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Objective:  In the era of group B Streptococcus (GBS) screening and intrapartum antibiotic prophylaxis (IAP), GBS colonization has been associated with a lower risk of chorioamnionitis, possibly due to a protective effect of IAP. We sought to confirm this finding and assess whether this association varies by gestational week at delivery., Study Design:  We performed a retrospective cohort study of term (37.0-42.6 weeks), singleton parturients with known GBS status who delivered from 2005 to 2021 at two academic medical centers in Israel. We excluded patients who underwent planned cesarean, out of hospital birth, or had a fetal demise. Patients received GBS screening and IAP for GBS positivity as routine clinical care. The primary outcome was a diagnosis of clinical chorioamnionitis as determined by the International Classification of Diseases 10th Revision code, compared between GBS-positive and -negative groups, and assessed by gestational week at delivery., Results:  Of 292,126 deliveries, 155,255 met inclusion criteria. In total, 30.1% were GBS positive and 69.9% were negative. GBS-positive patients were 21% less likely to be diagnosed with clinical chorioamnionitis than GBS-negative patients, even after controlling for confounders (1.5 vs. 2.2%, adjusted odds ratio: 0.79, 95% confidence interval: 0.68-0.92). When assessed by gestational week at delivery, there was a significantly greater difference in rates of clinical chorioamnionitis between GBS-positive versus GBS-negative groups with advancing gestational age: 1.5-fold difference at 38 to 40 weeks, but a twofold difference at 42 weeks. The risk of clinical chorioamnionitis remained stable in the GBS-positive group, but increased significantly in the GBS-negative group at 41- and 42-week gestation (2.0 vs. 2.9%, p  < 0.01 at 41 weeks; up to 3.9% at 42 weeks, p  < 0.01)., Conclusion:  In a large multicenter cohort with universal GBS screening and IAP, GBS positivity was associated with a lower risk of chorioamnionitis, driven by an increasing rate of chorioamnionitis among GBS-negative patients after 40 weeks., Key Points: · GBS positivity and IAP may be associated with lower risk of chorioamnionitis.. · GBS-positive patients were less likely to be diagnosed with chorioamnionitis.. · This difference increased with advancing gestational age after 40 weeks.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: In singleton pregnancies, delivery of large for gestational age (LGA) newborn is associated with various adverse maternal and neonatal outcomes, yet data regarding LGA in twin pregnancies is scarce. We aimed at evaluating maternal and neonatal outcomes associated with LGA presenting twin., Study Design: A multicenter retrospective computerized database study in two university-affiliated obstetrical centers, between 2005 and 2021. Parturients with di-amniotic twin pregnancy who had a trial of vaginal delivery were included. Maternal and neonatal outcomes of parturients with LGA presenting twin were compared to parturients with non-LGA presenting twin., Results: During the study period, 2,491 parturients with twin pregnancies were found eligible, of those 287 (11.5%) had LGA presenting twin. Parturients with LGA presenting twin were of higher gravidity and parity, had higher rates of previous cesarean deliveries and diabetes (pre-gestational & gestational). Mode of delivery of both presenting and second twin did not differ between the study groups. Maternal outcomes were comparable, specifically, rates of shoulder dystocia, and postpartum hemorrhage did not differ. Neonatal outcomes did not differ significantly between the groups other than a single case of clavicular fracture and a single case of encephalopathy in the group of LGA presenting twin., Conclusion: In our study, delivery of LGA presenting twin was found safe to both, mother and neonate. Our findings provide reassurance regarding the safety of vaginal labor in this specific population and should be presented during counseling prior to twins' delivery., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To evaluate maternal and neonatal outcomes of women with twin pregnancies following a short interpregnancy interval (IPI < 6 months)., Study Design: A retrospective computerized database study in a single tertiary medical center between 2005 and 2021. Women who had an index singleton delivery and a subsequent twin gestation in their next pregnancy at the Shaare Zedek Medical Center (SZMC) were included. Maternal and neonatal outcomes of twin pregnancies following a short IPI (<6 months) were compared to those with an optimal IPI (18-48 months). Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) were calculated., Results: During the study period, 2,079 women had an index singleton delivery followed by a twin gestation in their next pregnancy recorded at our medical center; 116 (5.9 %) had a history of short IPI, and 1,057 (50.8 %) had a history of optimal IPI. Women with a history of short IPI had higher rates of preterm labor < 37 weeks and < 34 weeks, NICU admissions and prolonged hospital stay of the first and second fetuses, mechanical ventilation of the first fetus, 1 and 5 Minute Apgar score lower than 7 of the second fetus and lower rates of elective cesarean delivery. An adjusted multivariate analysis showed that a history of short IPI was not an independent risk factor for preterm birth either < 34 weeks or < 37 weeks or for composite adverse neonatal outcome of the first and second twin., Conclusion: Twin pregnancy following a short IPI was not associated with neither preterm labor nor composite adverse neonatal outcome., (Copyright © 2022 Elsevier B.V. All rights reserved.)