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Objective: To compare stress, anxiety and depression levels among 3 groups of pregnant women: 1) low-risk outpatient (LRO), 2) high-risk outpatient (HRO), and 3) inpatient (IP). Methods: This was a cross-sectional study using validated instruments. Inclusion criteria were pregnancies 23–37 weeks and maternal age > 18 years. The primary outcome was mean/median scores of Perceived Stress Scale (PSS), State Trait Anxiety Inventory (STAI), and Edinburgh Depression Scale (EDS). Secondary outcome was rate of abnormal scores. Results: Among 190 women approached, 180 (95%) participated, with 60 (33%) in each group. Mean PSS scores (range 0–40) significantly increased from LRO (12.0, standard deviation [SD] 7.8) to HRO (14.7, SD 7.9) to IP (15.6, SD 8.2); p = .04. Mean STAI scores (range 20–80) also significantly increased from LRO (32.0, SD 11.1) to HRO (35.8, SD 11.9) to IP (40.9, SD 13.1); p < .01. Abnormal anxiety (STAI ≥ 40) was present in 40% of women and significantly higher among IP compared to LRO (56% vs 25%; RR 2.24, 95% CI 1.36–3.67; aRR 2.24, 95% CI 1.34–3.74). Conclusion: Stress and anxiety scores significantly differ in LRO, HRO, and IP women. While depression screening is common postpartum, screening for stress, anxiety and depression prenatally may be beneficial. [ABSTRACT FROM AUTHOR]

Objective: To compare the birth injury outcomes and hospital length of stay and costs among newborns delivered at 34–42 weeks with neonatal brachial plexus palsy (NBPP) versus those without. Study design: We conducted a retrospective, cross-sectional study using data from the National Inpatient Sample to identify all newborns hospitalizations that occurred in the U.S. between 2016 and 2017. We included non-anomalous single liveborn delivered in-hospital at 34–42 weeks. The newborns with NBPP were identified by International Classification of Diseases, 10th Revision, Clinical Modification codes. Birth injury outcomes, and hospital length of stay and hospital costs were examined. A multivariable Poisson regression model with robust error variance was used to examine the association between NBPP and birth injury outcomes. A multivariable generalized linear regression model was used to examine the association between NBPP and hospital length of stay and hospital costs. Results: Of 7,019,722 non-anomalous single liveborn delivered at 34–42 weeks in the U.S. from 2016 to 2017, the rate of NBPP (n = 6695) was 0.95 per 1000 newborn hospitalizations. After multivariable regression adjustment, compared to newborns without NBPP, the risk of the composite birth injury outcome was 2.91 (95% CI 2.61–3.25) times higher in those with NBPP. Similar results of an increased risk among newborns with NBPP were observed in all individual birth injury outcomes. Compared to newborns without NBPP, after adjustment, the hospital length of stay was 1.48 (95% IC 1.38–1.59) times higher and the hospital costs were 2.21 (95% CI 1.97–2.48) times higher in those with NBPP. Conclusions: Among newborns delivered at 34–42 weeks, the risk of associated birth injuries, hospital length of stay and costs, were significantly higher in newborns with NBPP than those without. [ABSTRACT FROM AUTHOR]

Objective To assess whether an early recovery after surgery (ERAS) pathway after scheduled cesarean delivery was associated with a reduction in postoperative length of stay compared with standard perioperative care. Methods This was a prospective pre- and post-intervention study. Women were included if they were between 18 and 45 years of age and delivered a singleton, term, non-anomalous fetus via scheduled cesarean delivery by a provider within an academic practice. The ERAS pathway consisted of 23 evidence-based components regarding preoperative, intraoperative, and postoperative care. The primary outcome was the rate of postoperative length of stay of 3 or more days. Secondary outcomes included total postoperative narcotic use, postoperative complications, 30-day hospital readmission rates, and quality of recovery questionnaire scores. Results A total of 116 women were included. There were no significant differences in patient characteristics between the pre- and post-implementation groups in the post-implementation group, surgery time was longer (78.3 ± 27.8 vs 59.1 ± 19.2 min, p < .001) and blood loss volume was higher (910.3 ± 405.1 vs 729.1 ± 202.0, p = .003), compared to pre-implementation group. An ERAS pathway was not associated in a significant reduction in postoperative length of stay of 3 or more days (70.7% vs 75.9%, p = .529). It was also not significantly associated with a difference in postoperative narcotic use, maximum pain score, transfusion, postoperative complications or hospital readmission rates. Conclusion An early recovery after surgery pathway after scheduled cesarean delivery was not associated with a reduction in postoperative length of stay or narcotic use, though the recovery scores were better after implementation. [ABSTRACT FROM AUTHOR]

Objective To compare the composite neonatal and maternal adverse outcomes among low-risk pregnancies with versus without chorioamnionitis. Methods We conducted a retrospective cohort study using U.S. Vital Statistics Data. The study population was restricted to full term, low-risk, singleton pregnancies. Pregnancies were categorized into those affected and unaffected by chorioamnionitis. The primary outcome was composite neonatal adverse outcome and the secondary outcome was composite maternal adverse outcome. Multivariable Poisson regression models with robust error variance were used to examine the factors associated with chorioamnionitis and to evaluate the association between chorioamnionitis and adverse outcomes [using adjusted relative risk (aRR) and 95% confidence interval (CI)]. Results Of 19.7 million live births, 59.4% met inclusion criteria; among them, 1.7% were complicated by chorioamnionitis. The risk of composite neonatal adverse outcome was higher in newborns delivered by women with chorioamnionitis (aRR = 3.40; 95% CI = 3.30–3.49). Compared to women without chorioamnionitis, those with chorioamnionitis had a higher risk of composite maternal adverse outcome (aRR = 2.42; 95% CI = 2.31–2.55). Infant mortality was also higher in affected pregnancies (aRR = 1.23; 95% CI = 1.09–1.38). Conclusion Among low-risk pregnancies, chorioamnionitis is associated with a higher risk of composite neonatal and maternal adverse outcomes. Infant death is also increased. [ABSTRACT FROM AUTHOR]

Introduction To determine the impact of route of delivery on maternal outcomes among individuals who deliver preterm (before 37 weeks). Materials and methods This was a population-based retrospective cohort study using the U.S. vital statistics datasets on Period Linked Birth-Infant Death Data from 2014 to 2018. The study population was restricted to live births from women with non-anomalous singletons who delivered at 24–36 weeks of gestation. The main explanatory variable for this study was route of delivery, which was categorized as: (i) vaginal delivery, (ii) cesarean delivery with labor, and (iii) cesarean delivery without labor. The primary outcome was composite maternal adverse outcome, which encompassed any of the following: admission to the intensive care unit, maternal blood transfusion, uterine rupture, or unplanned hysterectomy. The results were presented as adjusted relative risk (aRR) with 95% confidence interval (CI). Results Over the study period 1,440,510 live births met the inclusion criteria, and the overall composite maternal adverse outcome was 14.38 per 1,000 live births. After multivariable adjustment, compared to women who underwent a vaginal delivery, the risk of composite maternal adverse outcome was higher in women who had a cesarean delivery with labor (aRR 3.70; 95% CI 3.52–3.90) and those who had a cesarean delivery without labor (aRR 4.79; 95% CI 4.59–4.98). Conclusion With preterm birth, cesarean delivery without labor has higher rate of composite maternal morbidity than cesarean during labor or vaginal delivery. [ABSTRACT FROM AUTHOR]

Objectives To compare the composite neonatal and maternal adverse outcomes among women with diabetes who labor and deliver at 37–41 weeks at distinct time shifts. Methods This population-based retrospective cohort study using the US Vital Statistics dataset on Period Linked Birth-Infant Death Data from 2013–2017. The study population was restricted to non-anomalous singleton live births from women with pregestational or gestational diabetes, who labored and delivered at 37 0/7 to 41 6/7 weeks of gestation. The time of delivery was categorized as the first shift (7:00–15:00), the second shift (15:00–23:00), and the third shift (23:00–7:00). The primary outcome was a composite neonatal adverse outcome; the secondary outcome was a composite maternal adverse outcome. Multivariable Poisson regression models were used to estimate the association between the time of delivery and adverse outcomes (using adjusted relative risk [aRR] and 95% CI). Results Of 19.8 million live births during the study period, 3.3% (643,610) met the study inclusion criteria. The overall rate of composite neonatal and maternal adverse outcomes were 9.62 and 3.63 per 1000 live births, respectively. Multivariable adjusted regression analysis showed that, compared to newborns delivered at the first shift, the risk of composite neonatal adverse outcome was modestly but significantly higher (aRR 1.19, 95% CI 1.12–1.27) in the third shift (23:00–7:00). There was no significant difference in the risk of composite maternal adverse outcomes between time shifts. In the sensitivity analysis stratified by the day of the week (weekday vs weekend), the results were consistent with the primary analyses. Conclusion Among term pregnancies complicated by diabetes, compared with delivery at 7:00–15:00, the risk of a composite neonatal adverse outcome is marginally but significantly higher if delivery occurs at the third shift (23:00–7:00). [ABSTRACT FROM AUTHOR]

Objective Among low-risk pregnancies, we ascertained the association between 10-minute Apgar score and adverse outcomes of newborn infants. Method We conducted a retrospective cohort study using the U.S. vital statistics datasets (2011–2018), which included live births from low-risk women with non-anomalous singleton gestations who delivered at 37–41 weeks. When a newborn infant had an abnormal 5-minute Apgar score (0–5), a 10-minute Apgar score was documented in the birth certificate. Apgar score at 10 min was categorized as low (0–3), moderate (4–6), and normal (7–10). The primary outcome was composite neonatal adverse outcome. The secondary outcomes were individual neonatal adverse outcomes and infant mortality. Multivariable Poisson regression analyses were used to estimate the association between 10-minute Apgar score and adverse outcomes (using adjusted relative risk [aRR] and 95% confidence intervals [CI]). Results Of 31.5 million live births delivered (2011–2018), 111,163 (0.4%) met inclusion criteria; of them, 74.2%, 20.7%, and 5.1% had normal, moderate, and low 10-minute Apgar scores, respectively. The overall composite neonatal adverse outcome was 100.6 per 1,000 live births and the risk was significantly higher among those with a moderate (aRR 3.19; 95% CI 3.06–3.31) or low 10-minute Apgar score (aRR 6.62; 95% CI 6.34–6.91) than with a normal 10-minute Apgar score. Infant mortality also showed a similar pattern. Newborn infants with improved Apgar scores from 5 to 10 min were associated with lower risks of the composite neonatal adverse outcome, as well as infant mortality, than those with scores that remained stable. Conclusion Among low-risk pregnancies, newborn infants with a lower 10-minute Apgar score were associated with a higher risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective: Among low-risk pregnancies, we aimed to ascertain the association between 5-minute Apgar score and adverse outcomes of newborn-maternal dyad.Study Design: We conducted a retrospective cohort study using the U.S. vital statistics datasets (2012-2016), including live births from low-risk women with non-anomalous singleton gestations who delivered at 37-41 weeks. Apgar score was categorized as low (0-3), moderate (4-6), and normal (7-10). The primary outcome was composite neonatal adverse outcome (any of the following: assisted ventilation > 6 h, neonatal seizure, or neonatal death). The secondary outcomes were infant mortality and composite maternal adverse outcome (any of the following: admission to the intensive care unit, blood transfusion, uterine rupture, or unplanned hysterectomy). Multivariable Poisson regression analyses were used to estimate the association between 5-minute Apgar score and adverse outcomes (using adjusted relative risk [aRR] and 95% confidence intervals [CI]).Results: Of 19.9 million live births delivered between 2012 and 2016, 11.7 million (58.7%) met inclusion criteria; 98.9% had a normal 5-minute Apgar score, 0.9% had a moderate score, and 0.2% had a low score. The overall composite neonatal adverse outcome was 3.2 per 1,000 live births and the rates were significantly higher among those with a moderate (aRR 20.8; 95% CI 20.2-21.4) or low score (aRR 43.1; 95% CI 41.6-44.5) than normal score. The overall composite maternal adverse outcome was 2.45 per 1,000 live births and it was significantly higher in deliveries with a moderate (aRR 3.1; 95% CI 2.9-3.3) and low (aRR 4.6; 95% CI 4.2-5.0) 5-minute Apgar score than those with a normal score. Infant mortality also showed a similar pattern.Conclusion: Though approximate 1% of live births had a 5-minute Apgar score below 7 among low-risk pregnancies, a decreased score was associated with a significantly higher risk of neonatal and maternal adverse outcomes, as well as infant mortality. [ABSTRACT FROM AUTHOR]

Introduction: To compare neonatal respiratory morbidity among small for gestational age (SGA; birth weight less than 10th percentile for gestational age) versus appropriate for gestational age (AGA; BW at 10-90th percentile) neonates born in the late preterm period.Methods: A secondary analysis of a multicenter randomized trial of antenatal corticosteroids for women at risk for late preterm birth. Singleton, nonanomalous, AGA or SGA births that delivered at 34-36 weeks were included. Women were excluded if they delivered after 37 weeks or had a large for gestational age baby (LGA; weight over 90th for gestational age). The primary outcome was a composite of any of the following: respiratory support by 72 h (continuous positive airway pressure or high flow nasal cannula ≥2 h, oxygen with a fraction of inspired oxygen of ≥30% for ≥4 h, extra corporeal membrane oxygenation or mechanical ventilation) or neonatal death. The secondary outcomes included several neonatal and maternal morbidities. Multivariable Poisson regression models were used to examine the association between neonatal weight and outcomes (using adjusted relative risk [aRR] and 95% confidence intervals [CI]).Results: Of the 2831 women in the parent trial, 2315 (82%) women met inclusion criteria; among them, 426 (18%) of the neonates were SGA. There was no significant difference in the risk of the primary outcome between SGA and AGA (13.1 versus 15.1%, aRR 0.85, 95% CI 0.66-1.10). SGA, however, was associated with an increased risk for neonatal intensive care unit admission (68 versus 45%, aRR 1.60, 95% CI 1.47-1.74), hypothermia (12.2 versus 8.8%, aRR 1.36, 95% CI 1.01-1.83), feeding problems (47.2 versus 36.9%, aRR 1.24, 95% CI 1.07-1.45) and a decreased risk of neonatal hyperbilirubinemia (7.5 versus 12.7%, aRR 0.59, 95% CI 0.41-0.84), when compared to AGA.Conclusion: In this cohort of late preterm birth, there was no significant difference in the rate of composite respiratory morbidity between SGA and AGA newborns. [ABSTRACT FROM AUTHOR]

Objective: To compare infant mortality rates among women with a failed versus successful trial of labor after cesarean (TOLAC) following labor induction or stimulation. Study design: Using US linked birth and infant death cohort data (2000-2004), we identified women who delivered non-anomalous singleton births at 34-41 weeks with TOLAC whose labors were induced or stimulated. Multivariable log-binomial regression models were fitted to estimate the association between TOLAC success and infant mortality. Results: Of the 164,113 women who underwent TOLAC, 41% were unsuccessful. After adjustment for potential confounding factors, a failed TOLAC was associated with a 1.4 fold (95% confidence interval [CI] 1.1, 1.7) increased risk of infant mortality. Conclusions: Among women undergoing labor induction or stimulation, a failed TOLAC is associated with higher likelihood of infant mortality. [ABSTRACT FROM AUTHOR]

Objective: To compare the rate of neonatal hypoglycemia among newborns delivered by individuals with Type 2 diabetes mellitus (T2DM) in two clinical scenarios: who attempted vaginal delivery vs. had a planned cesarean delivery (CD); who had intrapartum insulin infusion vs. who did not. Methods: This was a retrospective cohort study of individuals with insulin-treated T2DM who had non-anomalous singleton pregnancy and delivered at a single tertiary center (March 2012 and May 2018). Individuals with chronic renal failure, proliferative retinopathy, or major congenital anomalies were excluded. The primary outcome was neonatal hypoglycemia (blood glucose < 40 mg/dl <24 h of age or < 50 mg/dl >24 h of age). Secondary outcomes included neonatal outcomes. Multivariable Poisson regression models with robust error variance were used to examine the association between groups and the primary outcome. Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated. Results: Of 233 individuals with T2DM, 215 (92.2%) met the inclusion criteria, of whom 95 (44%) attempted vaginal delivery and 120 (56%) had a planned CD. Individuals who labored had a higher gestational age at delivery (36.6 vs. 35.8 weeks, p = .005), and higher blood glucose levels upon admission (125 vs 103, p < .001) compared to those with a planned CD. After adjustment for potential confounders, there was no difference in risk of neonatal hypoglycemia between the groups (41.2 vs 44.1%, aRR 1.05, 95% CI = 0.75-1.45). Among those who attempted vaginal delivery, 34 (35.8%) required insulin infusion. There was no difference in the risk of neonatal hypoglycemia (aRR = 0.79, 95% CI = 0.45-1.37) between newborns delivered by individuals who required insulin infusion and those who did not. Conclusion: Over 40% of newborns delivered by individuals with insulin-dependent T2DM had hypoglycemia; however, there was no significant difference in the risk of hypoglycemia, irrespective of the route of delivery and the use of insulin infusion. [ABSTRACT FROM AUTHOR]