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Purpose: To determine whether meconium-stained amniotic fluid (MSAF) encountered in pregnancies complicated by preterm premature rupture of membranes (PPROM) is associated with adverse maternal and perinatal outcome.Methods: A retrospective cohort study of all singleton pregnancies with PPROM and MSAF who delivered in a tertiary hospital at 24 + 0-36 + 6 weeks of gestation between 2007 and 2017. Women with PPROM-MSAF (study group) were compared to women with PPROM and clear amniotic fluid (control group). Controls were matched to cases according to age, gravidity, parity and gestational age at delivery in a 3:1 ratio. Primary outcome was defined as neonatal intensive care unit admission. Secondary outcomes were neonatal adverse outcomes, chorioamnionitis and placental abruption diagnosed clinically or by placental cultures and histology.Results: Seventy-five women comprised the study group and were matched to 225 women representing the control group. A significantly higher rate of neonatal intensive care unit admissions was noted in the study group compared to controls (61.3% vs. 45.7%, p = 0.03). Multivariate analysis demonstrated that MSAF is an independent risk factor for neonatal intensive care unit admission (adjusted OR = 2.82, 95% CI 1.39-5.75, p = 0.004). MSAF was found to be associated to higher rates of cesarean and operative vaginal deliveries (30.7% vs. 24.4% and 5.3% vs. 2.7%, p = 0.057, respectively) as well as to chorioamnionitis and placental abruption (33.3% vs. 19.3%, p = 0.034 and 16.0% vs. 7.7%, p = 0.021, respectively).Conclusion: MSAF is associated with higher frequencies of adverse perinatal outcome when compared to clear amniotic fluid in pregnancies complicated by PPROM. [ABSTRACT FROM AUTHOR]

Background: The two most commonly used nomograms for amniotic fluid index (AFI) were developed by Moore and Cayle and Magann et al. However, there are several inconsistencies between the two methods.Objective: The aim of the study was to determine whether these differences carry clinical significance.Methods: A retrospective cohort of women with singleton pregnancies evaluated for AFI during pregnancy at a tertiary medical center in 2007-2014 were divided into five groups: group A, definite oligohydramnios-AFI below the fifth percentile according to the nomograms of both Moore and Cayle and Magann et al.; group B, intermediate oligohydramnios-AFI below the fifth percentile according to only one nomogram (Moore and Cayle); group C, euhydramnios-normal AFI according to both nomograms; group D, intermediate polyhydramnios-AFI above the 95th percentile according to one nomogram (Magann et al.); group E, definite polyhydramnios-above the 95th percentile according to both nomograms. The association of group by maternal and perinatal outcomes was analyzed.Results: A total of 6987 women were included: group A, 996 (14%); group B, 1344 (19%); group C, 2561 (37%); group D, 1051 (15%); group E, 1034 (15%). Group B (intermediate oligohydramnios) was characterized by significantly lower rates of adverse perinatal outcomes than group A (definite oligohydramnios): small for gestational age neonate (12.3 versus 15.2%, p = .05), neonatal intensive care unit admission (11.1 versus 21.5%; p < .001), composite respiratory outcome (4.8 versus 9.8%; p < .001), and neonatal sepsis (6.4 versus 10.8%; p < .001). No such differences were found between groups B and C. Group D (intermediate polyhydramnios) differed from group E (definite polyhydramnios) by lower rates of 5 minutes Apgar score <7 (1.3 versus 3.2%; p = .003), neonatal intensive care unit admission (10.9 versus 14.4%; p = .02), and major congenital anomalies (1.7 versus 5.6%; p = .02). There was no difference in these parameters between groups D and C.Conclusion: This study suggests that intermediate oligohydramnios and intermediate polyhydramnios are not associated with adverse perinatal outcomes. Outcome in these pregnancies is similar to pregnancies with euhydramnios. Commonly used AFI nomograms should be updated. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the association between second trimester biochemical markers and pathological placentation. Methods: This was a retrospective case-control study (2007–2014) of singleton gestations at a university-affiliated tertiary center. Women with pathologic placentation were subdivided into three groups: placenta accreta (group A), placenta previa (group B), or both (group C). We compared second trimester biochemical screening markers taken between 16 + 0 and 19 + 6 weeks of gestation between groups A, B, and C, and women with normal placentation (group D). Obstetrical and neonatal outcomes, risk factors for pathologic placentation, and second trimester biochemical marker values were compared between groups. Results: Overall, 301 deliveries were evaluated: 64 (21%) in group A, 66 (22%) in group B, 17 (6%) in group C, and 153 (51%) in group D. Each of the pathological placentation groups individually had a higher median alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) multiples of median (MoM) than the controls, with the highest values of AFP and hCG observed among women with placenta accreta and the lowest values among the controls. When a multivariant analysis was applied, the hCG levels remained significantly correlated with pathological placentation. Receiver operation characteristic curves for AFP, hCG, or both were computed. For AFP the area under the ROC curve (AUC) was 0.573 (95% CI 0.515–0.630, p < 0.0274) and a cut-off value above 0.99 MoM demonstrated a sensitivity and specificity of 71 and 46%, respectively, for the prediction of pathological placentation. For hCG, the AUC was 0.662 (95% CI 0.605–0.715, p < 0.0001) and a cut-off value of 1.25 MoM demonstrated a sensitivity and specificity of 53 and 68%. When both markers were plotted, the AUC was 0.668 (95% CI 0.611–0.721, p < 0.0001) and sensitivity and specificity were 63 and 64%, respectively. A percentile MoM cut-off approach distinguished between two groups: a high-risk group (patients with AFP or hCG or both above the 75th percentile, odds ratio (OR) for pathological placentation 2.27, 95% CI 1.42–3.63), and a low-risk group (patients with AFP or hCG or both below the 25th percentile, OR for pathological placentation 0.38, 95% CI 0.24–0.60). Conclusion: Second trimester biomarkers such as hCG and AFP can be used to raise a suspicion towards characterizing women into high-risk and low-risk groups for pathological placentation. [ABSTRACT FROM AUTHOR]

Objective: To compare pregnancy outcomes following induction of labor with prostaglandins versus extra-amniotic balloon catheter indicated for term isolated oligohydramnios.Study Design: Retrospective cohort study of all women who underwent induction of labor due to term isolated oligohydramnios at a university affiliated medical center (2007-2016). The cohort was divided into two subgroups, according to induction method: vaginal prostaglandins E2 versus extra-amniotic balloon catheter. Primary outcomes were successful cervical ripening, defined as a Bishop score ≥ 8, and vaginal delivery rate. Secondary outcomes were neonatal adverse events.Results: Five hundred and ten women were included, of whom 454 (89%) underwent induction by prostaglandins and 56 (11%) by extra-amniotic balloon. Cervical ripening success rate was significantly higher in the prostaglandins group (89.4 vs. 76.79%, p = 0.006), as was the rate of vaginal delivery (77.53 vs. 48.21%, p < 0.0001). Induction with prostaglandins remained superior to extra-amniotic balloon in vaginal delivery rate following adjustment to potential confounders (aOR 3.470, 95% CI 1.296-9.296, p < 0.0001). Neonates delivered following induction with extra-amniotic balloon catheter were more often admitted to the neonatal intensive care unit (14.55 vs. 3.39%, p = 0.002).Conclusion: Both prostaglandins and extra-amniotic balloon catheter are reasonable interventions for isolated term oligohydramnios. Prostaglandins were superior to extra-amniotic balloon both in cervical ripening success and in vaginal delivery rates. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate various sonographic estimated fetal weight (sEFW) formulas’ accuracy for small- and large-for-gestational age (SGA/LGA) prediction in breech-presenting fetuses. Materials and methods: A retrospective analysis of all ultrasound-based fetal biometrical measurements performed within 3 days of delivery in term pregnancies, in one medical center (2007–2014). Overall, 274 breech-presenting fetuses (study group) were compared to 274 vertex-presenting fetuses (control group) matched by gender, gestational age and birth weight. sEFW was calculated by six previously published formulas. Accuracy was compared utilizing systematic error and random error for every formula. Prediction precision of SGA and LGA was evaluated by calculating each formula’s sensitivity, specificity, +/− predictive value, and the area under the receiver-operating characteristic (ROC) curve (AUC). Results: Systematic error and random error varied greatly between formulas, ranging from −7.4% to 3.1%, 7.3% to 8.3% for the vertex-presenting fetuses and −8.9% to 1.9%, 7.9% to 8.6% for the breech-presenting fetuses, respectively. There was no statistical difference in small- or large-for-gestational age prediction parameters between the groups. The highest sensitivity and specificity for prediction was achieved by same formula regardless of presentation. Conclusion: In our cohort, overall accuracy was slightly superior among vertex-presenting fetuses without difference in prediction accuracy for small- and large-for-gestational age neonates. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between antenatal corticosteroid treatment and neonatal complications in diabetic mothers delivering after 34 weeks of gestation.Methods: A retrospective cohort study of women with singleton pregnancies diagnosed with gestational diabetes who delivered after 34 weeks of gestation in a university-affiliated medical center (2012-2016). Mothers treated with corticosteroids prior to 34 + 0 weeks of gestation were divided according to gestational age at delivery: late-preterm (34 + 0 to 36 + 6) and term (37 + 0 to 41 + 6). Each group was compared to women delivering at the same gestational age who were not treated with corticosteroids. Primary outcome was defined as a neonatal adverse composite outcome. Birth weight was amongst secondary outcomes measured. Logistic regression analysis was utilized to adjust results to potential confounders.Results: During the study period, 161 diabetic mothers delivered at late-preterm. Amongst them, 47 (30%) were treated with corticosteroids. 2101 diabetic mothers delivered at term, amongst them 82 (4%) were treated with corticosteroids. Primary outcome did not differ between groups. Multivariate analysis demonstrated that corticosteroid treatment was not associated with neonatal adverse composite outcome when delivery occurred at the late preterm, nor at term (adjusted odds ratio (aOR) = 0.708, 95% CI 0.2-2.3, p = 0.572, and aOR = 1.6, 95% CI 0.2-12.7, p = 0.635, respectively). Birth weight was significantly lower in women treated with corticosteroids (2486 vs. 2675 g, p = 0.02 at late-preterm, and 3160 vs. 3319 g, p < 0.001 at term).Conclusion: Corticosteroid treatment for diabetic mothers was not associated with neonatal adverse outcomes, but was found associated with a lower birth weight, when delivery occurs after 34 weeks of gestation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether cesarean delivery (CD) indication, labor status, and other primary CD characteristics affect the risk for uterine rupture in subsequent deliveries.Methods: A case-control study of women attempting trial of labor after cesarean (TOLAC) in a single, tertiary, university-affiliated medical center (2007-2016). Deliveries complicated by uterine rupture were matched to successful vaginal birth after cesarean (VBAC) deliveries in a 1:3 ratio. Indication, labor status and post-partum complications (postpartum hemorrhage and postpartum infection) at primary CD were compared between study and control group.Results: During study period, there were 75,682 deliveries, of them, 3937 (5.2%) were TOLAC. Study group included 53 cases of uterine rupture at TOLAC and 159 women with successful VBAC. Women in study group had significantly lower rates of previous VBAC (15.1 vs. 28.9%, p = 0.047). Rate of postpartum complications at primary CD was significantly higher in women with TOLAC complicated by uterine rupture (7.5 vs. 1.9%, respectively, p = 0.042). Utilizing the multivariate logistic regression analysis, postpartum complications remained an independent risk factor for uterine rupture in the following TOLAC (aOR 4.07, 95% CI 1.14-14.58, p = 0.031).Conclusion: Postpartum hemorrhage and infection, in primary CD, seem to be associated with increased risk for uterine rupture during subsequent TOLAC. [ABSTRACT FROM AUTHOR]

Objective: To estimate the effect of prior successful vaginal birth after cesarean (VBAC) on the rate of uterine rupture and delivery outcome in women undergoing labor after cesarean.Methods: A retrospective cohort study of all women attempting labor after cesarean delivery in a university-affiliated tertiary-hospital (2007-2014) was conducted. Study group included women attempting vaginal delivery with a history of cesarean delivery and at least one prior VBAC. Control group included women attempting first vaginal delivery following cesarean delivery. Primary outcome was defined as the rate of uterine rupture. Secondary outcomes were delivery and maternal outcomes.Results: Of 62,463 deliveries during the study period, 3256 met inclusion criteria. One thousand two hundred and eleven women had VBAC prior to the index labor and 2045 underwent their first labor after cesarean. Women in the study group had a significantly lower rate of uterine rupture 9 (0.7%) in respect to control 33 (1.6%), p = .036, and had a higher rate of successful vaginal birth (96 vs. 84.9%, p < .001). In multivariate analysis, previous VBAC was associated with decreased risk of uterine rupture (OR = 0.46, 95% CI 0.21-0.97, p = .04).Conclusions: In women attempting labor after cesarean, prior VBAC appears to be associated with lower rate of uterine rupture and higher rate of successful vaginal birth. [ABSTRACT FROM AUTHOR]

Objective: To determine the perinatal outcome associated with cup detachment during vacuum-assisted vaginal delivery (VAVD).Methods: A retrospective cohort study of all women attempting VAVD in a tertiary hospital (2012-2014). Singleton-term pregnancies were included. Antepartum fetal death and major fetal structural or chromosomal abnormalities were excluded. Primary outcome was neonatal birth trauma (subgaleal hematoma, subarachnoid hematoma, subdural hematoma, skull fracture, and/or erb's palsy). Secondary outcomes were maternal complications or other neonatal morbidities. Outcomes were compared between women after ≥1 cup detachment (study group) and the rest (control group). Logistic regression analysis was utilized to adjust results to potential confounders.Results: Overall, 1779 women attempted VAVD during study period. Of them, in 146 (8.2%), the cup detached prior to delivery; 130/146 (89%) had a single detachment. After detachment, 4 (2.7%) delivered by cesarean section, 77 (52.7%) delivered after cup reapplication, and 65 (44.6%) delivered spontaneously. Women in the study group were more likely to undergo VAVD due to prolonged second stage, and were characterized by lower rates of metal cup use. Neonates in the detachment group had higher rates of subarachnoid hematoma and composite neonatal birth trauma (2.7 vs. 0.1% and 4.8 vs. 1.8%, respectively, p < 0.05). This remained significant after adjustment to potential confounders (subarachnoid hematoma aOR = 45.44, 95% CI 6.42-321.62 and neonatal birth trauma aOR = 2.62, 95% CI 1.1-6.22, p < 0.05 for all). Other neonatal and maternal morbidities were similar between groups.Conclusion: Cup detachment is associated with a higher rate of adverse neonatal outcome. Cup reapplication should be considered carefully. [ABSTRACT FROM AUTHOR]

Purpose: Maternal thyroid gland dysfunction may adversely affect pregnancy outcome. We aimed to examine the association between subclinical thyroid dysfunction, both hypothyroidism and hyperthyroidism, to adverse pregnancy outcome.Materials and Methods: Retrospective cohort study of all women with an available first trimester thyroid function testing and known pregnancy outcome, categorized to subclinical hypothyroidism, or hyperthyroidism and evaluated for complication during gestation and delivery.Results: Four thousand five hundred and four women were included in the final analysis - 3231 were euthyroid, 73 (1.6%) were categorized as subclinical hyperthyroidism and 1200 (26.6%) had subclinical hypothyroidism. Low thyroid-stimulating hormone (TSH) levels, i.e. subclinical hyperthyroidism, correlates with higher rates of placental abruption and extremely low birth weight, below 1500 g. Also, the risk for preterm delivery prior to 34 gestational weeks is higher among women with subclinical hypothyroidism, with greater risk among those with a higher TSH level. (OR 1.81, 95% CI 1.0-3.28 for TSH 2.5-4.0 mIU/L and OR 2.33, 95% CI 1.11-4.42 for those with TSH > 4 4.0 mIU/L).Conclusions: Subclinical hypothyroidism is associated with an increased risk for preterm delivery prior to 34 gestational weeks. Additionally, subclinical hyperthyroidism may also have a role in adverse pregnancy outcome - low birth weight and placental abruption - although this needs to be further explored. [ABSTRACT FROM AUTHOR]

Purpose: Maternal age is an important consideration for antenatal care, labor and delivery. We aimed to evaluate the induction of labor (IoL) failure rates among elderly nulliparous women.Materials and Methods: We conducted a retrospective analysis of all nulliparous women at 34 + 0 to 41 + 6 weeks, undergoing cervical ripening by prostaglandin E2 (PGE2) vaginal insert. Study group included elderly (≥35 years) nulliparous and control group included non-elderly (<35 years) nulliparous women. Primary outcome was IoL failure rate and secondary outcome was cesarean delivery rate. Outcomes were compared between the groups by univariate analysis followed by regression analysis to adjust results to potential confounders.Results: Of 537 women undergoing IoL, 69 (12.8%) were elderly. The univariate analysis demonstrated no difference in IoL failure rate (26.5% versus 34.8%, p = 0.502) between groups. However, elderly nulliparous women had higher rates of cesarean delivery (36.2% versus 21.4%, p = 0.009). This difference was no longer significant after adjustment for maternal body mass index, indication for delivery, birth weight and gestational age at delivery.Conclusion: Among nulliparous women, older maternal age is not associated with higher rates of IoL failure or cesarean deliveries. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate pregnancy outcome following false diagnosis of fetal growth restriction (FGR).Methods: Retrospective analysis of all singleton term deliveries of appropriately grown fetuses (10-90th weight percentiles) in a single medical center (2007-2014). Elective cesarean-section, diabetes, and hypertension were excluded. Cohort was stratified based on third trimester sonographic estimated-fetal-weight (≥32 weeks). Women with false diagnosis FGR (<10th percentile) were compared with the rest (control). Induction of labor, cesarean deliveries, and short-term perinatal outcome were compared. Logistic regression analysis was performed to adjust outcome for birth weight and gestational age at delivery.Results: Of 34,474 pregnancies, 415 were falsely diagnosed as FGR (1.2%). Women in study group delivered earlier (38.6 ± 1.1 versus. 39.0 ± 0.9) with lower birth weights (2856 ± 270 versus 3271 ± 307 grams) and increased rate of labor inductions (19.8% versus 6.4%) and cesarean deliveries (10.8% versus 5.7%). Despite appropriate birth weight, study group neonates had higher rates of NICU admissions (10.6% versus 6.8%), mechanical ventilation (1.7% versus 0.5%), transient tachypnea of the newborn (1.7% versus 0.5%), hypoglycemia (1.7% versus 0.5%), and jaundice (11.3% versus 7.0%). p < 0.01 for all. All remained significant after adjustment to confounders.Conclusions: False diagnosis of FGR is associated with higher rates of induction of labor, cesarean deliveries, and short-term adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

This study describes a retrospective analysis of all women admitted for induction of labour (IoL), carrying a viable singleton foetus, after 34 + 0 weeks of gestation. We aimed to evaluate if foetal sex has an impact on the rate of caesarean delivery following labour induction. Our results demonstrate that among the 1062 women who met the inclusion criteria, 49% (521/1062) were carrying a male foetus. Other than a lower rate of Oxytocin use for the female sex pregnancies, there were no significant differences in pre-labour and labour characteristics between male or female sex pregnancies. There was no difference in caesarean delivery rate between groups (14.4% vs. 14.2%, male vs. female, respectively, p = .505). We concluded conclude that foetal sex does not impact the caesarean delivery rate among women undergoing IoL, regardless of the indication for induction and the indication for the caesarean delivery. Impact statement Male sex foetuses are at increased risk for adverse perinatal outcomes including, among others, an increased risk for caesarean delivery. The possible contribution of male sex to caesarean delivery after labour induction has not been specifically explored. Following induction of labour, there is no difference in failed induction or caesarean delivery rate between male and female sex pregnancies. Induction of labour may be safely employed for both male and female foetuses. [ABSTRACT FROM AUTHOR]

Objective: To compare perinatal outcome of women after third trimester oral glucose tolerance test (GTT) following normal glucose challenge test (GCT) stratified by test results.Study Design: Retrospective cohort study of women delivered in a tertiary, university affiliated medical center (2007-2012). Inclusion criteria were women with a normal 50 g GCT (<140 mg/dl) followed by GTT, who delivered a live-born fetus >28 gestational weeks. Gestational diabetes mellitus (GDM) was defined as ≥2 pathological values on GTT (Carpenter and Coustan's criteria). Perinatal outcome was stratified by GTT results: normal (if all 4 values were normal), single pathological value or GDM. Logistic regression analysis was utilized to adjust outcomes to potential confounders.Results: Overall, 323 women met inclusion criteria. Of them, 277 (85.8%) had 4 normal values, 32 (9.9%) had a single pathological value and 14 (4.3%) had late-onset GDM. Infants of mothers diagnosed and treated as GDM had lower birth weights, compared to non-diabetics and those with a single pathological value GTT. Mothers with GTT ≥1 pathological values had statistically insignificant higher rates of cesarean delivery. However, this difference was not significant after adjustment to potential confounders.Conclusion: Treatment of late-onset GDM may lead to lower birthweights, presumably due to glucose control. No association was found with cesarean delivery or neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: To determine predictive factors for vaginal birth after cesarean section (VBAC). Methods: A retrospective cohort study of all women with singleton pregnancies and a prior single low transverse cesarean section (CS) who attempted vaginal delivery in a tertiary hospital (2010–2014). Pregnancy outcome of women with VBAC was compared to those who failed vaginal delivery. Sub-analysis for women with no prior vaginal deliveries was performed. Pregnancies with non-cephalic presentation, estimated fetal weight >4000 g and any contraindications for vaginal delivery were excluded. Results: Of the 40 714 deliveries, 1767 women met inclusion criteria. Among them 1563 (88.5%) had a VBAC and 204 (11.5%) failed. There was no significant difference between the groups regarding maternal age, comorbidities and pregnancy complications. Predictors for VBAC were (odds ratio, 95% confidence interval) interval from prior CS (1.13, 1.04–1.22,p=0.004), previous VBAC (2.77, 1.60–4.78,p < 0.001), prior vaginal delivery prior to the CS (3.05, 1.73–5.39,p < 0.001) and induction of labor (0.62, 0.40–0.97,p = 0.03). For women with no prior vaginal birth, only birthweight was associated with VBAC (0.99, 0.99–1.00,p = 0.02). Conclusion: While different variables may influence the rate of VBAC, the predictive ability of VBAC for women with no previous vaginal deliveries remains poor. [ABSTRACT FROM PUBLISHER]

Objective: To determine the association between single previous abortion and pregnancy outcome in nulliparous women.Methods: A retrospective cohort study of all nulliparous women who delivered in a university-affiliated tertiary hospital (2009-2014). Pregnancy outcome of women with single previous first trimester abortion (study group) was compared to those of primigravida (control group).Results: Of the 44 371 deliveries during the study period, 14 498 (32.6%) were of nulliparous women, of them 1501 (10.3%) had single previous abortion (<13 weeks). Except for a higher rate of diabetes mellitus in the study group (6.1 versus 4.4%, p = 0.003), no differences were found between the groups regarding pregnancy complications. In multivariate analysis, previous single abortion was independently associated with induction of labor (OR = 1.31, 95%C.I 1.04-1.63, p = 0.01), cesarean section (OR = 1.38, 95%C.I 1.18-1.60, p < 0.001) and retained placenta (OR = 1.29, 95%C.I 1.03-1.61, p = 0.02). Among nulliparous women with previous single abortion no difference in pregnancy outcome was observed between those with previous induced termination of pregnancy and spontaneous abortion, except for increased risk for retained placenta in those with previous spontaneous abortion.Conclusion: Single early previous abortion in nulliparous women was associated with higher rate of induction of labor, cesarean section and retained placenta compared to primigravida women. [ABSTRACT FROM AUTHOR]

Objective This study aims to determine the impact of meconium-stained amniotic fluid (MSAF) in low-risk pregnancies at term on pregnancy outcome. Study Design A retrospective cohort study of women with MSAF during labor who delivered in a tertiary hospital at 37 to 41+6 weeks of gestation (2007-2013). Exclusion criteria included: multiple gestations, noncephalic presentation, fetal structural/chromosomal anomalies, hypertensive disorders, diabetes, oligohydramnios, or small for gestational age. Pregnancy outcome of women with MSAF (N = 4,893) was compared with a control group of women without MSAF (N = 39,651). Neonatal respiratory morbidity was defined as the presence of any of the following: respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, or need for ventilatory support. Results Overall, 10.9% of low-risk pregnancies at term were diagnosed with MSAF. Compared with the controls, women with MSAF had higher rates of nulliparity, gestational age at delivery ≥ 41 weeks, induction of labor, nonreassuring fetal heart rate, and operative deliveries. In multivariate analysis MSAF was associated with operative delivery (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.63-2.09; p < 0.001), cesarean section (OR, 1.48; 95% CI, 1.31-1.69; p < 0.001), respiratory morbidity (OR, 4.74; 95% CI, 3.87-5.82; p < 0.001), and increased risk for short-term neonatal morbidity. Conclusions MSAF is associated with a higher rate of adverse perinatal outcome even in low-risk pregnancies at term. [ABSTRACT FROM AUTHOR]

Background Decreased sensation of fetal movements ( DFM) is a common maternal complaint. Thus, we aimed to evaluate the association between DFM and pregnancy outcome in singleton gestation at term according to parity. Methods A retrospective cohort study of singleton pregnancies at term between 2008 and 2013. Eligibility was limited to women carrying a fetus with no known structural or chromosomal anomalies, at 37+0/7 to 42+0/7 weeks of gestation. Women presenting to the delivery ward with DFM were compared with women without similar complaints. Results Overall, 12,564 nulliparous women and 25,292 multiparous women gave birth during the study period; of them, 300 nulliparous women (2.4%) and 525 multiparous women (2.1%) complained of DFM. For nulliparous women, after adjusting for potential confounders, DFM was associated with antepartum fetal death (aOR 4.6 [95% CI 1.1-19.8]), cesarean delivery ( CD) (aOR 1.3 [95% CI 1.01-1.8]), 1-minute Apgar score less than 7 (aOR 2.3 [95% CI 1.5-3.5]) and neonatal seizures (aOR 3.2 [95% CI 1.3-8.2]). For multiparous women, DFM was associated with unscheduled CD (aOR 2.7 [95% CI 1.6-4.6]) and CD indicated by intermediate/abnormal fetal heart rate tracing (aOR 4.8 [95% CI 2.8-8.4]). Conclusions DFM carries different outcomes according to parity. Although for nulliparous women, DFM is associated with increased risk of CD and immediate adverse perinatal outcome, for multiparous women it is associated with increased risk for CD, with no immediate increased risk for adverse perinatal outcome. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to identify specific risk factors for spontaneous preterm delivery (PTD) among women with arrested preterm labor (PTL). Method: A retrospective study of women admitted due to imminent PTL and intact membranes, which did not progress to PTD within 24 h from admission. Eligibility was limited to singleton gestations at 24 + 0/7–33 + 6/7 weeks of gestations with no known chromosomal or structural anomalies. All women were treated with corticosteroids and tocolysis. Comparison was made between those who delivered at <37 + 0/7 weeks of gestation (study group) to women who delivered at ≥37 + 0/7 weeks of gestation (controls). Results: Overall, 301 women were recruited, of which 85 (28.2%) delivered before 37 + 0/7 weeks and 216 (71.8%) delivered at term. Advanced cervical dilatation was found to be an independent risk factor for PTD [for women with no past PTD: adjusted odds ratio (aOR) 1.66, 95% CI: 1.06–2.61 for each 1 cm dilatation; for women with past PTD: aOR 2.81, 95% CI: 1.02–7.73 for each 1 cm dilatation]. Among women without past PTD, additional independent risk factors for PTD were earlier gestational week at admission (OR: 1.20, 95% CI: 1.09–1.32 for each earlier week) and short cervical length (OR: 1.04, 95% CI: 1.01–1.08 for each decrease of 1 mm in cervical length). Conclusion: Advanced cervical dilatation, earlier gestational age at the episode of arrested PTL, and short cervical length are specific risk factors for PTD in women with arrested PTL. These findings may assist in counseling women and direct further investigation. [ABSTRACT FROM PUBLISHER]

Objective: To estimate the association of fetal head position prior to vacuum extraction (VE) and pregnancy outcome.Study Design: A retrospective cohort study of singleton pregnancies who underwent VE. Pregnancy outcome of occipito-anterior (OA) position of the fetal head was compared to those with occipito-posterior (OP) position.Results: Amongst overall 12,063 women undergoing trial of labor, there were 1118 (9.2%) VE deliveries. Of them, 871 (77.9%) had OA and 247 (22.1%) had OP position of the fetal head. Except for a higher rate of nulliparity in the OA group, no significant differences between the groups regarding pregnancy complications and birthweight were noted. In the OP group, there were higher rates of prolonged 2nd-stage of labor as an indication for VE (49.8 vs. 36.5%, p < 0.001) and single detachment of vacuum cup (11.3 vs. 6.7%, p = 0.02) without any increased risk of failed extraction. Higher risks for sub-galeal hematoma (aOR = 4.36, p = 0.03) and low 5-min Apgar score (aOR = 4.63, p = 0.02) were observed in the OP group with otherwise similar rates of adverse maternal and neonatal outcomes.Conclusion: Among women undergoing VE, OP position is associated with higher rate of vacuum cup detachment, low 5-min Apgar score and increased risk for sub-galeal hematoma with otherwise similar rates of adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate whether midtrimester isolated short femur length is associated with pregnancy complications.Study Design: Retrospective analysis of pregnancies with a midtrimester femur length <5th percentile for gestational age compared to controls with a femur length ≥5th percentile. Outcome measures included hypertensive disorders, being small for gestational age, oligohydramnios and preterm delivery.Results: 2,105 women were eligible for this study, 85 (3.45%) of whom were in the study group and 2,020 were controls. Birth weight <10th percentile for gestational age (OR 4.4, 95% CI 2.5-7.8), birth weight <3rd percentile for gestational age (OR 31.0, 95% CI 13.3-72.3) and severe preeclampsia (OR 6.3, 95% CI 1.4-28.6) were significantly associated with midtrimester isolated short femur length.Conclusions: Midtrimester isolated short femur length is associated with higher rates of being small for gestational age and preeclampsia. [ABSTRACT FROM AUTHOR]

Background In the last three decades, systemic methotrexate ( MTX) has become widely accepted as the primary treatment for unruptured tubal pregnancy. This has prompted investigations into the use of MTX in the management of interstitial pregnancy. Aim To determine the effectiveness of methotrexate for treatment of interstitial pregnancy. Methods We retrospectively reviewed 17 haemodynamically stable women admitted to our tertiary, university-affiliated medical centre with an intact interstitial pregnancy from January 2003 through February 2013. First-line treatment consisted of intramuscular MTX 1 mg/kg/day x4 alternating with folinic acid 0.1 mg/kg or, in cases of low beta-human chorionic gonadotropin (β- hCG) and no embryonic pole, one dose of 50 mg/m2 body surface area. Uterine artery MTX injection was administered on the ipsilateral side of the pregnancy followed by uterine artery embolisation as second-line treatment. Failure criteria were <15% decrease in β- hCG or sonographic evidence of pregnancy development. Second-line failures were referred for surgery. Results Twelve women (70.5%) underwent successful first-line treatment and 5 (29.5%) required second-line treatment. Baseline characteristics were similar except for a higher rate of two previous ectopic pregnancies in the first-line failures (80% versus 8.3%, P = 0.01). Two women eventually required surgery, both with two previous ectopic pregnancies. Of the three women with fetal cardiac activity on admission, two had successful first-line treatment and one required surgery. Conclusion Systemic MTX is effective for treatment of intact interstitial pregnancy in haemodynamically stable women. The success rate is increased with uterine artery MTX injection as second-line treatment. [ABSTRACT FROM AUTHOR]

Objective: As inconsistency exists concerning the rate and risk factors for re-laparotomy after cesarean section (CS), we aimed to determine the incidence, risk factors and indications for re-laparotomy after CS. Methods: This is a retrospective study. Women underwent re-laparotomy following CS were compared to a control group in a 1:3 ratio. Demographic, obstetrical and surgical data were analyzed. CS complications were defined as intra-operative abnormal hemorrhage, summoning surgical personnel, inverted T incision, uterine and/or hypogastric arteries ligation or cesarean hysterectomy. Results: Overall, 35,779 women delivered during the study, of them 7,926 by CS (22.1 %) and 62 patients (0.7 %) underwent re-laparotomy. Re-laparotomies occur during the first 24 h, first week and beyond it, following CS in 64.5, 22.6 and 12.9 %, respectively. Previous abdominal/pelvic surgery (14.5 vs. 8.1 %, p < 0.01), emergent surgery (24.2 vs. 13.4 %, p = 0.04), intra-operative complications (26.8 vs. 0.5 %, p < 0.001), post-operative complication (40.7 vs. 0.5 %, p < 0.001) and adhesions (65.5 vs. 33.3 %, p < 0.001) were significantly increased in the study group. Indications for re-laparotomy varied according to the interval elapsed to the re-laparotomy with post-partum hemorrhage (27.4 %) being the leading indication in the early period. Conclusion: Risk factors for re-laparotomy following CS can be recognized and are mainly associated with previous abdominal and/or pelvic surgeries and intra-operative adhesions. [ABSTRACT FROM AUTHOR]

Objective: To determine whether an abnormal 50-g glucose-challenge test (GCT) is independently associated with adverse pregnancy outcome. Methods: A retrospective study of women with abnormal GCT (>140 mg/dL) but normal subsequent 100-g oral glucose-tolerance test (OGTT). Pregnancy outcome was compared with that of women with normal GCT (<140 mg/dL). Results: Of the 79,153 women delivered during the study period, the results of the GCT were available for 14,268. Of these, 809 (5.7%) had an abnormal GCT and normal OGTT and were eligible for the study group. An abnormal GCT was independently associated with an increased risk for macrosomia (odds ratio [OR] = 2.0, 95% CI: 1.5-2.7), large for gestational age (OR = 1.6, 95% CI: 1.3-2.0), cesarean section (OR = 1.3, 95% CI: 1.1-1.6), respiratory morbidity (OR = 1.6, 95% CI: 1.1-2.7) and neonatal hypoglycemia (OR = 1.8, 95% CI: 1.1-3.2). In contrast, an abnormal GCT was associated with decreased risk for preterm delivery at less than 37 weeks (OR = 0.7, 95% CI: 0.5-0.9) and 34 weeks (OR = 0.3, 95% CI: 0.1-0.6). The association between abnormal GCT and adverse pregnancy outcome was unrelated to the degree of GCT abnormality except for cases in which the GCT was extremely high (≥180 mg/dL). Conclusion: Women with abnormal-GCT result are at increased risk for adverse pregnancy outcome even in the presence of a normal subsequent OGTT. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether episiotomy prevents 3rd or 4th degree perineal tears in critical conditions such as shoulder dystocia, instrumental deliveries (vacuum or forceps), persistent occiput-posterior position, fetal macrosomia (>4,000 g), and non-reassuring fetal heart rate (NRFHR) patterns. Methods: A retrospective study comparing 3rd and 4th degree perineal tears during vaginal deliveries with or without episiotomy, in selected critical conditions was performed. Multiple gestations, preterm deliveries (<37 weeks' gestation) and cesarean deliveries were excluded from the analysis. Stratified analysis (using the Mantel-Haenszel technique) was used to obtain the weighted odds ratio (OR), while controlling for these variables. Results: During the study period, there were 168,077 singleton vaginal deliveries. Of those, 188 (0.1 %) had 3rd or 4th degree perineal tears. Vaginal deliveries with episiotomy had statistically significant higher rates of 3rd or 4th degree perineal tears than those without episiotomy (0.2 vs. 0.1 %; P < 0.001). The association between episiotomy and severe perineal tears remained significant even in the critical conditions. Stratified analysis revealed that the adjusted ORs for 3rd or 4th degree perineal tears in these critical conditions (Macrosomia OR = 2.3; instrumental deliveries OR = 1.8; NRFHR patterns OR = 2.1; occipito-posterior position OR = 2.3; and shoulder dystocia OR = 2.3) were similar to the crude OR (OR = 2.3). Conclusions: Mediolateral episiotomy is an independent risk factor for 3rd or 4th degree perineal tears, even in critical conditions such as shoulder dystocia, instrumental deliveries, occiput-posterior position, fetal macrosomia, and NRFHR. Prophylactic use of episiotomy in these conditions does not seem beneficial if performed to prevent 3rd or 4th degree perineal tears. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for adverse pregnancy outcome in women with inflammatory bowel disease (IBD) and to assess the effect of maternal pre-pregnancy weight and weight gain during pregnancy on pregnancy outcome. Methods: A retrospective, matched control study of all gravid women with IBD treated in a single tertiary center. Data were compared with healthy controls matched to by age, parity and pre-pregnancy BMI in a 3:1 ratio. Results: Overall, 300 women were enrolled, 75 women in the study group (28 with ulcerative colitis and 47 with Crohn's disease) and 225 in the control group. The rates of preterm delivery and small for gestational age were higher in the study group (13.3 vs. 5.3% p = 0.02 and 6.7 vs. 0.9%, p = 0.004). The rate of cesarean section (36 vs. 19.1%; p = 0.002), NICU admission (10.7 vs. 4.0%, p = 0.03) and low 5-Min Apgar (4.0 vs. 0.4%, p = 0.02) were increased in the study group. Disease activity within 3 months of conception [OR 8.4 (1.3-16.3)] and maternal weight gain of less than 12 kg. [OR 3.6 (1.1-12.2)] were associated with adverse pregnancy outcome. Conclusion: Active disease at conception and inappropriate weight gain during pregnancy are associated with increased adverse pregnancy outcome in patients with IBD. [ABSTRACT FROM AUTHOR]

Objective: To investigate risk factors for relaparotomy after cesarean section (CS). Methods: A retrospective case-control study comparing all CS that were complicated with relaparotomy to cesarean deliveries without this complication. Results: Relaparotomy complicated 0.23% ( n = 80) of CS during the study period ( n = 34,389). Independent risk factors for relaparotomy following CS from a multivariable logistic regression model were post partum hemorrhage, cervical tears, placenta previa, uterine rupture, placental abruption, severe preeclampsia and previous CS. Most women (51.2%) underwent relaparotomy during the first 24 h after CS. The leading causes for relaparotomy was bleeding (70%) and burst abdomen (8.8%). Hysterectomy was performed in 31.3% of the patients. Conclusion: Risk factors for relaparotomy after CS are previous CS, severe preeclampsia, placenta previa, uterine rupture, placental abruption, cervical tear and PPH. Experienced obstetricians should be involved in such cases and the possibility for complications including relaparotomy should be emphasized. [ABSTRACT FROM AUTHOR]

Purpose: To describe the prevalence of lack of prenatal care (LOPC) over the years and to examine the association between LOPC and perinatal complications among Bedouin parturients. Methods: A retrospective study comparing all singleton births of Bedouin women with and without prenatal care, between the years 1988 and 2009, was conducted. Multiple logistic regression models were used to control for confounders. Results: Out of 123,506 singleton deliveries, 16.5% ( n = 20,402) were of women lacking prenatal care. A gradual increase in the rate of LOPC was noted between the years 2006 and 2009. Using multivariable analyses, controlling for parity, LOPC was found to be significantly associated with preterm delivery (PTD) < 37 weeks (odds ratio (OR) 1.13, 95% CI 1.07-1.19), PTD < 34 weeks (OR 1.53, 95% CI 1.40-1.67), low birth weight < 2,500 g (LBW; OR 1.39, 95% CI 1.32-1.46), very LBW < 1,500 g (OR 1.67, 95% CI 1.49-1.86), and perinatal mortality (OR 1.63, 95% CI 1.47-1.80). Conclusions: Lack of prenatal care in a traditional community is associated with adverse obstetric outcomes and specifically is an independent risk factor for preterm delivery, low birth weight, and perinatal mortality. [ABSTRACT FROM AUTHOR]

Most studies on safety/risk of drugs in pregnancy consider the proportion of births (but not pregnancy terminations) affected by the drug from all exposed infants. Lack of data on pregnancy terminations could bias results. A computerized database for medications dispensed to pregnant women in southern Israel was linked with records from the district hospital; 84 823 deliveries and 998 medical pregnancy terminations took place; 571 of the women were exposed to folic acid antagonists in the first trimester. When only births were examined, there was no association between folic acid antagonists and fetal malformations. When data on pregnancy terminations were examined and births and pregnancy terminations were combined, there was a significant risk (neural tube defects: odds ratio 18.83, 95% confidence interval 9.24-38.37; cardiovascular defects: odds ratio 3.86, 95% confidence interval 1.67-8.88; and neural tube defects: odds ratio 6.30, 95% confidence interval 3.34-9.15; cardiovascular defects: odds ratio 1.76, 95% confidence interval 1.05-2.92, respectively). Inclusion of only birth data in observational studies of drugs in pregnancy constitutes a source of bias toward the null hypothesis. [ABSTRACT FROM PUBLISHER]

Background: We wished to investigate whether women with a history of eating disorders have an increased risk for adverse obstetric and perinatal outcomes. Study design: A retrospective study was conducted comparing pregnancy complications in patients with and without eating disorders. Deliveries occurred during the years 1988-2009 in a tertiary medical center. Women lacking prenatal care and with multiple gestations were excluded from the study. Stratified analyses were performed using multivariable logistic regression models. Odds ratios (OR) and their 95% confidence interval (CI) were computed. A p value<0.05 was considered statistically significant. Results: During the study period, of 117,875 singleton deliveries, 122 (0.1%) occurred in patients with eating disorders. Eating disorders were significantly associated with fertility treatments (5.7% vs. 2.8%, p=0.047), intrauterine growth restriction (7.4% vs. 2.3%, p<0.001), term low birth weight (<2500g) (7.4% vs. 2.8%, p=0.002), preterm delivery (15.6% vs. 7.5%, p=0.002), and cesarean delivery (25.4% vs. 15.0%, p=0.001). Using multivariable analyses, low birth weight (OR 2.5, 95% CI 1.3-5.0), preterm delivery (OR 2.2, 95% CI 1.4-3.6), and cesarean section (OR 1.9, 95% CI 1.3-2.9) were significantly associated with eating disorders. Conclusions: Eating disorders are associated with increased risk of adverse pregnancy outcomes. Accordingly, careful surveillance is needed for early detection of possible complications. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether colonization with GBS in a previous pregnancy is associated subsequently with adverse obstetric and perinatal outcomes. Methods: A retrospective study was undertaken comparing pregnancy complications of patients with and without colonization with GBS in a previous pregnancy from 1988 to 2006. Women with a positive GBS culture in the current pregnancy, women lacking prenatal care and multiple gestations were excluded from the analysis. Main outcome measures: Adverse obstetric and perinatal outcomes including premature rupture of membranes, intrapartum fever, chorioamnionitis and perinatal mortality. Results: Out of 184,266 singleton deliveries, 230 (0.12%) were of patients with a positive GBS culture in their previous pregnancy. Previous GBS colonization was not found to be associated with adverse pregnancy outcomes such as PROM (9.1 vs. 6.8%; P = 0.16), intrapartum fever (1.3 vs. 2.2%; P = 0.72) and chorioamnionitis (1.3 vs. 0.8%; P = 0.29). Conclusions: GBS colonization in a previous pregnancy is not associated with adverse pregnancy outcomes in the current pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To investigate pregnancy outcome of patients following splenectomy. Methods: A retrospective study comparing pregnancies of women who have and have not undergone splenectomy was performed. The study investigated a select population representing the south of Israel. Women lacking antenatal care as well as those having multiple gestations were excluded from the analysis. Stratified analysis, using a multiple logistic regression model, was performed to control for confounders. Results: During the study period, there were 219,656 deliveries, of which 150 occurred in women who underwent splenectomy. Postsplenectomy women tended to be older, were more likely to be Jewish, and had a lower number of deliveries and an earlier gestational age at delivery. Higher rates of fertility treatment, previous cesarean delivery, and severe preeclampsia were found among postsplenectomy women. In addition, splenectomy was significantly associated with pregnancy and labor complications, such as cesarean delivery, pneumonia during pregnancy, and complications of anesthesia and sedation during labor. Using a multivariate analysis with backward elimination, the following conditions were independently associated with splenectomy: previous cesarean delivery (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.3, p=0.039), fertility treatment (OR 2.6, 95% CI 1.3-5.4, p=0.008), preterm delivery (OR 1.9, 95% CI 1.3-3.1, p=0.003), and maternal age (OR 1.04, 95% CI 1.015-1.07, p=0.002). After controlling for possible confounders by using another multivariate analysis with preterm delivery as the outcome variable, splenectomy was found to be an independent risk factor for preterm delivery (OR 2.1, 95% CI 1.4-3.3, p=0.001). Conclusion: Splenectomy is an independent risk factor for preterm delivery. [ABSTRACT FROM AUTHOR]

Objective: To investigate pregnancy outcome in patients with condyloma acuminata. Methods: A retrospective cohort study comparing pregnancy outcome of women with and without condyloma acuminata was performed. A sub-group analysis was performed between patients with localized disease ( n = 40), extended disease ( n = 25) and no condyloma acuminata ( n = 227,202). Results: Using a multivariate logistic regression model, condyloma acuminata was significantly associated with cesarean delivery (OR = 3.4; 95% CI 1.9-5.8; P < 0.001), nulliparity (OR = 4.8; 95% CI 2.6-9.0; P < 0.001), and Jewish ethnicity (vs. Bedouin Arabs; OR = 2.3; 95% CI 1.3-4.1; P < 0.001). A significant linear association was found between the three subgroup (extended condyloma, localized condyloma and no condyloma) and cesarean delivery (40.0% in the extended disease vs. 32.5% in the localized disease vs. 13.0% in the comparison group P < 0.001). No significant differences were noted between the groups in terms of perinatal outcomes, such as low Apgar score (<7) at 1 min (4.2 vs. 1.6%; P = 0.298) and 5 min (0.6 vs. 0.0% P = 0.534) and perinatal mortality (1.4 vs. 1.5% P = 0.912). Conclusions: Women with condyloma acuminata are at an increased risk for cesarean delivery, while the risk for cesarean delivery is higher for pregnancies with extended when compared with localized disease. Nevertheless, condyloma acuminata is not associated with adverse perinatal outcome. [ABSTRACT FROM AUTHOR]

Objective. To investigate pregnancy outcome in patients post-total thyroidectomy. Methods. A retrospective study comparing pregnancy outcome of women post-total thyroidectomy ( n == 50), patients with hypothyroidism due to other reasons ( n == 1015) and pregnancies without hypothyroidism ( n == 200,000) was performed. Results. A significant linear association was documented between the three groups and adverse outcomes such as placental abruption (6.1%% in the total thyroidectomy group, 1.0%% in hypothyroidism and 0.8%% in the no-hypothyroidism group; p == 0.002), and caesarean delivery (33.3%% in the total thyroidectomy, 30.4 in hypothyroidism and 14.4%% in the no-hypothyroidism group; p < 0.001). Total thyroidectomy was independently associated with placental abruption and fertility treatment in a multivariable model controlling for maternal age. No significant differences were noted between the groups in terms of perinatal outcomes such as low Apgar score (<7) at 1 min (6.1%% vs. 4.5%% and 4.3%%; p == 0.846) and 5 min (3.0%% vs. 0.6%% and 3.0%%; p == 0.198); perinatal mortality (0.0%% vs. 0.9%% and 0.01%%; p == 0.293). Conclusions. Women post-total thyroidectomy and women with hypothyroidism due to other reasons are at increased risk for adverse obstetric outcomes, while the risk is higher for pregnancies with total thyroidectomy as compared to hypothyroidism due to other reasons. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to assess the factors affecting the latency period in woman with preterm premature rupture of membranes (PPROM) and evaluate morbidity associated with prolonged latency. Study design: A population-based retrospective study including all women with PPROM (prior to 37 weeks' gestation) during the years 1998-2008 was conducted. Comparison of the latency period was conducted by the Mann-Whitney U test since the latency period was not normally distributed (most delivered in 24 h). Multivariable logistic regression model was constructed to find independent factors associated with prolonged latency period (>72 h). Results: During the study period, there were 1,399 singleton deliveries of patients with PPROM; 24.6% (345) occurred prior to 34 weeks' gestation. The duration of the latency period was significantly longer among woman with PPROM before 34 weeks as compared to PPROM after 34 weeks' gestation (5.78 vs. 2.02 days; p < 0.001). Other factors associated with longer latency period were multiparity (more than one previous delivery) and maternal age >35. Using a multivariable analysis, the following factors were significantly associated with latency period >72 h: lower gestational age (weeks, OR = 0.8, 95% CI 0.77-0.84; p < 0.001) and multiparity (OR = 1.7, 95% CI 1.3-2.2; p < 0.001). Prolonged latency period (>72 h) was significantly associated with chorioamnionitis (OR = 2.095, 95% CI 1.44-3.04; p < 0.001) and oligohydramnios (OR = 3.041, 95% CI 1.43-6.45; p = 0.004) but not with placental abruption (OR = 0.854, 95% CI 0.41-1.78; p = 0.674) or perinatal mortality (OR = 1.2, 95% CI 0.6-2.2; p = 0.556). Conclusion: The duration of the latency period is inversely associated with gestational age. Nulliparity is associated with lower latency period. Prolonged latency is a significant risk factor for chorioamnionitis. [ABSTRACT FROM AUTHOR]

Objective: The present study was aimed to investigate perinatal outcome of elderly nulliparous patients. Study design: A retrospective study was performed comparing pregnancy outcomes of nulliparous patients at three age groups: less than 35 years (reference group), 35-40 years, and above 40 years. The linear-by-linear association test was used to examine linear association between advanced maternal age and adverse pregnancy outcomes. A multiple logistic regression model was used to control for confounders. Results: Out of 45,033 nulliparous women with singleton gestations, 1,036 were of women over the age of 35, and 188 over 40. A significant linear association was documented between advanced maternal age and adverse outcomes, such as intra uterine growth restriction, low birth weight, congenital malformations, and perinatal mortality. Using a multiple logistic regression model, controlling for gestational age, IUGR and malformations, advanced maternal age was not found to be an independent risk factor for perinatal mortality (adjusted odds ratio = 1.04, 95% confidence interval 0.7-1.4). Conclusion: A significant linear association exists between advanced maternal age and adverse maternal and perinatal outcomes. Nevertheless, in our population, advanced maternal age is not an independent risk factor for perinatal mortality. [ABSTRACT FROM AUTHOR]

Objective: To examine pregnancy outcomes associated with diet-controlled gestational diabetes mellitus (GDM A1).Methods: A retrospective cohort study compared pregnancy characteristics of women with and without GDM A1 at a center where GDM A1 patients are routinely induced at 40 weeks.Results: Higher rates of complications such as shoulder dystocia, congenital malformation, and macrosomia were observed in GDM A1 patients. A lower incidence of perinatal mortality was present in GDM A1 women compared with women without GDM A1. This association lost its significance when controlled for maternal age, ethnicity, induction, cesarean delivery, and birth weight in a multivariate model. Although the stillbirth rate before 40 weeks of gestation was identical among all participants, after 40 weeks it was significantly higher in women without GDM A1.Conclusion: Induction of women with GDM A1 at 40 weeks may play a role in lowering perinatal mortality to below that of the general population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the perinatal outcomes of women who delivered before with women who delivered after bariatric surgery. Methods: A retrospective study was undertaken to compare perinatal outcomes of women who delivered before with women who delivered after bariatric surgery in a tertiary medical center between 1988 and 2006. A multivariate logistic regression model was constructed to control for confounders. Results: During the study period, 301 deliveries preceded bariatric surgery and 507 followed surgery. A significant reduction in rates of diabetes mellitus (17.3% vs 11.0; P =0.009), hypertensive disorders (23.6% vs 11.2%; P <0.001), and fetal macrosomia (7.6% vs 3.2%; P =0.004) were noted after bariatric surgery. Bariatric surgery was found to be independently associated with a reduction in diabetes mellitus (OR 0.42, 95% CI 0.26–0.67; P <0.001), hypertensive disorders (OR 0.38, 95% CI 0.25–0.59; P <0.001), and fetal macrosomia (OR 0.45, 95% CI 0.21–0.94; P =0.033). Conclusion: A decrease in maternal complications, such as diabetes mellitus and hypertensive disorders, as well as a decrease in the rate of fetal macrosomia is achieved following bariatric surgery. [Copyright &y& Elsevier]

Objective: To compare body length and head circumference at birth of neonates conceived after in vitro fertilization/intracytoplasmic injection (IVF/ICSI), ovarian stimulation alone (OSa) or by natural conception (NC). Methods: A retrospective, cohort study of all singleton neonates conceived after fertility treatment and born at 38-40 gestational weeks in 2011 in a tertiary, university-affiliated hospital. Pregnancy, delivery and neonatal data were obtained from the medical records. NC singleton neonates born at 38-40 weeks were selected to serve as controls. Results: The sample included 81 IVF/ICSI neonates, 102 OSa neonates and 91 neonates after NC. Mean gestational age (GA) was 38.8 weeks. Gravidity and parity were significantly higher in the NC group. Mean neonatal length was 50.0 ± 2.1 cm in the IVF/ICSI group, 49.7 ± 2.6 cm in the OSa group and 50.3 ± 2 cm in the NC group ( p = 0.123). Corresponding mean head circumference was 34.4 ± 1.5, 34.2 ± 1.8 and 34.5 ± 1.2 cm ( p = 0.287). Neither of these parameters was significantly different even after adjustment for GA at delivery and sex. Conclusions: Our study showed no significant difference in body length or head circumference at birth related to the mode of conception. Previously reported differences in anthropometric parameters in childhood may be related to other factors. [ABSTRACT FROM AUTHOR]

Objective: The present study was aimed to evaluate long-term morbidity of patients with hypertensive disorders of pregnancy. Study design: A retrospective cohort study was conducted, including women who gave birth between the years of 1988 to 1998, and had a follow-up until December 2009. Data were extracted by linking a computerized database of hospitalizations with computerized database containing maternal records from the same regional medical center. The exposed group comprised 2072 patients with mild or severe preeclampsia in one or more of their pregnancies and the comparison group included 20742 patients without preeclampsia. Excluded from the study were patients with chronic hypertension and pre-gestational diabetes before the index pregnancy. Data included subsequent hospitalizations in internal medicine, oncology, nephrology, neurology, cardiac intensive care unit, and hematology, as well as a diagnosis of chronic hypertension during the follow-up period. Results: Patients with preeclampsia had significantly higher rates of chronic hypertension diagnosed after the index pregnancy as compared with patients without preeclampsia (12.5% vs. 0.9%; OR = 15.8, 95% CI 12.9-19.3; p < 0.001). Likewise, patients with preeclampsia were more likely to be hospitalized at least once (13.7% vs. 11.4%; OR = 1.2, 95% CI 1.1-1.4; p = 0.002) as compared with patients without preeclampsia. Exposed women had 582 hospitalizations (0.28 hospitalization/patient), while the non-exposed patients had a total of 4687 hospitalizations (0.23 hospitalization/patient; p < 0.001). Conclusion: Preeclampsia is a significant risk factor for long-term morbidity such as chronic hypertension and hospitalizations later in life. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate factors associated with latent syphilis and pregnancy outcome among women with latent syphilis. Methods: A retrospective population-based study was conducted to compare all pregnancies among women with and without latent syphilis at Soroka University Medical Center, Be''er-Sheva, Israel, between 1988 and 2010. Stratified analysis using a multiple logistic regression model was performed to control for confounders. Results: Of the 219656 deliveries during the study period, 159 (0.1%) involved women with latent syphilis. Multivariate analysis with backward elimination revealed the following conditions to be significantly associated with latent syphilis: fetal growth restriction (odds ratio [OR] 2.20; 95% confidence interval [CI], 1.07–4.49; P =0.03); drug abuse (OR 9.95; 95% CI, 1.31–75.46; P =0.02); tobacco use (OR 3.35; 95% CI, 1.74–6.45; P <0.05); and Jewish (vs Bedouin) ethnicity (OR 4.05; 95% CI, 2.65–6.20; P <0.05). Conclusion: Women with latent syphilis are at risk for adverse maternal and perinatal outcomes, including fetal growth restriction. Careful surveillance of these high-risk pregnancies should be considered. [Copyright &y& Elsevier]

Objective: This study was undertaken to determine fetal heart rate (FHR) tracing patterns associated with congenital hypothyroidism. Study Design: FHR patterns of 59 women whose babies were diagnosed with congenital hypothyroidism were retrospectively compared with tracings of 78 of their siblings. Tracings were interpreted during the first stage of labor. Multivariable analysis was used to control for confounders. Results: Neonates with congenital hypothyroidism had significantly higher rates of reduced variability in FHR tracing patterns as compared with those without congenital hypothyroidism (49.2% vs 3.8%; odds ratio, 24.1; 95% confidence interval, 6.8-85.3; P < .001). No significant differences were noted between the groups regarding decelerations or baseline abnormalities. The significant association between congenital hypothyroidism and reduced variability persisted after controlling for confounders such as treatment with pethidine, MgSO4, and gestational age (odds ratio, 14.1; 95% confidence interval, 1.1-190.7; P = .046). Conclusion: Congenital hypothyroidism is significantly and independently associated with reduced variability in FHR tracing patterns. [Copyright &y& Elsevier]

Aims: To assess the association of gestational weight gain or loss with adverse pregnancy outcome among women with gestational diabetes mellitus (GDM).Methods: Retrospective study of all women diagnosed with GDM, from July 2012 to December 2016, stratified by gestational weight change according to the institute of medicine recommendations. Primary maternal outcome was glycemic control and primary neonatal outcome was large or small for gestational age (LGA or SGA).Results: 451 women were enrolled. Total weight change was associated with poor glycemic control, cesarean delivery, polyhydramnios, higher birthweight (when above recommendations), oligohydramnios and SGA (when below recommendations). GDM-related weight change was associated with polyhydramnios, cesarean delivery, higher birthweight (when above recommendations) and lower incidence of hypertensive disorders (when below recommendations). Adjusted odds ratio for poor glucose control among those with total weight gain above recommendations was 2.194 (95% CI 1.214-3.961) vs. those within-; and 1.048 (95% CI 0.611-1.799) vs. those who gained below- recommendations. The rate of SGA or LGA was not different for those gaining below or above vs. within recommendations.Conclusion: Gestational weight gain is an important predictor of glycemic control and adverse pregnancy outcome among women with GDM - both overall and GDM-related. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the association between impaired fasting glucose (IFG) prior to pregnancy with maternal and neonatal outcome.Methods: A retrospective cohort study of singleton deliveries in a single, tertiary, university-affiliated medical center between August 2007 and December 2012. We included women who had a fasting glucose test done up to 26 weeks prior to pregnancy. We excluded women with diabetes mellitus and women carrying a fetus with structural or chromosomal anomalies. Maternal and neonatal outcome were compared between two groups: women with pre-pregnancy IFG (defined as fasting glucose ≥100 mg/dl and <126 mg/dl) versus those with normoglycemia (fasting glucose <100 mg/dl).Results: Overall, 1945 women met inclusion criteria. Of whom, 1790 had pre-pregnancy glucose <100 mg/dl and 155 had IFG. There were no differences between groups in basic characteristics. As for maternal outcome, IFG was associated with higher rates of mild preeclampsia (5.16% vs. 0.67%), abnormal glucose challenge test (21.94% vs. 13.46%) and gestational diabetes (13.55 vs. 2.85%), p < 0.05 for all. There were no significant differences in neonatal outcome. After adjusting for potential confounders, on multivariable logistic regression, pre-pregnancy IFG remained significantly and independently associated with mild preeclampsia (aOR 6.92, 95% CI 2.68-18.05, p < 0.001).Conclusions: Pre-pregnancy IFG is associated with increased risk for abnormal glucose challenge test and gestational diabetes, and it is an independent risk factor for adverse pregnancy outcome including mild preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between first-trimester inter- and intrafetal size discrepancies and pregnancy outcome, among bichorionic-biamniotic twins conceived by IVF.Design: A retrospective study design was used.Setting: Tertiary university-affiliated medical center.Patient(s): All women with a viable first-trimester bichorionic-biamniotic twin gestation, who conceived after IVF in 2007-2015.Intervention(s): None.Main Outcome Measure(s): The association between fetal size differences and pregnancy outcome was analyzed. Intrafetal size discordance was defined as a difference between the actual gestational age calculated by ovum pickup (OPU) date and the evaluated gestational age by crown-rump length (CRL), for each twin. Intertwin size discrepancy was defined as a difference in CRL between the twins. The primary outcome was the number of live-born fetuses; the secondary outcome measures were gestational age at birth, birth weight percentile, and birth weight discordancy.Result(s): A total of 277 women met the study criteria and were divided into three groups by outcome: 218 (78.7%) live-born twins, 41 (14.8%) live-born singleton, and 19 (6.5%) non-live-born pregnancy. Among the smaller than expected twin, the association of CRL-OPU differences with the primary outcome was significant for twin live-born delivery (-1.43 day), singleton live-born delivery (-4.12 days), and non-live-born pregnancy (-6.72 days). For the relatively larger twin, the association was significant for non-live-born pregnancy (-4.33 days) compared with any live-born delivery, either singleton (-0.95 days) or twin (-0.21 days).Conclusion(s): Among IVF conceived twin gestations, a CRL-OPU gap was associated with an increased risk of a negative pregnancy outcome. [ABSTRACT FROM AUTHOR]

Background: Urinary bladder injury is a rare complication during cesarean delivery. Little is known on maternal outcome following this injury.Objective: To evaluate short and long-term maternal outcome following bladder injury during cesarean delivery.Study Design: A retrospective case series of all pregnancies complicated by full-thickness bladder injury during cesarean delivery in a single university affiliated tertiary medical center (August 2007-June 2016). Data on demographics, labor and surgery parameters, postpartum sequelae, and cystography were collected and reviewed by study personnel. Short-term maternal outcome included catheterization period, cystography results (if performed), any febrile illness and/or need for second operation prior to maternal discharge. Long term maternal outcome was obtained by searching our urology departmental and ambulatory database for follow up for all women. Univariate analysis was used to compare maternal outcome following first or repeat cesarean delivery.Results: Of 17,326 cesarean deliveries performed during study period, 81 (0.47%) were complicated by bladder injury. Of them, 8 cases (9.9%) occurred during primary cesarean delivery (overall risk in primary cesarean 0.07%). Of the other 73 cases that followed repeated cesarean, adhesions were documented in 55 (75.3%) of them. Six cases (8.2%) had placenta accreta. Bladder injury occurred at peritoneal entry in 55 (67.9%) cases, and involved the bladder dome in 49 (60.5%) of them. Injury was diagnosed during cesarean delivery in all but 3 women, in whom abdominal pain and bloating prompted evaluation on first to third postoperative day. All 3 underwent re-laparotomy with bladder closure without further adverse sequelae. Cystography was performed in 35 patients on median postoperative day 8 (6-11 days). Eleven patients had abnormal findings as follows: 5 urinary leakage, 4 bladder wall irregularity and two urinary reflux. Two of the 11 patients (18%) required additional interventions: One patient required bilateral nephrostomy and re-laparotomy for bladder closure followed by additional surgery to repair consequent vesico-vaginal fistula. The second patient required left nephrostomy and ureteral re-implantation. Both women had combined ureteral and bladder injury. For the rest of the cohort, no febrile illness or other short- or long-term adverse events were reported. There were no clinically significant differences in adverse maternal outcomes between women with repeat cesarean delivery compared to primary cesarean delivery.Conclusion: Bladder injury is a rare complication of cesarean delivery. In our case series, unless there is combined ureteral and bladder injury, prognosis was favorable without any long-term sequelae. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between sonographically measured head circumference (HC) and labor outcome.Methods: In a retrospective study at a tertiary medical center in Israel, data were reviewed for all term singleton deliveries between July 2007 and December 2012 with HC measurements up to 7days before delivery. HC was compared between women with operative vaginal delivery (OVD) or cesarean delivery for prolonged second stage and those with normal vaginal delivery. The impact of HC above the 75th percentile on pregnancy outcome was analyzed.Results: The study included 2351 women, of whom 2045 (87.0%) had a normal vaginal delivery, 259 (11.0%) underwent OVD, and 47 (2.0%) cesarean. Each 10mm increase in HC was associated with increased risk for obstetric intervention because of a prolonged second stage (adjusted odds ratio [aOR] 1.26; 95% confidence interval [CI] 1.08-1.46). HC above the 75th percentile was independently associated with increased odds of OVD (aOR 1.77; 95% CI 1.30-2.41), 1-minute Apgar score less than 7 (aOR 2.91; 95% CI 1.50-5.66), and neonatal asphyxia (aOR 2.19; 95% CI 1.02-4.71).Conclusion: Term HC above the 75th percentile was associated with increased rates of obstetric interventions because of a prolonged second stage and might be associated with neonatal asphyxia. [ABSTRACT FROM AUTHOR]