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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]

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: A potential manner to lower the morbidity with the hypertensive disoreders of pregancy is to explore the time of day of delivery.Objective: To compare composite neonatal adverse outcomes among term women with hypertensive disorders.Methods: This population-based cohort study used the U.S. vital statistics dataset from 2013 to 2017. Time of delivery was categorized into three shifts. The primary outcome was composite neonatal adverse outcome..Results: Compared to neonates delivered at the first shift, the risk of composite neonatal adverse outcome was higher at the third shift (aRR = 1.19, 95% CI = 1.13-1.25).Conclusion: the risk of composite neonatal adverse outcome is higher if the delivery occurs at the third (23:00-7:00) shift. [ABSTRACT FROM AUTHOR]

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: 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]