vacuum-assisted vaginal delivery, or cesarean delivery from a low station in the second stage of labor. Primary outcomes were stratified by parity and included a maternal adverse outcome composite (postpartum hemorrhage, transfusion, endometritis, peripartum hysterectomy, or intensive care unit admission) and a neonatal adverse outcome composite (5-minute Apgar score less than 4, respiratory morbidity, neonatal intensive care unit admission, shoulder dystocia, birth trauma, or sepsis).

Pregnancy Outcomes Among Obese Women and Their Offspring by Attempted Mode of Delivery.

Objective: To compare maternal and neonatal morbidities among obese women and their offspring by attempted delivery approach.

Methods: We performed a retrospective cohort study of 47,372 obese women at delivery (body mass index 30 or greater) eligible for vaginal delivery who were carrying singleton vertex fetuses at 37 weeks of gestation or greater. Prior cesarean delivery, congenital anomalies, and antepartum stillbirth were exclusion criteria.

Adverse Maternal and Neonatal Outcomes in Adolescent Pregnancy.

Study Objective: To investigate the outcomes of adolescent pregnancy.

Design: Retrospective cohort study from the Consortium on Safe Labor between 2002 and 2008.

Setting: Twelve clinical centers with 19 hospitals in the United States.

Risk factors for retained placenta.

Objective: Retained placenta complicates 2-3% of vaginal deliveries and is a known cause of postpartum hemorrhage. Treatment includes manual or operative placental extraction, potentially increasing risks of hemorrhage, infections, and prolonged hospital stays. We sought to evaluate risk factors for retained placenta, defined as more than 30 minutes between the delivery of the fetus and placenta, in a large US obstetrical cohort.