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The objective of this work is to compare the rate of spontaneous preterm birth and associated neonatal morbidity among low-risk pregnancies conceived spontaneously versus pregnancies conceived using infertility medications/intrauterine insemination (IFM/IUI). This population-based retrospective cohort study utilized the US Vital Statistics data set from 2015 to 2019. Low-risk pregnancies, resulting in a live birth, of individuals who conceived either spontaneously or with the assistance of IFM/IUI were examined. The primary measured outcome was the rate of spontaneous preterm delivery, defined as delivery before 37 weeks' gestation without induction of labor. Of the 19,382,574 deliveries during the study period, 7,876,515 (40.6%) met the inclusion criteria. While 7,843,328 (99.6%) conceived spontaneously, 33,187 (0.4%) conceived using IFM/IUI. The rate of spontaneous preterm delivery was significantly higher for patients who conceived using IFM/IUI (71.0 per 1,000 live births) compared to patients who conceived spontaneously (60.3 per 1,000 live births; adjusted relative risk, 1.40; 95% confidence interval, 1.35–1.46). While the rate of spontaneous preterm births and associated composite of neonatal adverse outcomes are significantly higher in pregnancies conceived using IFM/IUI than spontaneous conception, the mortality is similar. [ABSTRACT FROM AUTHOR]

Objective In an effort to reduce the primary cesarean delivery (CD) rate, the American College of Obstetricians and Gynecologists (ACOG) recommended new labor guidelines in 2014 that allow longer duration of labor times. There are little data on the impact of these guidelines on CD rates and pregnancy outcomes in a predominantly Hispanic population. This study aimed to compare the primary CD rates and maternal and neonatal outcomes in patients undergoing primary CD for arrest of labor before and after implementation of the 2014 guidelines. Study Design This was a retrospective cohort study of term patients who underwent a CD for an arrest disorder between January 2011 and April 2017 at a county teaching hospital. Our primary outcome was the composite maternal and neonatal morbidities (CMM and CNM, respectively). Differences in the demographic and clinical characteristics, CMM, and CNM stratified by time period (pre- vs. postimplementation) were examined. Results There were 4,976 deliveries in the study period: 525 (11%) underwent primary CD for arrest disorder; 298 (6%) prior to 2014, and 227 (5%) after 2014 (p = 0.62). There was no significant difference in the rate of CD between the two periods (13.4 vs. 13.3%, p = 0.81). In patients undergoing CD for arrest of dilation (n = 389), the CMM and CNM did not significantly change between both groups (63.3 vs. 56%, p = 0.15). In patients who had a CD for arrest of descent (n = 136), the rate of CMM significantly increased from 50 to 75% (p = 0.02) with no significant change in the CNM (13.2 vs. 20%, p = 0.3). Conclusion Despite significant changes in labor management after the publication of the 2014 guidelines, our primary CD rate was not reduced, and we noticed an increase in CMM in patients who had CD for arrest of descent. A randomized controlled trial is needed to further evaluate the effect of these guidelines nationally. Key Points The Obstetric Care Consensus statement aims to decrease the rate of cesarean delivery (CD). We observed an increase in morbidity in CD if done for arrest of descent (pre/post the consensus). A randomized controlled trial is needed to further assess the impact of the guidelines on morbidity. [ABSTRACT FROM AUTHOR]

Objective  Women with placenta accreta spectrum (PAS) having an unplanned delivery may have worse outcome compared with women with a planned delivery. The primary objective of this study was to compare severe maternal morbidity among women with PAS who had a planned scheduled delivery versus an unplanned delivery. Secondary objective was to compare neonatal outcomes. Study Design  Retrospective cohort study at two tertiary centers (January 2009 to June 2019) of all women who underwent a hysterectomy with a histologic proven PAS. Primary outcome was severe maternal morbidity which defined as any of the following: transfusion of ≥4 RBC units or ureter/bowel injury. Neonatal outcome was a composite neonatal morbidity defined as any of the following: Apgar score's < 5 at 5 minutes, mechanical ventilation, or respiratory distress syndrome. Maternal demographic, clinical, and sonographic characteristics were compared between the two groups (planned vs. unplanned). Descriptive statistics were used as appropriate, and a statistical significance was established if p -value was < 0.05. Results  Of 109 women who underwent cesarean hysterectomy for PAS, 41 (37.6%) had an unplanned delivery. There was no significant difference in the number of previous cesarean deliveries or ultrasound findings between the two groups. Women with an unplanned delivery were more likely to bleed during pregnancy than those that had a planned delivery (p  = 0.04). Women with unplanned delivery had lower gestational age at delivery (30.3 vs. 33.8 weeks, p  = 0.001) had a 75% higher rate of the primary outcome (63 vs. 36%, p  = 0.007) and had a higher rate of intensive care unit admissions (39 vs. 17.7%, p  = 0.01) compared with women with a planned delivery. The neonatal morbidity did not differ between the two groups. Conclusion  Since unplanned cesarean hysterectomy among women with PAS occurs in 40% and is associated with significantly higher morbidity, interventions are needed to mitigate the rate of adverse outcomes. Key Points Only 60% of women with PAS reached planned delivery at 34 weeks. PAS unplanned delivery is associated with high morbidity. Some women with PAS may need a scheduled earlier delivery. [ABSTRACT FROM AUTHOR]

Background: Multiple surgical approaches have been proposed to repair the congenital choanal atresia. However, there remains no general consensus about the optimal surgical technique. This study aimed to describe and evaluate outcomes of the endoscopic septonasal flap technique combined with bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants. Methods: Clinical data of 37 neonates and infants with congenital choanal atresia who received nasal endoscopic surgery with the flap technique between January 2018 and July 2020 were analyzed retrospectively. All patients underwent the ultra‑low‑dose paranasal sinus computed tomography imaging preoperatively to confirm diagnosis and plan the surgery. In these patients, the mirrored L-shaped flap technique was performed for bilateral atresia and the cross-over L-shaped flap technique was performed for unilateral atresia. A total of 22 patients had silicone stents postoperatively and 15 patients had bioabsorbable steroid-eluting stents postoperatively. Silicone stents were removed at one month postoperatively under secondary general anesthesia, while no anesthesia was needed to remove the bioabsorbable steroid-eluting stents. Postoperative follow-up ranged from 10 months to 3 years. Results: The septonasal flap technique was performed in all patients. Compared with the silicone stents group, the average operative duration and the hospital length of stay in the bioabsorbable steroid-eluting stents group were decreased [(97.46 ± 15.37) min vs (83.49 ± 19.16) min t = 13.733, P < 0.001] [(12.8 ± 3.22) d vs (7.67 ± 3.91) d t = 15.082, P < 0.001], the average number of procedures was reduced [(2.04 ± 0.64) vs (1.00 ± 0.00), t = 82.689, P < 0.001], the differences were statistically significant. There were no reports of postoperative restenosis and complications in the bioabsorbable steroid-eluting stents group, and follow-up endoscopic examinations showed patency and stable nasal passages in all cases. Conclusions: The endoscopic septonasal flap technique can effectively expose and expand the choanal bony structure for repair of congenital choanal atresia in neonates and infants. The combined use of this technique along with bioabsorbable steroid-eluting stents can help prevent the need for revision procedures and also against stent-related injuries. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to assess the risk of adverse outcomes among low-risk pregnancies at 39 to 41 weeks, stratified by birth weight percentile. Study Design  This retrospective cohort study utilized the U.S. vital statistics datasets (2013–2017) and evaluated low-risk women with nonanomalous cephalic singleton gestations who labored and delivered at 39 to 41 weeks, regardless of ultimate mode of delivery. Newborns were categorized as small (<10th percentile), large (>90th percentile), or appropriate (10–90th percentile) for gestational ages (SGA, LGA, and AGA, respectively). The primary outcome, composite neonatal adverse outcome (CNAO), included Apgar's score <5 at 5 minutes, assisted ventilation >6 hours, seizure, or neonatal death. The secondary outcome, composite maternal adverse outcome (CMAO), included intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. Multivariable Poisson's regression was used to estimate the association (using adjusted relative risk [aRR] and 95% confidence interval [CI]). Results  Of 19.8 million live births during the study interval, approximately 8.9 million (44.9%) met the inclusion criteria, with 9.9% being SGA, 9.2% being LGA, and 80.9% being AGA. SGA newborns delivered at 40 (aRR = 1.17; 95% CI: 1.12–1.23) and at 41 weeks (aRR = 1.55; 95% CI: 1.45–1.66) had a higher risk of CNAO than at 39 weeks. Similarly, LGA newborns delivered at 40 (aRR = 1.13; 95% CI: 1.07–1.19) and 41 weeks (aRR = 1.44; 95% CI: 1.35–1.54) and AGA newborns delivered at 40 (aRR = 1.24; 95% CI: 1.21–1.26) and 41 weeks (aRR = 1.57; 95% CI: 1.53–1.61) also had a higher risk of CNAO than at 39 weeks. CMAO was also significantly higher at 40 and 41 weeks than at 39 weeks, regardless of whether the mothers delivered SGA, LGA, or AGA newborns. Conclusion  Among low-risk pregnancies, the risks of composite neonatal and maternal adverse outcomes increase from 39 through 41 weeks' gestation, irrespective of whether newborns are SGA, LGA, or AGA. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to compare morbidities among nonmacrosomic versus macrosomic singleton live births of nondiabetic women who labored. Study Design  This retrospective study utilized the 2003 revision of U.S. birth certificate data of singleton live births (2011–2013) at 37 to 41 weeks who labored. The primary outcomes were composite maternal and neonatal morbidities (CMM and CNM, respectively). We compared these outcomes by birth weight, 2,500 to 3,999 g (group 1; reference), 4,000 to 4,449 g (group 2), and 4,500 to 5,999 g (group 3). We used multivariable Poisson regression analyses to examine the association between birth weight groups and the outcomes. Results  Among 6,691,338 live births, 92.0% were in group 1, 7.1% in group 2, and 0.9% in group 3. The overall CMM and CNM rates were 4.4 and 6.8 per 1,000 live births, respectively. Compared with group 1, the risk of CMM was significantly higher in group 2 (adjusted risk ratio [aRR] = 1.50; 95% confidence interval [CI]: 1.44–1.56) and group 3 (aRR = 2.00; 95% CI: 1.82–2.19). Likewise, the risk of CNM was significantly higher in group 2 (aRR = 1.38; 95% CI: 1.33–1.43) and group 3 (aRR = 2.57; 95% CI: 2.40–2.75) than in group 1. Conclusion  Nondiabetic women who labor with a macrosomic newborns have a significantly higher rate of adverse outcomes than nonmacrosomic. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to compare the maternal and neonatal adverse outcomes among singletons delivered at 36 weeks or later with cerclage during index pregnancy versus those without cerclage. Study Design  This retrospective cohort study utilized the U.S. vital statistics datasets from 2011 to 2013. Inclusion criteria were women with nonanomalous singletons, with and without cerclage placement, without diabetes or hypertensive disorders, and delivered at 36 to 41 weeks. The coprimary outcomes were composite maternal and neonatal adverse outcomes. Composite maternal adverse outcome included admission to intensive care unit, maternal transfusion, ruptured uterus, unplanned hysterectomy, or unplanned operating room procedure. Composite neonatal adverse outcome included Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, neonatal seizure, birth injury, or neonatal death. Secondary outcomes were chorioamnionitis and cesarean delivery. Multivariable Poisson's regression models with error variance were used while adjusting for confounders. Adjusted relative risk (aRR) with 95% confidence intervals (CIs) were calculated. Results  Of the 8,508,228 women who met inclusion criteria, 0.2% had a cerclage and reached 36 weeks. Composite maternal (aRR: 2.04; 95% CI: 1.76–2.36) and neonatal (aRR: 1.28; 95% CI: 1.11–1.47) adverse outcomes were significantly higher among those with cerclage than those without cerclage. Chorioamnionitis (aRR: 1.47; 95% CI: 1.30–1.67) and cesarean delivery (aRR: 1.10; 95% CI: 1.08–1.12) were also significantly higher in women with cerclage than those without cerclage. Conclusion  There is an association between increased composite maternal and neonatal adverse outcomes among women with cerclage who delivered at 36 to 41 weeks as compared with those without cerclage. Key Points Cerclage is associated with increased composite maternal adverse outcome in women at 36–41 weeks. Cerclage is associated with increased composite neonatal adverse outcome in women at 36–41 weeks. Increased chorioamnionitis and cesarean delivery rates are associated with cerclage in women at 36–41 weeks. [ABSTRACT FROM AUTHOR]

Objective  To evaluate the degree of adherence to the new the American College of Obstetricians and Gynecologists/Society for Maternal–Fetal Medicine guidelines in labor arrest management. Study Design  A retrospective study of term, live, singleton deliveries with intrapartum primary cesarean delivery solely for failed induction of labor or labor arrest. Adherence was defined according to the Safe Prevention of the Primary Cesarean Delivery 2014 criteria. We evaluated adherence and compared maternal and perinatal outcomes, delivery time frame, and billing provider. Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI). Results  Two-hundred six deliveries met the inclusion criteria; 73% were deemed not adherent to the guidelines. The majority of cases were under the care of nonacademic private practice OB/GYN physicians. The adherence rate was higher in the active phase of labor (45%) than in second stage (17%) and latent phase (14%). There were no differences in perinatal outcomes between the two groups. The adherence to guidelines was higher among academic OB/GYN physicians (aRR, 2.24, 95% CI, 1.49–3.36) and during the weekday–night shift (aRR, 1.81, 95% CI, 1.10–2.98). Conclusion  Despite recent guidelines aimed to reduce the primary cesarean delivery rate, most cesarean deliveries performed for labor arrest disorders were not adherent to the guidelines. [ABSTRACT FROM AUTHOR]

Objective We aimed to compare the rates of wound separation (WS) and surgical site infection (SSI) after cesarean delivery (CD) by a single surgeon. Pfannenstiel skin incision (PSI) was closed with Dermabond, staples, or suture. Study Design Retrospectively all women having CD via PSI were identified.WS and SSI rates with Dermabond were compared with other two techniques. Results Of 239 CDs performed, 88% (n = 211) were available for postpartum evaluation. The PSI was closed with Dermabond in 85 (40%), staples in 76 (36%), and suture in 50 (24%). Overall WS rate was 7%; with Dermabond, it was 5% versus 13% with staple (p = 0.090) and 2% with suture (p = 0.651). Post hoc calculation suggests a randomization of 4325 women is needed to determine if Dermabond has one-third less wound complication than suture. Conclusion For the PSI closure, Dermabond may be a useful alternative skin closure device, though a randomized trial is warranted. [ABSTRACT FROM AUTHOR]