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Publisher: John Wiley and Sons   (Total: 1584 journals)

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Showing 1 - 200 of 1584 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 12, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 58, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 45, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 51, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 137, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 5, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 6, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 2)
Addiction     Hybrid Journal   (Followers: 33, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 12, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 24, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 50, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 13, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 249, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 5, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 19)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 12)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 9)
African Development Review     Hybrid Journal   (Followers: 35, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 14, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 10, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 6, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 14, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 44, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 29, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 35, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 49, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 128, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 91, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 27, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 31, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 15, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 3, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 5, SJR: 2.315, h-index: 79)
American J. of Orthopsychiatry     Hybrid Journal   (Followers: 4, SJR: 0.756, h-index: 69)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 36, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 252, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 16, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 120, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 11, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 16)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 159)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 210, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 34, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 8, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 44, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 12)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 24, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 16, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 14)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 93, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 45, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 6, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 67, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 136, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 48, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 14, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 31, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 34, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 27, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 14, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 25, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 4)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 215, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 51, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 28, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 14)
Asia & the Pacific Policy Studies     Open Access   (Followers: 14)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 316, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 7, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 3, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 4, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 4, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 13, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 2, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 12, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 10, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 7, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 13, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 4, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 43, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 23, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 13, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 17, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 388, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 4, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 66, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 11, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 19, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 31, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 10, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 3, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 23, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 9, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 14, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 3, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 42, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 36, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 45, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 135, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 13, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 18, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 10, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 34, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 5, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)

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Journal Cover Acta Obstetricia et Gynecologica Scandinavica
  [SJR: 1.197]   [H-I: 81]   [15 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0001-6349 - ISSN (Online) 1600-0412
   Published by John Wiley and Sons Homepage  [1584 journals]
  • Fetal head circumference and subpubic angle are independent risk factors
           for unplanned cesarean and operative delivery
    • Authors: Giuseppe Rizzo; Elisa Aiello, Costanza Bosi, Francesco D’ Antonio, Domenico Arduini
      Abstract: IntroductionTo ascertain whether combined ultrasound assessment of fetal head circumference (HC) and maternal subpubic angle (SPA) prior to the onset of labour may predict the likelihood of an unplanned operative delivery (UOD) in nulliparous women at term.Material and methodsProspective cohort study of singleton pregnancies in cephalic presentation. Pregnancies experiencing UOD secondary to fetal distress were excluded. HC was assessed transabdominally while SPA values were obtained from a reconstructed coronal plane on three-dimensional(3D) ultrasound performed trans-labially at 36-38 weeks of gestation. Maternal characteristics, HC expressed as multiple of median and SPA were compared according to the mode of delivery. Logistic regression and receiver operating characteristics curve analyses were used to analyse the data.Results597 pregnancies were included in the study. Spontaneous vaginal delivery occurred in 70.2% of the cases, while UOD was required in 29.8%. There was no difference in pregnancy characteristics and birthweight between women who had a spontaneous vaginal birth compared to UOD. HC multiple of median was larger (1.00±0.02 vs 1.03±0.02 p≤0.0001), while SPA was narrower in the UOD group (124.02±13.64 vs 102.61±16.13 p≤0.0001). At logistic regression, SPA (OR 0.91, 95%CI 0.89-0.93), HC multiple of median (OR 1.13, 95% CI 1.09-1.17) and maternal height (OR 0.95, 95% CI 0.92-0.99) were independently associated with UOD. When combined, the diagnostic accuracy of a predictive model integrating HC, SPA and maternal height was highly predictive of UOD with an area under the curve of 0.904 (95%CI 0.88-0.93).ConclusionsUltrasound assessment of fetal HC and maternal SPA after 36 weeks of gestation can identify a sub-set of women at higher risk of UOD during labour, for whom early planned delivery might be beneficial.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-27T16:58:06.920911-05:
      DOI: 10.1111/aogs.13162
  • Predictors of success of external cephalic version and cephalic
           presentation at birth among 1,253 women with non-cephalic presentation
           using logistic regression and classification tree analyses
    • Authors: Eileen K Hutton; Julia C Simioni, Lehana Thabane,
      Abstract: IntroductionAmong women with a fetus in non-cephalic presentation, external cephalic version (ECV) has been shown to reduce the rate of breech presentation at birth and cesarean birth. Compared to ECV at term, beginning ECV prior to 37 weeks gestation decreases the number of infants in a non-cephalic presentation at birth. The purpose of this secondary analysis was to investigate factors associated with a successful ECV procedure and to present this in a clinically useful format.Material and methodsData were collected as part of the Early ECV Pilot and Early ECV2 Trials, which randomised 1,776 women with a fetus in breech presentation to either early ECV (34 to 36 weeks gestation) or delayed ECV (at or after 37 weeks). The outcome of interest was successful ECV, defined as the fetus being in a cephalic presentation immediately following the procedure, as well as at the time of birth. The importance of several factors in predicting successful ECV was investigated using two statistical methods: logistic regression and classification and regression tree (CART) analyses.ResultsAmong nulliparas, non-engagement of the presenting part and an easily palpable fetal head were independently associated with success. Among multiparas, non-engagement of the presenting part, gestation less than 37 weeks and an easily palpable fetal head were found to be independent predictors of success. These findings were consistent with results of the CART analyses.ConclusionsRegardless of parity, descent of the presenting part was the most discriminating factor in predicting successful ECV and cephalic presentation at birth.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-27T16:57:53.705565-05:
      DOI: 10.1111/aogs.13161
  • Full dilatation cesarean section: a risk factor for recurrent
           second-trimester loss and preterm birth
    • Authors: Helena A. Watson; Jenny Carter, Anna L David, Paul T Seed, Andrew H Shennan
      Abstract: IntroductionA previous cesarean section at full dilatation (FDCS) is a risk factor for preterm birth. To provide insight on the risk to subsequent pregnancies, this cohort study compares the outcomes of pregnant women with a previous preterm birth associated either with a prior FDCS or a prior term vaginal delivery.Material and methodsWe identified women attending two inner-city preterm surveillance clinics (Guy's and St Thomas Hospital and University College London Hospital, London, UK) who had a spontaneous late miscarriage (14+0–23+6 weeks) or sPTB (
      PubDate: 2017-04-27T16:57:52.351053-05:
      DOI: 10.1111/aogs.13160
  • Parenting stress and its association with perceived agreement about the
           disclosure decision in parents following donor conception
    • Authors: Anja J. Gebhardt; Gunilla Sydsjö, Agneta Skoog Svanberg, Astrid Indekeu, Claudia Lampic
      Abstract: IntroductionFor many donor-conceiving heterosexual parents, the process of deciding whether and what to tell children about their genetic origin is challenging. We hypothesized that incomplete couple agreement about disclosure could be associated with parenting stress. The aim of the study was to investigate (1) parenting stress levels among heterosexual parents of young children following gamete donation and (2) whether parenting stress is related to perceived agreement about disclosure of the donor conception to the childrenMaterial and methodsThis study is part of the longitudinal multicenter Swedish Study on Gamete Donation and included a total of 213 heterosexual parents with children age 1–4 years following oocyte donation (n = 103) and sperm donation (n = 110). Parents individually completed a questionnaire that included validated instruments on parenting stress (SPSQ) and relationship quality (ENRICH), as well as a study-specific measure on disclosure agreement. Multiple regression analysis was appliedResultsIncomplete couple agreement on disclosure to the children was not statistically significantly associated with increased levels of parenting stress. Relationship satisfaction consistently accounted for the statistically significant variation in parenting stress levels, indicating that relationship satisfaction had a buffering impact on parenting stressConclusionsParental stress does not appear to be negatively influenced by incomplete couple agreement about disclosure to children. As children grow up, reaching agreement about what to tell the child about the donor conception might become more relevant for couples’ stress related to parenthood.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-22T09:55:47.445824-05:
      DOI: 10.1111/aogs.13157
  • Association of external cephalic version before term with late preterm
    • Authors: Kristie L. Poole; Sarah D. McDonald, Lauren E. Griffith, Eileen K. Hutton
      Abstract: IntroductionWhile evidence suggests that beginning an external cephalic version (ECV) before term (340/7 to 366/7) compared to after term may be associated with an increase in late preterm birth (340/7 to 366/7 weeks), it remains unknown what might account for this risk. The objective of the present study is to further investigate the association between ECV before term and late preterm birthMaterial and methodsSecondary analysis of data collected from the international, multicenter Early ECV trials. We evaluated the relation between ECV exposure and late preterm birth (340/7 to 366/7 weeks), as well as if additional risk factors for preterm birth (e.g., maternal age, height, body mass index, parity, placental location, and perinatal mortality rate) moderated this relation. Generalized linear mixed methods were used to account for center effect and adjust for covariatesResultsAmong 1,765 women with breech pregnancies and without a prior preterm birth, 749 (42.4%) received at least one ECV before term. Exposure to an ECV before term was not significantly independently associated with odds of preterm birth. However, placenta location moderated the association between early ECV exposure and late preterm birth. Women who were exposed to an ECV before term and had an anterior placenta were at double the odds of preterm birth (OR: 2.05; 95% CI: 1.12–3.71; p=.02)ConclusionIn a large cohort of women without known risks for preterm birth, those with an anterior placenta who undergo an ECV before term constitute a subgroup at particular risk for late preterm birth.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T14:50:24.732049-05:
      DOI: 10.1111/aogs.13153
  • Women's attitude towards routine HPA-screening in pregnancy
    • Authors: Dian Winkelhorst; Rosanne M. Loeff, Elske van den Akker - van Marle, Masja de Haas, Dick Oepkes
      Abstract: IntroductionFetal and neonatal alloimmune thrombocytopenia (FNAIT) is a potentially life-threatening disease with excellent preventative treatment available for subsequent pregnancies. In order to prevent index cases, the effectiveness of a population-based screening program has been suggested repeatedly. Therefore, we aimed to evaluate women's attitude towards possible future human platelet antigen (HPA)-screening in pregnancyMaterial and methodsWe performed a cross-sectional questionnaire study amongst healthy pregnant women receiving prenatal care in one of seven participating midwifery practices. Attitude was assessed using a questionnaire based on the validated Multidimensional Measurement of Informed Choice model, containing questions assessing knowledge, attitude and intention to participateResultsA total of 143 of the 220 women (65%) completed and returned the questionnaire. A positive attitude towards HPA-screening was expressed by 91% of participants, of which 94% was based on sufficient knowledge. Attitude was more likely to be negatively influenced by the opinion that screening can be frightening. Informed choices were made in 87% and occurred significantly less in women from non-European origin, 89% in European women vs. 60% in non-European women (p = 0.03)ConclusionsPregnant women in the Netherlands expressed a positive attitude towards HPA-screening in pregnancy. We therefore expect a high rate of informed uptake when HPA-screening is implemented. In future counselling on HPA-screening, ethnicity and possible anxiety associated with screening test need to be specifically addressed.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-12T03:15:54.138663-05:
      DOI: 10.1111/aogs.13150
  • Exercise during pregnancy and risk of gestational hypertensive disorders:
           a systematic review and meta-analysis
    • Authors: Elena Rita Magro-Malosso; Gabriele Saccone, Mariarosaria Di Tommaso, Amanda Roman, Vincenzo Berghella
      Abstract: IntroductionGestational hypertensive disorders, including gestational hypertension and preeclampsia, are one of the leading causes of maternal morbidity and mortality. The aim of our study was to evaluate the effect of exercise during pregnancy on the risk of gestational hypertensive disordersMaterial and methodsElectronic databases were searched from their inception to February 2017. Selection criteria included only randomized controlled trials of uncomplicated pregnant women assigned before 23 weeks to an aerobic exercise regimen or not. The summary measures were reported as relative risk (RR) with 95% confidence intervals (CI). The primary outcome was the incidence of gestational hypertensive disorders, defined as either gestational hypertension or preeclampsiaResultsSeventeen trials, including 5,075 pregnant women, were analyzed. Of them, seven contributed data to quantitative meta-analysis for the primary outcome. Women who were randomized in early pregnancy to aerobic exercise for about 30-60 minutes 2-7 times per week had a significant lower incidence of gestational hypertensive disorders (5.9% vs 8.5%; RR 0.70, 95% CI 0.53 to 0.83; 7 studies, 2,517 participants), specifically a lower incidence of gestational hypertension (2.5% vs 4.6%; RR 0.54, 95% CI 0.40 to 0.74; 16 studies, 4,641 participants) compared to controls. The incidence of preeclampsia (2.3% vs 2.8%; RR 0.79, 95% CI 0.45 to 1.38; 6 studies, 2,230 participants) was similar in both groups. The incidence of cesarean delivery was decreased by 16% in the exercise groupConclusionsAerobic exercise for about 30-60 minutes 2-7 times per week during pregnancy, as compared to being more sedentary, is associated with a significantly reduced risk of gestational hypertensive disorders overall, gestational hypertension, and cesarean delivery.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-12T03:15:49.216376-05:
      DOI: 10.1111/aogs.13151
  • Prevalence of urinary incontinence among women and analysis of potential
           risk factors in Germany and Denmark
    • Authors: Louise Schreiber Pedersen; Gunnar Lose, Mette Terp Høybye, Susanne Elsner, Annika Waldmann, Martin Rudnicki
      Abstract: IntroductionUrinary incontinence (UI) is a prevalent condition that interferes with women's health-related quality of life. Prevalence rates from earlier studies are wide-ranging, due to heterogeneity in methodology, definition of UI and the populations included. We aimed to determine the prevalence of UI and associated risk factors in Germany and Denmark by using the same methodology, definition and populationMaterial and methodsPostal survey conducted in two regions Germany and Denmark, including 8000 women aged 18+ years. UI was defined as any complaint of involuntary loss of urine. The questionnaire contained socio-demographic questions and the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF)ResultsThe response rate in Germany and Denmark was 46.2% and 66.6% (p
      PubDate: 2017-04-12T03:15:42.736738-05:
      DOI: 10.1111/aogs.13149
  • Maternal super obesity and risk for intensive care unit admission in the
           MFMU Cesarean Registry
    • Authors: Marcela C Smid; Sarah K Dotters-Katz, Arthur J Vaught, Catherine J Vladutiu, Kim A. Boggess, David M Stamilio
      Abstract: IntroductionObesity is risk factor for intensive care unit (ICU) admission in non-pregnant populations. Less is known about maternal obesity and ICU admission risk. The objective of this study was to estimate the association between maternal obesity and ICU admission among women who delivered via cesarean or vaginal birth after cesarean (VBAC).Material and methodThis is a retrospective cohort analysis of women who delivered via VBAC or cesarean in the Maternal-Fetal Medicine Unit (MFMU) Cesarean Registry. We defined exposure as body mass index (BMI) at delivery stratified as non-obese (BMI 18.5-29.9 kg/m2), class I/II obese (BMI 30-39.9 kg/m2), morbidly obese (BMI 40-49.9 kg/m2), and super obese (BMI ≥ 50 kg/m2). The primary outcome was ICU admission. Modified Poisson regression models estimated relative risk (RR) of ICU admission by obesity strata, after adjusting for confounders. Mediation analysis was used to estimate the proportion of ICU admission risk attributable specifically to obesity.ResultsWe included 68,455 women; 40% non-obese, 46% class I/II obese, 12% morbidly obese, and 2% super obese. Super obese women were at higher risk for ICU admission compared to non-obese women (0.7 vs 1.3%, adjusted RR 1.61 (95% confidence interval 1.01-2.65), after adjusting for confounders. Among super obese women, medical co-morbidities mediated 58% of ICU admission risk, suggesting that a significant proportion of ICU admission is driven by maternal obesity.ConclusionsSuper obese women who deliver via cesarean or VBAC are at increased risk of peripartum ICU admission. Obstetricians and critical care specialists should consider possible ICU admission during delivery planning.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-06T02:30:49.929348-05:
      DOI: 10.1111/aogs.13145
  • Long-acting recombinant FSH in random start ovarian stimulation protocols
           for fertility preservation in women with cancer
    • Authors: Veronica Sarais; Alessio Paffoni, Luca Pagliardini, Francesca Filippi, Fabio Martinelli, Giorgia Mangili, Massimo Candiani, Enrico Papaleo
      Abstract: IntroductionThe objective of this study was to assess effectiveness and the potential benefits of the use of long-acting recombinant follicle-stimulating hormone (FSH) in random-start protocol for fertility preservation in women with cancer.Material and methodsThis is a retrospective before and after study performed between February 2013 and December 2015 in women that underwent ovarian hyper-stimulation for oocyte cryobanking using a random start approach. In the first part of the study period, the subjects were treated with daily recombinant FSH whereas in the second part the stimulation was initiated with long-acting recombinant FSH. The primary aim of the study was to compare the number of oocytes stored in the two study periods. 140 women were ultimately selected.ResultsCompared to daily recombinant FSH, the use of the long-acting compound was associated with a reduced number of injections (12.5 ± 3.5 vs 16.4 ± 0.3; p
      PubDate: 2017-04-06T02:30:45.956081-05:
      DOI: 10.1111/aogs.13146
  • Thromboembolism and in-vitro fertilization -NDASH- a systematic review
    • Authors: Maria Sennström; Karin Rova, Margareta Hellgren, Ragnhild Hjertberg, Eva Nord, Lars Thurn, Pelle G Lindqvist
      Abstract: IntroductionThere is no accepted consensus on thromboprophylaxis in relation to in-vitro fertilization (IVF). We aimed to study the frequency of thromboembolism and to assess thromboprophylaxis in relation to IVF.Material and methodsWe performed a systematic review. All study designs were accepted except single case reports. Language of included articles was restricted to English.ResultsOf 338 articles, 21 relevant articles (9 cohort studies, 6 case-control studies, 3 case series, and 3 reviews of case series) were identified. The antepartum risk of venous thromboembolism (VTE) after IVF is doubled, (OR 2.18, 95% CI; 1.63–2.92), compared to the background pregnant population. This is due to a 5-10-fold increased risk during the first trimester in IVF pregnancies, in turn related to a very high risk of VTE after ovarian hyperstimulation syndrome (OHSS), i.e. up to a 100-fold increase or an absolute risk of 1.7%. The interval from embryo transfer to VTE was 3-112 days and the interval from embryo transfer to arterial thromboembolism was 3-28 days. No robust study on thromboprophylaxis was found.ConclusionsThe antepartum risk of VTE after IVF is doubled, compared to the background pregnant population, and is in turn related to a very high risk of VTE after OHSS in the first trimester. Our group of authors and clinical experts recommend that IVF patients with OHSS be prescribed low-molecular-weight heparin during the first trimester, while other IVF patients should be given thromboprophylaxis based on the same risk factors as other pregnant women.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-06T02:30:41.08944-05:0
      DOI: 10.1111/aogs.13147
  • Cervical collagen is reduced in non-pregnant women with a history of
           cervical insufficiency and a short cervix
    • Authors: Iben Sundtoft; Jens Langhoff-Roos, Puk Sandager, Steffen Sommer, Niels Uldbjerg
      Abstract: IntroductionPreterm cervical shortening and cervical insufficiency may be caused by a constitutional weakness of the cervix. The aim of this study was to assess the cervical collagen concentration in non-pregnant women with a history of cervical insufficiency or a history of a short cervix in the second trimester of pregnancy.Material and methodsIn this case-control study we included non-pregnant women one year or more after pregnancy: 55 controls with a history of normal delivery; 27 women with a history of cervical insufficiency; and 10 women with a history of a short cervix (95th percentile) at gestation weeks 18–20. We obtained biopsies (3 x 3-4 mm) from the ectocervix and determined the collagen concentration by measuring the hydroxyproline concentration.ResultsWomen with cervical insufficiency had lower collagen concentrations (63.5 ± 5.1%; mean ± SD) than controls (68.2 ± 5.4%; p=0.0004); area under the ROC curve 0.73 (95% CI 0.62-0.84). A cut-off value at 67.6% collagen resulted in a positive likelihood ratio of 3.2, a sensitivity of 60%, and a specificity of 81%. Also, women with a short cervix in the second trimester had lower collagen concentrations in a non-pregnant state (62.1% ± 4.9%) than women with a long cervix (67.8% ± 5.0%; p=0.02).ConclusionsBoth cervical insufficiency and a short cervix in the second trimester of pregnancy are associated with low cervical collagen concentrations in a non-pregnant state more than one year after pregnancy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T05:45:47.251362-05:
      DOI: 10.1111/aogs.13143
  • Predictive value of plasma hCG measured 14 days after Day-2 single embryo
    • Authors: Kristine Løssl; Anna Oldenburg, Mette Toftager, Jeanette Bogstad, Lisbeth Prætorius, Anne Zedeler, Claus Yding Andersen, Marie Louise Grøndahl, Anja Pinborg
      Abstract: IntroductionPrediction of pregnancy outcome after IVF is important for patients and clinicians. Early plasma hCG (p-hCG) levels are the best known predictor of pregnancy outcome, but no studies has been restricted to single embryo transfer (SET) of Day-2 embryos. The aim of the present study was to investigate the predictive value of p-hCG measured exactly 14 days after the most commonly used Day-2 SET on pregnancy, delivery and perinatal outcome.Materials And MethodsA retrospective analysis of prospectively collected data on 466 women who had p-hCG measured exactly 14 days after Day-2 SET during a randomized trial including 1050 unselected women (aged 18-40 years) undergoing their first IVF/ICSI treatment.ResultsP-hCG predicted clinical pregnancy (AUC 0.953; 95% CI 0.915-0.992) significantly better than ongoing pregnancy (AUC 0.803, 95% CI; 0.717-0.890) and delivery (AUC 0.772, 95% CI; 0.691-0.854). Women with p-hCG levels in the lowest quartile had significantly lower clinical pregnancy, ongoing pregnancy, and delivery rates (p
      PubDate: 2017-04-04T05:45:43.07235-05:0
      DOI: 10.1111/aogs.13144
  • Patient selection for later delivery timing with suspected previa-accreta
    • Authors: Nicola C. Perlman; Sarah E. Little, Ann Thomas, David E. Cantonwine, Daniela A. Carusi
      Abstract: IntroductionWe identified patients with previa and suspected accreta who are at lowest risk of unscheduled delivery or major morbidity with planned delivery beyond 34 weeks gestation.Material and methodsThis was a retrospective cohort study of patients who had reached 34.0 weeks gestational age with a suspected previa-accreta. We evaluated rates of unscheduled and emergent delivery based on known risk factors for premature birth. In a second analysis, we stratified patients based on level of preoperative morbidity concern and evaluated rates of major transfusion and Intensive Care Unit admission by delivery week (34w, 35w or 36w and beyond).ResultsOf 84 available patients, we classified 31 patients as low risk for unscheduled delivery and 52 as high risk. The low risk group was scheduled later (36.6w vs. 36.0w; p
      PubDate: 2017-04-04T04:06:04.327257-05:
      DOI: 10.1111/aogs.13140
  • Live birth outcome, spontaneous pregnancy and adoption up to five years
           after undergoing assisted reproductive technology treatment
    • Authors: Helena Volgsten; Lone Schmidt
      Abstract: IntroductionThis study is part of a longitudinal cohort undertaken in both women and men to describe live birth outcome after undergoing assisted reproductive technology (ART) treatment in a clinical setting. Another objective was to follow women and men living with children from other alternatives after ART, such as adoption.Material and methodsA total of 439 (80.5%) women and 423 (77.6%) men were included in the baseline cohort (2005-2007). Live birth rate after ART was 24.8% at baseline. Up to five years later (2010-2011) the same participants were sent individual postal questionnaires (n=439).ResultsOverall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire at follow-up. The majority of women (91.7%) and men (93.4%) were living with children. A total of 225 (80.9%) women had a live birth at follow-up. Of these; almost three out of four (71.6%) had a live birth after ART and more than one out of four (28.0%) after spontaneous pregnancies or both. Of these, 52 (26.1%) women had a subsequent live birth after successful ART and 26 (32.9%) women after unsuccessful ART. Nine-teen (6.8%) women and 13 (7,1%) men had a child after adoption. Almost one out of five (19.1%) women had no live birth at follow-up.ConclusionThe majority of women and men were living with children; such as live birth after ART, spontaneous pregnancy and/or adoption up to five years later. However, almost one out of five had no live birth at follow-up.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T04:00:38.151966-05:
      DOI: 10.1111/aogs.13139
  • Incidence and risk factors of venous thromboembolism during
           postpartum-period: a population-based cohort-study
    • Authors: Päivi Johanna Galambosi; Mika Gissler, Risto Juhani Kaaja, Veli-Matti Ulander
      Abstract: IntroductionThe awareness of the incidence and timing of postpartum venous thromboembolic event (VTE) guides the use of thrombophophylaxis. Our aims were to assess the incidence and mortality of VTE and identify its associated risk factors during different postpartum periodsMaterial and methodsA population-based controlled cohort-study by combining four large registers in 2001-2011. All women with a recent delivery were identified. The incidence, risk factors and mortality of VTE 0-180 days after delivery were assessed by using all healthy delivered women as the control group. The incidence was compared to that of the non-pregnant womenResultsAmong the 634.292 delivered women 1169 had VTE 0-180 days postpartum. The incidence of VTE was highest during the first week postpartum: 37-fold compared to non-pregnant women, declining to 2-fold immediately after that. Almost half of the VTEs occurred between 43-180 days of postpartum. The incidence of VTE was four-fold compared to that of non-pregnant women. Three VTE-related deaths occurred. Older age, higher body mass index, thrombophilia, multiple pregnancy, gestational diabetes, anemia, chorioamnionitis, threatening premature birth, in vitro fertilization with ovarian hyperstimulation, primiparity, Cesarean section, cardiac/renal diseases and varicose veins were associated with an increased risk for postpartum VTE. The risk remained elevated for 180 days in women with thrombophilia, Cesarean section, multiple pregnancy, varicose veins and cardiac diseaseConclusionsThe risk of VTE remained elevated compared to that of the non-pregnant women after the usually defined postpartum period (six weeks). The results might assist in selecting women in need for thrombophophylaxis.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-30T10:55:29.139582-05:
      DOI: 10.1111/aogs.13137
  • Worldwide prevalence of tocophobia in pregnant women: systematic review
           and meta-analysis
    • Authors: Maeve A. O'Connell; Patricia Leahy-Warren, Ali S. Khashan, Louise C. Kenny, Sinéad M. O'Neill
      Abstract: IntroductionTocophobia is defined as a severe fear of pregnancy and childbirth. There is increasing evidence that tocophobia may have short and long-term adverse effects on mother and baby. We performed a systematic review and meta-analysis to determine the global prevalence of tocophobia in pregnancyMaterial and methodsRelevant articles were identified through searching six relevant databases: MEDLINE, CINAHL, Pubmed, PsycINFO, Maternity & Infant Care and Scopus between 1946 and April 2016. We used search terms for tocophobia prevalence in pregnant women which we agreed with a medical librarian. There were no language restrictions. Two review authors independently assessed data for inclusion, extracted data and assessed quality using a standardized appraisal tool. Meta-analysis was performed to determine the overall pooled-prevalence of tocophobia. Several subgroup and sensitivity analysis were conductedResultsThirty-three studies were included in the systematic review from 18 countries of which data from 29 studies were used in the meta-analysis of 853,988 pregnant women. Definition of tocophobia varied, while prevalence rates ranged between 3.7% and 43%. The overall pooled prevalence of tocophobia, using a random-effects model, was 14% (95% CI; 0.12-0.16). Significant heterogeneity was observed (I2=99.25%, p=0.00) which was not explained in subgroup analyses including tocophobia definition used, screening trimester and parityConclusionThe prevalence of tocophobia is estimated at 14% and appears to have increased in recent years (2000 onwards). Considerable heterogeneity (99.25%) was noted which may be attributed to lack of consensus on the definition of tocophobia therefore our results should be interpreted with caution.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-30T10:55:26.566593-05:
      DOI: 10.1111/aogs.13138
  • Computerized data-driven interpretation of the intrapartum cardiotocogram:
           a cohort study
    • Authors: Antoniya Georgieva; Christopher W.G. Redman, Aris T. Papageorghiou
      Abstract: IntroductionContinuous intrapartum fetal monitoring remains a significant clinical challenge. We propose utilising cohorts of routinely collected data. We aim to combine non-classical (data-driven) and classical cardiotocography (CTG) features with clinical features into a system (OxSys), which generates automated alarms for the fetus at risk of intrapartum hypoxia. We hypothesise that OxSys can outperform clinical diagnosis of ‘fetal distress’, when optimised and tested over large retrospective datasetsMaterial and methodsWe studied a cohort of 22,790 labouring women (≥36 weeks gestation). Paired umbilical blood analyses were available. Perinatal outcomes were defined by objective criteria (Normal; Severe, Moderate or Mild compromise). We used the data retrospectively to develop a prototype of OxSys, by relating its alarms to perinatal outcome, and comparing its performance against standards achieved by bedside diagnosisResultsOxSys1.5 triggers an alarm if the initial trace is nonreactive or the Decelerative Capacity (a non-classical CTG feature), exceeds a threshold, adjusted for preeclampsia and thick meconium. There were 187 newborns with Severe, 613 with Moderate and 3,197 with Mild compromise; and 18,793 with Normal outcome. OxSys1.5 increased the sensitivity for compromise detection: 43.3% vs. 38.0% for Severe (p=0.3) and 36.1% vs. 31.0% for Moderate (p=0.06); and reduced the false positive rate (14.4% vs. 16.3%, p
      PubDate: 2017-03-28T10:01:59.997142-05:
      DOI: 10.1111/aogs.13136
  • Obstetrical and perinatal complications of twin pregnancies: is there a
           link with the type of infertility treatment'
    • Authors: Sophie Deltombe-Bodart; Philippe Deruelle, Elodie Drumez, Sophie Cordiez, Sophie Catteau-Jonard, Charles Garabedian
      Abstract: IntroductionThe aim of this study was to compare the maternal and perinatal data from spontaneous twin pregnancies with twin pregnancies conceived via assisted reproductive technology, and to evaluate the outcomes depending on the type of treatmentMaterial and methodsA historical cohort of all twin live births between 1997 and 2014 was used to create two groups: spontaneous pregnancies and pregnancies after infertility treatment (ovulation induction, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection). The population characteristics and pregnancy, childbirth, and neonatal complications were compared, and the data were adjusted for age, parity, chorionicity, and the mother's body mass index to assess only the impact of the infertility treatmentsResultsIn total, 1,580 twin pregnancies were included, with 575 requiring assisted conception. We did not observe any differences between the assisted conception pregnancies and the spontaneous twin pregnancies with regard to the obstetric and childbirth complications and neonatal outcomes. In addition, there were no statistically significant differences between the types of infertility treatmentConclusionAfter adjusting for the maternal parameters and chorionicity, the twin pregnancies conceived via assisted reproductive technology were not at an increased risk of obstetric and neonatal complications. Moreover, the type of treatment did not alter the obstetric and neonatal complications. Therefore, the higher complication rate was related to the patient's medical specifics, rather than to the infertility treatment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:01:55.336076-05:
      DOI: 10.1111/aogs.13135
  • Ovarian reserve after salpingectomy: a systematic review and meta-analysis
    • Authors: Ahmed Aboelfadle Mohamed; Ali Haroun Yosef, Cathryn James, Tarek Khalaf Al-Hussaini, Mohamed Ali Bedaiwy, Saad Ali Amer
      Abstract: IntroductionAlthough there has been a growing concern over the possible damaging effect of salpingectomy on ovarian reserve, this issue remains uncertain. The purpose of this meta-analysis was to test the hypothesis that salpingectomy may compromise ovarian reserveMaterial and methodsA detailed search was conducted using MEDLINE, Embase, Dynamed Plus, ScienceDirect, TRIP database and the Cochrane Library from January 2000 to November 2016. All cohort, cross-sectional and randomized controlled studies investigating changes in circulating anti-Müllerian hormone (AMH) after salpingectomy were considered. Thirty-seven studies were identified, of which eight were eligible. Data were extracted and entered into RevMan software for calculation of the weighted mean difference (WMD) and 95% confidence interval (CI). Two groups of studies were analyzed separately including group 1 (six studies, n=464) comparing data before and after salpingectomy and group 2 (two studies) comparing data in women who have undergone salpingectomy (n=169) vs. healthy controls (n=154)ResultsPooled results of group 1 studies showed no statistically significant change in serum AMH concentration after salpingectomy (WMD, -0.10ng/ml; 95% CI; -0.19 – 0.00, I2=0%). Similarly, meta-analysis of group 2 showed no statistically significant difference in serum AMH concentration between salpingectomy group and controls (WMD, -0.11ng/ml; 95% CI; -0.37 – 0.14, I2=77%). Subgroup analyses based on laterality of surgery, type of AMH kit and participants’ age (
      PubDate: 2017-03-17T17:50:43.768576-05:
      DOI: 10.1111/aogs.13133
  • Validation of data in the Medical Birth Registry of Norway on delivery
           after a previous cesarean section
    • Authors: Sjur Lehmann; Elham Baghestan, Per Børdahl, Marta Ebbing, Lorentz Irgens, Svein Rasmussen
      Abstract: IntroductionTrial of labor (TOL) is an option in most deliveries after a previous cesarean section (CS). The Medical Birth Registry of Norway (MBRN) has received compulsory notification of all deliveries in the country since 1967, including data that could identify TOL in epidemiologic research. The objective of this study was to validate MBRN data for identification of TOL deliveries after a previous cesarean section (CS).Material and methodsThe MBRN provided a random national sample of 500 birth order two deliveries during 1989–2012 in women with a registered birth order one CS delivery. The reporting maternity units were asked to complete a questionnaire on data items in both deliveries, using hospital record data as the gold standard.ResultsCompleted questionnaires were returned for 477 women (95.5%) with data on both deliveries. An algorithm to identify TOL using MBRN data from the birth order two delivery had a positive predictive value of 93.2%, a negative predictive value of 93.5%, a sensitivity of 96.1%, and a specificity of 88.8%. Validity of MBRN data on mode and onset of delivery, CS subtype, and planned mode of delivery is also reported.ConclusionsMBRN data on planned and actual mode of delivery, CS subtype, and the algorithm to identify TOL in deliveries after a previous CS had satisfactory quality for a registry-based study of TOL.
      PubDate: 2017-03-15T08:56:18.248793-05:
      DOI: 10.1111/aogs.13115
  • Enlarged posterior fossa on prenatal imaging: Differential diagnosis,
           associated anomalies and post-natal outcome
    • Authors: Anja Wüest; Daniel Surbek, Roland Wiest, Christian Weisstanner, Harald Bonel, Maja Steinlin, Luigi Raio, Boris Tutschek
      Abstract: IntroductionThe primary aim of this study was to ascertain the prevalence the individual conditions and of associated anomalies in fetuses with the prenatal diagnosis of enlarged posterior fossa and to explore the diagnostic accuracy of ultrasound in these anomalies. The secondary aim was to evaluate the post-natal outcome of children affected by posterior fossa anomalies.Material and methodsAll fetuses with enlarged posterior fossa detected by prenatal sonography at a referral center from 2001-2015 were analyzed retrospectively. Some were also studied by fetal magnetic resonance imaging (MRI) or volume ultrasound examinations. Fetal sonographic and MRI were compared using following classification: Dandy-Walker malformation; Megacisterna magna (MCM); Blake's pouch cyst; isolated vermian hypoplasia; vermian agenesis; posterior fossa arachnoid cyst; and cerebellar hypoplasia.ResultsAmong the 69 fetuses the ultrasound diagnoses were: MCM (n=29; of these isolated n=15), Dandy-Walker malformation (n=28, isolated n=4), vermian hypoplasia (n=5, isolated n=4), Blake's pouch cyst (n=4, isolated n=1), cerebellar hypoplasia (n=2; none isolated) and arachnoid cyst in the posterior fossa (n=1, isolated). 13 of the 41 karyotyped fetuses were aneuploid, including seven with Dandy-Walker malformation. Associated malformations were found in 37/69 cases. There were 39 live births, including 11 with confirmed Dandy-Walker malformation six of whom show a normal development. 12 infants with truly isolated MCM show normal development. There were eight false-positive prenatal diagnoses (or resolution until birth) of “enlarged posterior fossa”: Three with Blake's pouch cyst, two MCM and one with vermian hypoplasia.ConclusionsAn enlarged posterior fossa requires specific diagnoses for best possible counseling. The term “Dandy-Walker variant” should not be used any more. Isolated MCM and Blake's pouch cyst can either resolve or be normal variants, but may also indicate the presence of a more severe anomaly or associated malformations.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-14T09:45:37.172281-05:
      DOI: 10.1111/aogs.13131
  • Impact of uterine balloon tamponade on the use of invasive procedures in
           severe postpartum hemorrhage
    • Authors: Emilie Gauchotte; Manuela De La Torre, Estelle Perdriolle-Galet, Catherine Lamy, Guillaume Gauchotte, Olivier Morel
      Abstract: IntroductionThe aim of this study was to assess the impact of tamponade, when uterotonic agents fail, on the need for surgery or interventional radiology.Material and MethodsAll women who received sulprostone for postpartum hemorrhage were retrospectively compared over two periods: December 2008 to December 2010 without use of tamponade (period 1) and June 2011 to June 2013 with use of tamponade (period 2), in the case of sulprostone failure (STROBE compliant retrospective cohort study). During period 2, interventional radiology or surgery was used only in the case of tamponade failure.Results165 women were included (74 for period 1, 91 for period 2). The rate of interventional radiology or surgery significantly decreased between period 1 (21 of 74 women, 28.4%) and period 2 (six of 91 women, 6.6%, p = 0.0003). The rate of assumed failure of uterotonic agents was higher for period 2: 22 of 74 women (29.7%) during period 1, and 41 of 91 (45.1%, p=0.0439) during period 2. The success rate of tamponade was 92.1% (35 of 38 women).ConclusionsAlthough the efficacy of tamponade should be viewed in the light of its widespread use, our findings confirm that tamponade significantly reduces the need for interventional radiology or surgery for postpartum hemorrhage treatment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T04:50:31.330489-05:
      DOI: 10.1111/aogs.13130
  • Hysterectomy for cesarean scar pregnancy: No or minimal bladder separation
    • Authors: Shigeki Matsubara; Shiho Nagayama, Risa Narumi, Rie Usui, Tatsuya Suzuki
      Abstract: For cesarean scar pregnancy (CSP), various uterus-preserving treatments have been proposed (1, 2); however, hysterectomy is eventually required in some cases (1, 2). Hysterectomy-related adverse events should be avoided, especially in CSP-hysterectomy, considering that patients are usually exhausted or compromised both mentally and physically after failed uterus-preserving therapy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T03:50:23.273596-05:
      DOI: 10.1111/aogs.13129
  • Antecedents and neuroimaging patterns in cerebral palsy with epilepsy and
           cognitive impairment: a population-based study in children born at term
    • Authors: Kristina Ahlin; Bo Jacobsson, Staffan Nilsson, Kate Himmelmann
      Abstract: IntroductionAntecedents of accompanying impairments in cerebral palsy (CP) and their relation to neuroimaging patterns need to be explored.Material and methodsA population-based study of 309 children with CP born at term in 1983-1994. Pre-, intra- and postpartum variables previously studied as antecedents of CP type and motor severity were analysed in children with CP and cognitive impairment and/or epilepsy, and in children with CP without these accompanying impairments. Neuroimaging patterns and their relation to identified antecedents were analysed. Data were retrieved from the CP register of western Sweden, obstetric and neonatal records.ResultsChildren with CP and accompanying impairments more often had low birth weight (kg) (OR 0.5 95% CI; 0.3-0.8), brain maldevelopment known at birth (p=0.007, OR ∞) and neonatal infection (OR 5.4 (1.04-28.4). Moreover, neuroimaging patterns of maldevelopment (OR 7.2 95% CI; 2.9-17.2), cortical/subcortical lesions (OR 5.3 95% CI; 2.3-12.2) and basal ganglia lesions (OR 7.6 95% CI; 1.4-41.3) were more common, wheras white matter injury was found significantly less often (OR 0.2 95% CI; 0.1-0.5). In most children with maldevelopment, the intra- and postpartum period was uneventful (p
      PubDate: 2017-03-12T03:45:28.308925-05:
      DOI: 10.1111/aogs.13128
  • Identification of first stage labor arrest by electromyography in term
           nulliparous women after induction of labor
    • Authors: Blanka Vasak; Elisabeth M. Graatsma, Elske Hekman-Drost, Marinus J. Eijkemans, Jules H Schagen Van Leeuwen, Gerard H.A. Visser, Benoit C. Jacod
      Abstract: IntroductionWorldwide induction and cesarean delivery rates have increased rapidly, with consequences for subsequent pregnancies. The majority of intra-partum cesarean deliveries are performed for failure to progress, typically in nulliparous women at term. Current uterine registration techniques fail to identify inefficient contractions leading to first stage labor arrest. An alternative technique, uterine electromyography has been shown to identify inefficient contractions leading to first stage arrest of labor in nulliparous women with spontaneous onset of labor at term. The objective of this study was to determine whether this finding can be reproduced in induction of laborMaterial and methodsUterine activity was measured in 141 nulliparous women with singleton term pregnancies and a fetus in cephalic position during induced labor. Electrical activity of the myometrium during contractions was characterized by its power density spectrumResultsNo significant differences were found in contraction characteristics between women with induced labor delivering vaginally with or without oxytocin and women with arrested labor with subsequent cesarean deliveryConclusionUterine electromyography shows no correlation with progression of labor in induced labor, which is in contrast to spontaneous labor.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T03:45:26.856445-05:
      DOI: 10.1111/aogs.13127
  • Glucose homeostasis, beta cell function, and insulin resistance in
           relation to vitamin D status after gestational diabetes mellitus
    • Authors: Nael Shaat; Claes Ignell, Anastasia Katsarou, Kerstin Berntorp
      Abstract: IntroductionWe wanted to determine vitamin D status after gestational diabetes mellitus (GDM) and to evaluate whether levels of 25-hydroxyvitamin D3 (25OHD3) are associated with beta cell function, insulin resistance, or a diagnosis of diabetes after GDM.Material and methodsGlucose homeostasis was assessed during a 75-g oral glucose tolerance test 1–2 years after delivery in 376 women with previous GDM (287 European and 78 non-European, including 33 Arab and 35 Asian women). Insulin resistance was estimated using homeostasis model assessment of insulin resistance (HOMA-IR). The insulinogenic index (I/G30) and the disposition index [(I/G30)/HOMA-IR] were used to calculate insulin secretion. Concentrations of serum 25OHD3 were determined.ResultsMean (± SD) 25OHD3 concentration was 50.0 ± 22.3 nmol/L and differed significantly among subgroups of body mass index, ethnicity, and glucose tolerance status; 53% had 25OHD3 levels
      PubDate: 2017-03-09T07:55:26.379421-05:
      DOI: 10.1111/aogs.13124
  • Intravenous fluid rate for reduction of cesarean delivery rate in
           nulliparous women: a systematic review and meta-analysis
    • Authors: Robert M. Ehsanipoor; Gabriele Saccone, Neil S. Seligman, Rebecca Pierce-Williams, Andrea Ciardulli, Vincenzo Berghella
      Abstract: IntroductionThe National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine have emphasized the need to promote vaginal delivery and have offered recommendations to safely prevent primary cesarean delivery. However, there has been limited discussion regarding management of intravenous fluids and other aspects of labor management that may influence labor. Therefore the aim of our study was to determine if an intravenous fluid rate of 250 vs 125 mL/hour is associated with a difference in cesarean delivery rateMaterial and methodsSearches were performed in Medline, OVID, Scopus, ClinicalTrials. gov, the PROSPERO International Prospective Register of Systematic Reviews, Embase, Web of Science, and the Cochrane Library for randomized controlled trials. We included all randomized controlled trials comparing intravenous fluid rates of 125 mL/hour vs. 250 mL/hour in nulliparous women in spontaneous labor at term with singleton pregnancies at ≥ 36 weeks. Studies were included regardless of the type of intravenous fluids used and regardless of whether or not oral intake was restricted during labor. Studies including multiparous women or women whose labor was induced were excluded. The primary outcome was the incidence of cesarean delivery. We planned to assess a sensitivity analysis according to type of fluids used and according to restriction of oral fluid intakeResultsSeven trials including 1,215 nulliparous women in spontaneous labor at term were analyzed. 593 (48.8%) were in the 250 mL/hour group, and 622 (51.2%) in the 125 mL/hour group. Five studies used lactated Ringer's solution, one used normal saline in dextrose water, and in one study it was unclear which intravenous fluid was used. Women who received intravenous fluids 250 mL/hour had a significantly lower incidence of cesarean delivery for any indication (12.5% vs 18.1%; RR 0.70, 95% CI 0.53 to 0.92; 7 studies, 1,215 participants; I2=0%) and for dystocia (4.9% vs 7.7%; RR 0.60, 95% CI 0.38 to 0.97; 5 studies, 1,093 participants; I2=18%) and a significantly shorter mean of duration of labor of about one hour (mean difference -64.38 minutes, 95% CI -121.88 to -6.88; 6 studies, 1,155 participants; I2=83%) and of length of second stage of labor (mean difference -2.80 minutes, 95% CI -4.49 to -1.10; 899 participants; I2=22%) compared to those who received intravenous fluid 125 mL/hour. No differences were found in the other secondary outcomes. There were no maternal or perinatal deaths and only one woman, in the 125 ml/hr group, developed pulmonary edema. The findings persisted regardless of the type of intravenous fluid used. No significant reduction in the incidence of cesarean delivery was demonstrated in women with unrestricted oral intake; however, this was limited to only 2 studies evaluating 254 womenConclusionsIn conclusion, our findings provide evidence that the duration of labor in low-risk nulliparous women may be shortened by a policy of intravenous fluids at a rate of 250 mL/hours rather than 125 mL/hours. This could also lead to a reduction in the incidence of cesarean delivery. The number needed to treat to prevent one cesarean delivery is 18 women. Our data support for increased hydration amongst nulliparous women in labor when oral intake is restricted. Further study is needed regarding risks and benefits of increased hydration among women with unrestricted oral intake, those undergoing induction of labor, and those with medical comorbidities.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-25T15:35:26.493393-05:
      DOI: 10.1111/aogs.13121
  • Decline in stillbirths and perinatal mortality after implementation of a
           more aggressive induction policy in post-date pregnancies: A nationwide
           register study
    • Authors: Anne R. Zizzo; Ida Kirkegaard, Anja Pinborg, Niels Ulbjerg
      Abstract: IntroductionIn 2011 the Danish national guidelines were changed towards a more aggressive induction and fetal surveillance policy from 1) induction of labor at gestational age (GA) of 42+0 weeks and 2) no fetal surveillance after 40+0 to 1) induction of labor between 41+2-41+6, 2) earlier induction at 41+0 weeks in case of maternal age> 40 years or body mass index (BMI)> 35 kg/m2 and 3) fetal surveillance at GA 41+0.Material and methodsThis national cohort study included all pregnancies that reached 41+0 weeks of gestation from 2008 to 2014 (N=102 167). Multivariate logistic regression analyses were used to estimate risks in the years after (2012-2014) versus before (2008-2010) new national guidelines, adjusted for maternal age, BMI, and parity.ResultsWe observed a decline in stillbirths from 0.9‰ to 0.5 ‰ (odds ratio (OR)adjusted 0.50, 95%CI;0.29-0.89, p=0.018). Furthermore a decline in perinatal deaths from 1.3‰ to 0.8‰ (ORadjusted 0.62, 95%CI;0.39-0.96, p=0.033) and vacuum extraction (ORadjusted 0.86, 95%CI;0.82-0.90, p=0.007) was observed. The risk of Cesarean section (ORadjusted 0.98, 95%CI;0.94-1.02, p=0.251), Apgar score below 7 at 5 minutes (ORadjusted 0.96, 95%CI;0.81-1.14, p=0.0.678) and admissions to the neonatal department (ORadjusted 1.04, 95%CI;1.00-1.14, p=0.064) did not change, while induction of labor increased from 28.2% to 42.6% (ORadjusted 1.89, 95%CI;1.84-1.95, p
      PubDate: 2017-02-10T11:55:33.856787-05:
      DOI: 10.1111/aogs.13113
  • Women treated for epilepsy during pregnancy: outcomes from a nationwide
           population-based cohort study
    • Authors: Miia Artama; Jemina Ahola, Jani Raitanen, Jukka Uotila, Mika Gissler, Jouko Isojärvi, Anssi Auvinen
      Abstract: IntroductionWomen with epilepsy (WWE) are generally treated as a risk group during pregnancy, but over 90% of pregnant WWE have favorable pregnancies. However, the risk of some pregnancy and delivery complications may be increased among WWE, especially regarding those on antiepileptic drugs.Material and methodsThis nationwide, retrospective population-based cohort study includes WWE who gave birth in Finland during 1987-2008 (n=1737) and the reference cohort of random sample of women without epilepsy (n=4357). Identification of the cohorts, information on hospitalizations and deliveries was obtained from the Finnish Health Registers and population statistics. Multivariate analyses were conducted by binomial regression.ResultsWWE were more often hospitalized during pregnancy for accidents or other external causes (adjusted risk ratio; aRR 1.74, 95% confidence interval (CI) 0.98−3.09), premature rupture of membranes (aRR 1.75, 95% CI 1.14−2.69) and premature contractions (aRR 1.75, 95% CI 1.36−2.23). Hospitalizations for infections were more frequent in WWE (1.4% vs. 0.4%, aRR 3.15, 95% CI 1.72−5.76). The risk for induction of delivery or a Cesarean section was increased in WWE. There was no difference in premature deliveries between the groups, but the risk of being small for gestational age (aRR 1.57, 95% CI 1.23-2.01), admission to neonatal intensive care unit (aRR 1.66, 95% CI 1.39-1.97), and need for respiratory care (aRR 2.37, 95% CI 1.57-3.60) was clearly increased in the offspring of WWE.ConclusionsWWE are at an increased risk of complications and hospitalizations during pregnancy and delivery. However, the majority of WWE have normal pregnancy and delivery.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-07T20:25:56.578029-05:
      DOI: 10.1111/aogs.13109
  • Accelerated fetal growth in early pregnancy and risk of severe large for
           gestational age and macrosomic infant: a cohort study in a low-risk
    • Abstract: IntroductionThe aim of the study was to examine the association between fetal growth in early pregnancy and risk of severely large for gestational age (LGA) and macrosomia at birth in a low-risk populationMaterial and methodsCohort study that included 68 771 women with non-anomalous singleton pregnancies, without history of diabetes or hypertension, based on electronic database on pregnancies and deliveries in Stockholm - Gotland Region, Sweden, 2008-2014. We performed multivariable logistic regression to estimate the association between accelerated fetal growth occurring in the first through early second trimester as measured by ultrasound and LGA and macrosomia at birth. Restricted analyses were performed in the groups without gestational diabetes and with normal body mass index (18.5-24.9 kg/m2).ResultsWhen adjusting for confounders, the odds of having a severely LGA or macrosomic infant were elevated in mothers with fetuses that were at least 7 days larger than expected as compared with mothers without age discrepancy at the second trimester scan (adjusted odds ratio 1.80; 95% confidence interval 1.23-2.64 and adjusted odds ratio 2.15; 95% confidence interval 1.55-2.98, respectively). Additionally, mothers without gestational diabetes and mothers with normal weight had an elevated risk of having a severely LGA or macrosomic infant when the age discrepancy by second trimester ultrasound was at least 7 days.ConclusionsIn a low-risk population, ultrasound-estimated accelerated fetal growth in early pregnancy was associated with an increased risk of having a severely LGA or macrosomic infant.This article is protected by copyright. All rights reserved.
  • Telling the whole story about simulation-based education
    • Abstract: The work of Draycott et al. using simulators to train professionals on obstetric emergencies clearly shows that rigorous simulation-based education improves perinatal outcomes, safety attitudes, and teamwork climate (1). We read “The cost of local, multi-professional obstetric emergencies training” (2) with great interest. In their study, the authors report an annual cost for the obstetric training intervention of up to €148,000. Although this is important information, we are concerned that telling only half the story about simulation-based education may have a paradoxical effect.This article is protected by copyright. All rights reserved.
  • Characterising levator-ani muscle stiffness pre- and post-childbirth in
           European and Polynesian women in New Zealand: a pilot study
    • Abstract: IntroductionThe influence of levator-ani muscles on second stage labour is poorly understood. The ability of these muscles to stretch without damage may affect birth outcomes, but little is known about material properties, effects of pregnancy and/or ethnicity on levator-ani stiffness. There are strong associations between muscle damage and subsequent pelvic floor disorders. This study aimed to quantify levator-ani muscle stiffness during the third trimester of pregnancy and postpartum in European and Polynesian women. Associations between stiffness, obstetric variables, and the risk of intrapartum levator-ani injury (avulsion) were investigated.Materials and methodsThis was a prospective observational pilot study. 167 nulliparous women were recruited antenatally; 106 European and 61 Polynesian, 129 returned postnatally. Participants were assessed between 36 and 38 weeks gestation and 3 to 5 months postpartum. Assessments included pelvic floor ultrasound, elastometry testing, and validated questionnaires on pelvic floor function. Logistic regression, Student t, Chi-squared and Mann-Whitney tests were used as appropriate.ResultsThere are significant differences between antenatal and postnatal muscle stiffness measurements (p 
  • Pregnancy outcome in women with cystic fibrosis related diabetes
    • Abstract: IntroductionWith increasing life expectancy more women with cystic fibrosis and diabetes mellitus become pregnant. We investigated how pre-gestational diabetes (cystic fibrosis related diabetes) influenced pregnancy outcome and the clinical status of these womenMaterial and methodsWe analyzed all pregnancies reported to the French cystic fibrosis registry between 2001 and 2012, and compared forced expiratory volume (FEV1) and body mass index before and after pregnancy in women with and without pre-gestational diabetes having a first deliveryResultsA total 249 women delivered 314 infants. Among these, 189 women had a first delivery and 29 of these had pre-gestational diabetes. There was a trend towards a higher rate of assisted conception among diabetic women (53.8%) as compared to non-diabetic women (34.5%, p=0.06), and the rate of cesarean section was significantly higher in diabetic women (48% versus 21.4%, p=0.005). The rate of preterm birth and mean infant birth weight did not differ significantly between diabetic and non-diabetic women. Before pregnancy forced expiratory volume was significantly lower in the diabetic group. The decline in forced expiratory volume and body mass index following pregnancy did not differ between the women with and without pre-gestational diabetesConclusionPre-gestational diabetes in cystic fibrosis women is associated with a higher rate of cesarean section, but does not seem to have a clinically significant impact on fetal growth or preterm delivery. The changes in maternal pulmonary and nutritional status following pregnancy in cystic fibrosis women were not influenced by pre-gestational diabetes.This article is protected by copyright. All rights reserved.
  • Early insights into Zika's microcephaly physiopathology, from the
           epicentre of the outbreak: teratogenic apoptosis on the central nervous
    • Abstract: Foetal infection by the Zika virus has been implicated in the exceptional rise in the number of mycrocephalic newborns recorded by the end of 2015 in Brazil. The mechanism by which this teratogenic effect is produced in the developing brain has not been entirely established. Very early in the outbreak, we addressed this question by evaluating available initial data from a gestational and post-natal clinical investigation in the Brazilian state of Pernambuco. The present study was undertaken to test the hypothesis that the subtractive dysmorphic brain malformations observed in Zika′s microcephaly are primarily due to the massive induction of apoptosis of neuroprogenitor cells. We have designed a physiopatological algorithm based on the examination of the following medical findings: epidemiological data, ultrasound images, computed tomography scans, placental tissue, cerebral fluid analysis, eye fundoscopy, neurological examination and necroscopic findings.This article is protected by copyright. All rights reserved.
  • Hysterectomy trends in Australia, 2000-01 to 2013-14: Joinpoint regression
    • Abstract: IntroductionHysterectomy is a common gynecological procedure, particularly in middle and high income countries. The aim of this paper was to describe and examine hysterectomy trends in Australia from 2000-01 to 2013-14.Material and MethodsFor women aged 25 years and over, data on the number of hysterectomies performed in Australia annually were sourced from the National Hospital and Morbidity Database. Age-specific and age-standardized hysterectomy rates per 10,000 women were estimated with adjustment for hysterectomy prevalence in the population. Using joinpoint regression analysis, we estimated the average annual percentage change over the whole study period (2000-2014) and the annual percentage change for each identified trend line segment.ResultsA total of 431 162 hysterectomy procedures were performed between 2000-01 and 2013-14; an annual average of 30 797 procedures (for women aged 25+ years). The age-standardized hysterectomy rate, adjusted for underlying hysterectomy prevalence, decreased significantly -3.5%, -2.2%). The trend was not linear with one joinpoint detected in 2008-09. Between 2000-01 and 2008-09 there was a significant decrease in incidence (annual percentage change -4.4% 95% CI: -5.2%, -3.7%) from 2008-09 to 2013-14 the decrease was minimal and not significantly different from zero (annual percentage change -0.1% 95% CI: -1.7%, 1.5%). A similar change in trend was seen in all age groups.ConclusionsHysterectomy rates in Australian women aged 25 years and over have declined in the first decade of the 21st century. However, in the last five years rates appear to have stabilized.This article is protected by copyright. All rights reserved.
  • Delivery parameters, neonatal parameters and incidence of urinary
           incontinence 6 months postpartum: a cohort study
    • Abstract: IntroductionContradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors.Material and methodThis study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. This substudy was based on 7561 primiparous women who were continent before and during pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and 6 months postpartum. Data were linked to the Medical Birth Registry of Norway. Single and combined delivery- and neonatal parameters were analyzed by logistic regression analyses.ResultsBirthweight was associated with significantly higher risk of urinary incontinence 6 months postpartum (3541 – 4180 g; OR 1.4, 95% CI: 1.2-1.6, > 4180 g: OR 1.6, 95% CI: 1.2-2.0). Fetal presentation, obstetric anal sphincter injuries, episiotomy and epidural analgesia were not significantly associated with increased risk of urinary incontinence. The following combinations of risk factors among women delivering by spontaneous vaginal delivery increased the risk of urinary incontinence 6 months postpartum; birthweight ≥ 3540 g and ≥ 36 cm head circumference; birthweight ≥ 3540 g and forceps, birthweight ≥ 3540 g and episiotomy; and ≥ 36 cm head circumference and episiotomy.ConclusionSome combinations of delivery parameters and neonatal parameters seem to act together and may increase the risk of incidence of urinary incontinence 6 months postpartum in a synergetic way.This article is protected by copyright. All rights reserved.
  • Timing surgery for previa-accreta: patient selection based on a priori
           risk factors
    • Abstract: We thank Dr. Matsubara and colleagues(1) for commenting on our study, “Patient selection for later delivery timing with suspected previa-accreta.”(2) We particularly appreciate the emphasis on individualized patient care, and that access (or lack thereof) to a tertiary center with experience in managing abnormally invasive placenta (AIP) is of paramount importance when considering delivery timing.This article is protected by copyright. All rights reserved.
  • Issue Information
  • Impact of changing global political landscape on women′s health
  • ZEB1 expression is a potential indicator of invasive endometriosis
    • Abstract: IntroductionAlthough endometriosis is a benign disease, it shares some features with cancers, such as invasiveness and the potential to metastasize. This study sought to investigate the epithelial-mesenchymal transition (EMT) status in human endometriotic lesions.Material and methodsThirteen endometriosis patients and ten control women without endometriosis undergoing surgery for benign indications were recruited. We examined the expression of E-cadherin, vimentin, and EMT-induced transcriptional factors, such as Snail and ZEB1, by immunohistochemistry. We evaluated the expression of each marker in epithelial cells of both endometriotic lesions (ovarian endometrioma, deep infiltrating endometriosis, adenomyosis) and normal endometria. The correlation between ZEB1 expression and serum level of CA125 was also investigated.ResultsImmunohistochemical analysis revealed that although E-cadherin, vimentin, and Snail were expressed in epithelia of normal endometria and endometriotic lesions, ZEB1 expression was only expressed in epithelia of endometriotic lesions. Additionally, ZEB1 was most frequently observed in epithelial cells of invasive endometriosis. The endometriosis patients with high serum CA125 level were more likely to have ZEB1-positive lesions.ConclusionThis is the first observation of ZEB1 expression in epithelial cells of benign disease. The preferential expression of ZEB1 in epithelial cells of endometriotic lesions suggests that these cells may have, at least in part, higher mesenchymal features possibly via ZEB1-driven EMT than normal endometria and that ZEB1 can be a potential indicator of invasiveness or severity of endometriosis.This article is protected by copyright. All rights reserved.
  • Routine provision of intrauterine contraception at elective cesarean
           section in a national public health service: a service evaluation
    • Abstract: IntroductionWe conducted a prospective health service evaluation to assess the feasibility and acceptability of routinely offering insertion of intrauterine contraception (IUC) at cesarean section in a maternity setting in the UK.Material and methodsOne month before scheduled cesarean section, women were sent information about postpartum contraception including the option of insertion of IUC at cesarean. Women choosing IUC (copper intrauterine device or levonorgestrel intrauterine system) were followed up in person at six weeks; telephone contact was made at three, six and 12 months postpartum. Our main outcome measures were uptake of IUC and complications by six weeks. Secondary outcomes were continuation and satisfaction with IUC at 12 months.Results120/877 women opted to have IUC (13.7%), of which 114 were fitted. By six weeks, there were seven expulsions (6.1%). The expulsion rate by one year was 8.8%. There were been no cases of uterine perforations and one case of infection (0.8%). Follow up rates were 82.5% at 12 months, and continuation rates with IUC at 12 months were 84.8% of those contacted. At 12 months 92.7% of respondents asked were either ‘very’ or ‘fairly’ happy with their IUC.ConclusionsRoutine provision of IUC at elective cesarean for women in a public maternity service is feasible and acceptable to women. It is associated with good uptake and good continuation rates for the first year. This could be an important strategy to increase use of IUC and prevent short inter-pregnancy intervals and unintended pregnancies.This article is protected by copyright. All rights reserved.
  • Vitamin D insufficiency, preterm delivery and preeclampsia in women with
           type 1 diabetes – an observational study
    • Abstract: IntroductionThe aim was to evaluate whether vitamin D insufficiency is associated with preterm delivery and preeclampsia in women with type 1 diabetes.Material and methodsAn observational study of 198 pregnant women with type 1 diabetes. 25-Hydroxy-Vitamin D and HbA1c were measured in blood samples in early (median 8 weeks, range 5-14) and late (34 weeks, 32-36) pregnancy. Kidney involvement (microalbuminuria or nephropathy) at inclusion, smoking status at inclusion, preterm delivery (
  • Tonic immobility during sexual assault – a common reaction predicting
           posttraumatic stress disorder and severe depression
    • Abstract: IntroductionActive resistance is considered to be the “normal” reaction during rape. However, studies have indicated that similar to animals, humans exposed to extreme threat may react with a state of involuntary, temporary motor inhibition known as tonic immobility. The aim of the present study was to assess the occurrence of tonic immobility during rape and subsequent posttraumatic stress disorder and severe depressionMaterial and methodsTonic immobility at the time of the assault was assessed using the Tonic Immobility Scale in 298 women who had visited the Emergency clinic for raped women within 1 month of a sexual assault. Information about the assault and the victim characteristics were taken from the structured clinical data files. After 6 months, 189 women were assessed regarding the development of posttraumatic stress disorder and depressionResultsOf the 298 women, 70% reported significant tonic immobility and 48% reported extreme tonic immobility during the assault. Tonic immobility was associated with the development of posttraumatic stress disorder (OR 2.75; 1.50-5.03, p = .001) and severe depression (OR 3.42; 1.51-7.72, p = .003) at 6 months. Further, prior trauma history (OR 2.36; 1.48-3.77, p
  • Modified posterior pelvic exenteration for advanced ovarian malignancies:
           a single-institution study of 35 cases
    • Abstract: IntroductionThis study aimed to investigate the possible benefits of a complete cytoreduction in patients with advanced ovarian cancer and concomitant rectal invasion. Furthermore, we evaluated the morbidity associated with radical surgery.Material and methodsA retrospective analysis examined 35 cases that underwent radical surgery in the form of modified posterior pelvic exenteration (MPPE). Descriptive statistics, Kaplan-Meier survival curves and Log-Rank test were used for statistical estimations. Surgical complications were analyzed using the Clavien-Dindo classification.ResultsThe analysis of survival in relation to residual disease assessed according to Sugarbaker confirmed an optimistic prognosis in patients with optimal debulking with a mean disease-free survival period of 33.6 months in R0 patients, 19.6 months in R1 patients and 14.3 months in R2 patients. A statistically significant difference in disease-free survival (p = 0.023) was observed between the R0 (without residual disease) and R1+2 (with residual disease) groups. Surgical complications occurred in 83% of patients, with early postoperative complications being most frequent (65.7%). While grade III–IV complications occurred in 37.7% of all patients, no cases of surgery-associated mortality occurred.ConclusionsMPPE is a highly effective method for achieving optimal debulking in cases of advanced ovarian cancer with the direct invasion of the rectum. MPPE does not delay the beginning of complementary chemotherapy. However, it is necessary to take into account surgery-related morbidity. As MPPE represents an extremely invasive technique, the surgical plan and perioperative care should be personalized in order to address the individual medical and surgical conditions of each patient.This article is protected by copyright. All rights reserved.
  • Echographic features and perinatal outcomes in fetuses with congenital
           absence of ductus venosus
    • Abstract: IntroductionThe purpose of this study was to describe the echographic features and perinatal outcomes of fetuses with absence of ductus venosus (ADV)Material and methodsRetrospective review of 10 cases with ADV diagnosed by prenatal ultrasonography between January 2014 and February 2016 at a single referral center. Prenatal findings, umbilical shunting type, perinatal outcomes, and autopsy reports were reviewedResultsA total of 11 491 fetuses underwent a first and second trimester screening during the study period. 10 cases of ADV were diagnosed. All of the cases presented an extrahepatic shunt: three cases from the umbilical vein to the right atrium and the seven remaining cases from the umbilical vein to the inferior vena cava. Major structural defects and fetal effusions were detected in six cases. There were two cases of chromosomal abnormalities. Five patients underwent legal termination of pregnancy and five decided to carry to term. In two of the cases, the ADV anomaly was isolated and had a normal outcome. In the remaining three cases, a follow-up of the children showed a variety of adverse outcomesConclusionsThe ADV is associated with high rates of adverse perinatal outcomes. The prognosis for this group of anomalies depends on the additional findings with targeted ultrasound. This pathology should lead to a detailed anatomical study and be closely monitored for signs of congestive heart failure.This article is protected by copyright. All rights reserved.
  • Pregnancy outcomes after liver transplantation in Finland
    • Abstract: IntroductionPregnancy after liver transplantation (LT) is possible but associated with increased risk of obstetrical complications. We report here for the first time the pregnancy outcomes after LT in FinlandMaterial and methodsAll of the 25 pregnancies ending in deliveries after LT in Finland in 1998-2015 were analyzed. The data were collected from the mothers′ medical records. The main outcome measures included pregnancy complications and the mode of the delivery. Neonatal outcome measures were birth weight, 5 minute Apgar score and umbilical artery pHResultsThere were 26 infants born. Of all deliveries, 76% occurred at the gestational weeks of 37 or more and the average birth weight was 3040g. Apgar scores were 7 or more in 25/26 (96%) of the infants and cases of birth asphyxia (umbilical artery pH ≤7.05) were not detected. Cesarean section rate was 32%. Pre-eclampsia occurred in 12% of the women and the preterm delivery rate was 24%. Co-morbidities (hypertension, intrahepatic cholestasis of pregnancy, Hodgkin′s disease, Colitis ulcerosa, epileptic attacks, cholangitis, splenic artery rupture, renal insufficiency and graft rejection) complicated 52% of pregnanciesConclusionPregnancies after LT in Finland result in good perinatal outcome with healthy, mostly full-term, normally grown off-springs, however, serious maternal complications related to underlying liver pathology, transplant surgery and immunosuppressive medication occur frequently.This article is protected by copyright. All rights reserved.
  • Early gestational age at preeclampsia onset is associated with subclinical
           atherosclerosis 12 years after delivery
    • Abstract: IntroductionWomen with a history of preeclampsia have increased risk of cardiovascular disease later in life. However, it is unclear if early gestational age at preeclampsia onset is associated with higher cardiovascular disease risk. This study aimed to test the association between gestational age at preeclampsia onset (including the early-onset/late-onset preeclampsia distinction) and subclinical atherosclerosis and arterial stiffness in age-matched women 12 years after index pregnancyMaterial and methodsEligible participants were identified in two Danish registries. Main outcome measures were carotid plaque presence, carotid intima-media thickness, aortic pulse wave velocity, and augmentation index adjusted for heart rateResultsTwenty-four women with previous early-onset preeclampsia, 24 with previous late-onset preeclampsia and 24 with previous normotensive pregnancies were included after matching on age (+/- 2 years) and time since delivery (+/- 1 year). In all outcome measures, the early-onset group had the highest percentage or mean value. In the adjusted analysis, the early-onset group significantly differed from the late-onset group in all outcome measures except aortic pulse wave velocity. The early-onset group also had significantly higher carotid intima-media thickness (average and left) compared to the normotensive group. Noteworthy, gestational age at preeclampsia onset as a continuous variable was significantly associated to both carotid plaque presence and carotid intima-media thickness (average and right)ConclusionsGestational age at preeclampsia onset is negatively associated with markers of subclinical atherosclerosis 12 years after delivery. Potentially, gestational age at preeclampsia onset might be helpful in directing cardiovascular disease prevention after preeclampsia.This article is protected by copyright. All rights reserved.
  • Maternal deaths in the Nordic countries
    • Abstract: IntroductionDespite the seriousness of the event, maternal deaths are substantially underreported. There is often a missed opportunity to learn from such tragedies. The aim of the study was to identify maternal deaths in the five Nordic countries, to classify causes of death based on internationally acknowledged criteria, and to identify areas that would benefit from further teaching, training or research to possibly reduce the number of maternal deaths.Material and methodsWe present data for the years 2005-2013. National audit groups collected data by linkage of registers and direct reporting from hospitals. Each case was then assessed to determine the cause of death, and level of care provided. Potential improvements to care were evaluated.ResultsWe registered 168 maternal deaths, 90 direct and 78 indirect cases. The maternal mortality ratio was 7.2/100 000 live births ranging from 6.8-8.1 between the countries. Cardiac disease (n=29) was the most frequent cause of death followed by preeclampsia (n=24), thromboembolism (n=20), and suicide (n=20). Improvements to care which could potentially have made a difference to the outcome were identified in 1/3 of the deaths, i.e. in as many as 60% of preeclamptic, 45% of thromboembolic, and 32% of the deaths from cardiac disease.ConclusionDirect deaths exceeded indirect maternal deaths in the Nordic countries. To reduce maternal deaths increased efforts to better implement existing clinical guidelines seem warranted, particularly for preeclampsia, thromboembolism and cardiac disease. More knowledge is also needed about what contributes to suicidal maternal deaths.This article is protected by copyright. All rights reserved.
  • Textbook of Caesarean Section. Edited by Eric Jauniaux and William A.
           Grobman. 224 pages. Oxford University Press. 2016. ISBN:
           978-0-19-875856-3. 77€
    • Abstract: Cesarean section is the most commonly performed major operation around the world and it has become one of the first major surgical procedures performed independently by residents and trainees in Obstetrics and Gynecology. This first edition of a new textbook of cesarean section, aims to provide an overview of the topic, including history, the technical details of the procedure, and the different techniques currently used around the world. Global epidemiological perspective, complication rates, anesthetic and neonatal implications are also presented.This article is protected by copyright. All rights reserved.
  • Cardiotocography interpretation skills and the association with size of
           maternity unit, years of obstetric work experience and healthcare
           professional background: a national cross-sectional study
    • Abstract: IntroductionWe aimed to examine whether cardiotocography (CTG) knowledge, interpretation skills and decision-making measured by a written assessment were associated with size of maternity unit, years of obstetric work experience and healthcare professional background.Material and methodsA national cross-sectional study in the setting of a CTG teaching intervention involving all 24 maternity units in Denmark. Participants were midwives (n=1260) and specialists (n=269) and residents (n=142) in obstetrics and gynecology who attended a one-day CTG course and answered a 30-item multiple-choice question test. Associations between mean test score and work conditions were analyzed using multivariable robust regression, in which the three variables were mutually adjusted.ResultsParticipants from units with >3000 deliveries/year scored higher on the test than participants from units with 20 years experience: mean difference -0.9, p
  • Diagnostic accuracy of polymerase chain reaction for intrapartum detection
           of group B Streptococcus colonization
    • Abstract: Many pregnant women are treated with antibiotics during labor to prevent transmission of group B Streptococcus (GBS, Streptococcus agalactiae) to their baby during the passage of the birth canal, and thus reducing the risk of serious infection of the newborn. Methods for intrapartum testing for GBS has been introduced to select women for whom intrapartum antibiotic prophylaxis should be offered. For such an intrapartum test to be useful in clinical practice, it has to be specific as well as sensitive. The aim of the present study is to evaluate the accuracy of the polymerase chain reaction (PCR) assay compared to an optimized culture method for GBSMaterial and methodsIn the period from 12.05.2015 to 18.12.2015 we collected rectovaginal swabs on 106 women at the labor ward presenting in labor between gestational week 35+0-36+6 or presenting with prelabor rupture of membranes (PROM/PPROM) for >14 hours after gestational week 34+0. We performed GBS culture (reference standard) and a molecular GBS test (Xpert GBS®, Cepheid Ltd., Sunnyvale, USA)Results Based on intrapartum culture 23.6% (25/106) were colonized with GBS. Intrapartum PCR showed a colonization rate of 25.7% (27/105). The sensitivity of the test was 100% (86,28% -100%). The specificity of the test was 97.5% (91,26%-99,70%). The positive predictive value is 92.6%. In one case, we had no result with PCR testing giving an invalid test rate of less than 1%Conclusions PCR test has sufficient accuracy to direct intrapartum antibiotic prophylaxis for GBS transmission during delivery.This article is protected by copyright. All rights reserved.
  • Effects of an antenatal lifestyle intervention on offspring obesity – a
           five year follow-up of a randomised controlled trial
    • Abstract: IntroductionStrategies to limit excessive maternal gestational weight gain could also have positive health effects for the offspring. This study informs us on the effect of an antenatal lifestyle intervention on offspring body mass index (BMI) trajectory until age fiveMaterial and methodsA secondary analysis of a randomized controlled trial aimed at reducing gestational weight gain, set in Ørebro, Sweden.Offspring were followed with standardised measures of weight and height until age five. Mean BMI z-score and proportion (%) of over- and undernutrition (BMI z-score >+2 standard deviation) was compared between groups. Risk estimates for obesity at age five were analysed in relation to maternal gestational weight gain and prepregnancy BMI as a secondary outcomeResultsWe analysed 374 children at birth and 300 at age five. No significant difference in mean BMI z-score was seen at birth (0.68 (I) vs 0.56 (C), p=0.242) or at age five (0.34 (I) vs 0.26 (C), p=0.510) and no significant difference in proportion of over- or undernutrition was seen. Excessive maternal gestational weight gain was an independent risk factor for offspring obesity at birth (OR=4.51, p
  • Risk of labor dystocia increases with maternal age irrespective of parity:
           a population-based register study
    • Abstract: IntroductionAdvanced maternal age is associated with labor dystocia (LD) in nulliparous women. This study investigates the age-related risk of LD in first, second and third birthsMaterial and methodsAll live singleton cephalic births at term (≥37 gestational weeks) recorded in the Swedish Medical Birth Register from1999 to 2011, except elective cesarean sections and fourth births and more, in total 998 675 pregnancies, were included in the study. LD was defined by ICD10 codes (O620, O621, O622, O629, O630, O631, and O639). In each parity group risks of LD at age 25-29 years, 30-34 years, 35-39 years and ≥40 years compared with age
  • Timing of surgery for placenta previa with suspected abnormally invasive
           placentation: A test of team competency'
    • Abstract: For patients with placenta previa (PP) with a suspected abnormally invasive placenta (AIP), “the higher the ‘concern’ for preterm delivery and severity of AIP, the earlier the surgery date” may be better. Perlman et al. (1) showed that “scheduled surgery” at ≥36 weeks was possible for many patients. The incidence of massive bleeding did not differ among 34, 35 vs. ≥36 weeks. They concluded “patients with ‘no concern’ for percreta/increta or no prior cesarean section (and no preterm-delivery risk) may be candidates for later delivery”. Thus, later (≥36 weeks) delivery was permitted in some cases, with which we agree.This article is protected by copyright. All rights reserved.
  • Placenta, cord and membranes: A dual center validation study of
           midwives’ classifications and notifications to the Medical Birth
           Registry of Norway
    • Abstract: IntroductionA validation of data regarding the placenta, cord and membranes in Medical Birth Registry of Norway (MBRN) is lacking. Here we investigate the inter- and intra-observer agreement of observations regarding the placenta, cord and membranes to the MBRN in two institutionsMaterial and methodsWe conducted a dual center validation study of data regarding placenta, cord and membranes. In the inter-observer study, 196 placentas in two institutions were examined by the attending midwife and a blinded colleague, whereas in the intra-observer study registrations by the attending midwife on 195 placentas were compared with her own registrations the MBRN. In a separate sample consisting of n=51 placental pathology reports, midwives’ registrations to the MBRN were compared with the pathology report. For categorical and continuous variables agreement was assessed by kappa value and paired sample t-test, respectivelyResultsInter-observer agreement between two midwives for cord insertion site and bi-placenta, cord knots and vessel anomalies were good (kappa values >0.79 and >0.96, respectively). The inter- and intra-observer study showed no significant differences regarding placental weight and cord length (p-value 0.31 and 0.28 and p-value 0.71 and 0.39, respectively). The inter-observer agreement between the pathology reports and midwives’ registrations was good for gross placental and cord variants (kappa 0.73 -1.0), but there were significant differences in placental weight and cord length (p-value
  • Mode of first delivery and severe maternal complications in the subsequent
    • Abstract: IntroductionSevere obstetric complications increase by the number of previous cesarean deliveries. In the Nordic countries most women have two children. We present the risk of severe obstetric complications at the delivery following a first elective or emergency cesarean and the risk by intended mode of second delivery.Material and methodA two-year population-based data-collection of severe maternal complications in women with two deliveries in the Nordic countries (n=213 518). Denominators were retrieved from the national medical birth registers.ResultsOut of 35 450 first cesarean deliveries (17%), 75% were emergency and 25% elective. Severe complications at second delivery were more frequent in women with a first cesarean than a first vaginal delivery and rates of abnormally invasive placenta, uterine rupture and severe postpartum hemorrhage were higher after a first elective than a first emergency cesarean delivery (RR 4.1 CI; 2.0-8.1, RR 1.8 CI; 1.3-2.5, RR 2.3 CI; 1.5-3.5). A first cesarean accounted for up to 97% of the severe complications in the second pregnancy. Induction of labor was associated with an increased risk of uterine rupture and severe hemorrhage.ConclusionElective repeat cesarean nearly prevents complete uterine rupture at the second delivery, while the risk of severe obstetric hemorrhage, abnormally invasive placenta and peripartum hysterectomy is unchanged by the intended mode of second delivery in women with a first cesarean. Women with a first elective versus emergency cesarean have increased risk of severe complications in the second pregnancy.This article is protected by copyright. All rights reserved.
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