The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study.
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ABSTRACT:
SUBMITTER: Wang L
PROVIDER: S-EPMC7542423 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
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The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study.
Wang Li L Wang Hongxia H Jia Lu L Qing Wenjie W Li Fan F Zhou Jie J
BMC pregnancy and childbirth 20201007 1
<h4>Background</h4>The correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women.<h4>Methods</h4>A retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they we ...[more]
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Project description:BackgroundThere is an increasing prevalence of women who tend to delay childbirth until a very advanced age. However, there is sparse data regarding very advanced maternal age (vAMA) and the interplay between vAMA and assisted reproductive technology (ART) on adverse perinatal outcomes. The study aimed to assess the risk of adverse maternal and neonatal outcomes of vAMA women (≥43 years), and to investigate the effect of maternal age on adverse maternal and neonatal outcomes in ART pregnancies.MethodsData was obtained from a population-based retrospective cohort of women who delivered in Ontario, Canada, between April 1st, 2012 and March 31st, 2015. The adjusted relative risks (ARR) and 95% confidence intervals (CI) for adverse maternal and neonatal outcomes were estimated by using multivariate log-binomial regression models among age groups. All models were stratified by the utilization of ART (ART and spontaneous conceptions).ResultsWomen at vAMA had a higher risk of composite outcome comprised of preeclampsia, intrauterine growth retardation, stillbirth, and placental abruption than the younger counterparts (ARR = 1.38, 95% CI: 1.23-1.55 compared to mothers aged 20-34; ARR = 1.26, 95% CI: 1.12-1.42 compared to mothers aged 35-42). Increased risk of the primary outcome in ART compared to spontaneous conception was only observed in women aged 20-34 years (ARR = 1.24, 95% CI: 1.14-1.35). For women conceived with ART, the risk for the primary outcome significantly increased in women at vAMA (ARR = 1.29, 95% CI: 1.01-1.65 compared to mothers aged 20-34; ARR = 1.36, 95% CI: 1.06-1.74 compared to mothers aged 35-42).ConclusionWomen at vAMA have higher risks of adverse maternal and neonatal outcomes. Although the utilization of ART may carry an independent role for adverse perinatal outcomes, it does not further enhance the adverse effect of vAMA.
| S-EPMC6318893 | biostudies-literature
Project description:ObjectiveTo estimate whether the frequency of adverse maternal and neonatal outcomes differs between low-risk nulliparous and multiparous women at 39-41 weeks of gestation.MethodsThis is a secondary analysis of an observational obstetrics cohort of maternal-neonatal dyads at 25 hospitals. Low-risk women with nonanomalous singletons who delivered between 39 0/7 and 41 6/7 weeks of gestation were included. The composite neonatal adverse outcome included 5-minute Apgar score less than five, ventilator support or cardiopulmonary resuscitation, seizure, hypoxic ischemic encephalopathy, sepsis, bronchopulmonary dysplasia, persistent pulmonary hypertension, necrotizing enterocolitis, birth injury or perinatal death. The composite maternal adverse outcome included infection, third- or fourth-degree perineal laceration, thromboembolism, transfusion of blood products, or maternal death. Small for gestational age (SGA), large for gestational age (LGA), and shoulder dystocia requiring maneuvers were also evaluated. Multivariable regression was used to estimate adjusted relative risks (aRRs) and adjusted odds ratios (aORs) with 95% CIs.ResultsOf the 115,502 women in the overall cohort, 39,870 (34.5%) met eligibility criteria for this analysis; 18,245 (45.8%) were nulliparous. The risk of the composite neonatal adverse outcome (1.5% vs 1.0%, aRR 1.80, 95% CI 1.48-2.19), composite maternal adverse outcome (15.1% vs 3.3%, aRR 5.04, 95% CI 4.62-5.49), and SGA (8.9% vs 5.8%, aOR 1.45, 95% CI 1.33-1.57) was significantly higher in nulliparous than multiparous patients. The risk of LGA (aOR 0.65, 95% CI 0.60-0.71) and shoulder dystocia with maneuvers (aRR 0.68, 95% CI 0.60-0.77) was significantly lower in nulliparous rather than multiparous patients.ConclusionThe risk of composite adverse outcomes and SGA among low-risk nulliparous women at 39-41 weeks of gestation is significantly higher than among multiparous counterparts. However, nulliparous women had a lower risk of shoulder dystocia with maneuvers and LGA.
| S-EPMC7483669 | biostudies-literature
Project description:ObjectiveTo assess neonatal and maternal outcomes when the second stage of labor was prolonged according to American College of Obstetricians and Gynecologists guidelines.MethodsElectronic medical record data from a retrospective cohort (2002-2008) from 12 U.S. clinical centers (19 hospitals), including 43,810 nulliparous and 59,605 multiparous singleton deliveries at 36 weeks of gestation or greater, vertex presentation, who reached 10-cm cervical dilation were analyzed. Prolonged second stage was defined as: nulliparous women with epidural greater than 3 hours and without greater than 2 hours and multiparous women with epidural greater than 2 hours and without greater than 1 hour. Maternal and neonatal outcomes were compared and adjusted odds ratios calculated controlling for maternal race, body mass index, insurance, and region.ResultsProlonged second stage occurred in 9.9% and 13.9% of nulliparous and 3.1% and 5.9% of multiparous women with and without an epidural, respectively. Vaginal delivery rates with prolonged second stage compared with within guidelines were 79.9% compared with 97.9% and 87.0% compared with 99.4% for nulliparous women with and without epidural, respectively, and 88.7% compared with 99.7% and 96.2% compared with 99.9% for multiparous women with and without epidural, respectively (P<.001 for all comparisons). Prolonged second stage was associated with increased chorioamnionitis and third-degree or fourth-degree perineal lacerations. Neonatal morbidity with prolonged second stage included sepsis in nulliparous women (with epidural: 2.6% compared with 1.2% [adjusted odds ratio (OR) 2.08, 95% confidence interval (CI) 1.60-2.70]; without epidural: 1.8% compared with 1.1% [adjusted OR 2.34, 95% CI 1.28-4.27]); asphyxia in nulliparous women with epidural (0.3% compared with 0.1% [adjusted OR 2.39, 95% CI 1.22-4.66]) and perinatal mortality without epidural (0.18% compared with 0.04% for nulliparous women [adjusted OR 5.92, 95% CI 1.43-24.51]); and 0.21% compared with 0.03% for multiparous women (adjusted OR 6.34, 95% CI 1.32-30.34). However, among the offspring of women with epidurals whose second stage was prolonged (3,533 nulliparous and 1,348 multiparous women), there were no cases of hypoxic-ischemic encephalopathy or perinatal death.ConclusionsBenefits of increased vaginal delivery should be weighed against potential small increases in maternal and neonatal risks with prolonged second stage.Level of evidence: II.
| S-EPMC4065200 | biostudies-literature
Project description:ObjectiveThe associations between duration of second stage of labor, pushing time and risk of adverse neonatal outcomes are not fully established. Therefore, we aimed to examine such relationships.Study designA population-based cohort study including 42 539 nulliparous women with singleton infants born in cephalic presentation at ⩾37 gestational weeks, using the Stockholm-Gotland Obstetric Cohort, Sweden, and the Swedish Neonatal Quality Register, 2008 to 2013. Poisson regression was used to analyze estimated adjusted relative risks (RRs), with 95% confidence intervals (CIs). Outcome measures were umbilical artery acidosis (pH <7.05 and base excess <-12), birth asphyxia-related complications (including any of the following conditions: hypoxic ischemic encephalopathy, hypothermia treatment, neonatal seizures, meconium aspiration syndrome or advanced resuscitation after birth) and admission to neonatal intensive care unit (NICU).ResultsOverall rates of umbilical artery acidosis, birth asphyxia-related complications and admission to NICU were 1.08, 0.63 and 6.42%, respectively. Rate of birth asphyxia-related complications gradually increased with duration of second stage: from 0.42% at <1 h to 1.29% at ≥4 h (adjusted RR 2.46 (95% CI 1.66 to 3.66)). For admission to NICU, corresponding rates were 4.97 and 9.45%, and adjusted RR (95% CI) was 1.80 (95% CI 1.58 to 2.04). Compared with duration of pushing <15 min, a duration of pushing ⩾60 min increased rates of acidosis from 0.57 to 1.69% (adjusted RR 2.55 (95% CI 1.51 to 4.30)).ConclusionProlonged durations of second stage of labor and pushing are associated with increased RRs of adverse neonatal outcomes. Clinical assessment of fetal well-being is essential when durations of second stage and pushing increases.
| S-EPMC5339416 | biostudies-literature
Project description:BackgroundThis study aimed to investigate the effect of maternal age and duration of labor on perinatal and neonatal outcomes. The results of this study are expected to provide a basis to aid maternal and child health care personnel to implement health education for late childbearing women.MethodsThis was a retrospective observational study, wherein 9,241 parturients were included from 2016 to 2018. Parturients were divided into three groups based on age: <28 (n=2,911), 28-30 (n=3,631), and >30 (n=2,699) years. According to the total duration of labor, those who did not undergo cesarean section (CS) were subgrouped into <420 minutes (n=4,065) and ≥420 minutes (n=4,094) groups. A multivariate logistic regression model was used to investigate associations between age/total duration of labor group factors to different postpartum outcomes, including a switch to emergency CS, puerperal morbidity, abnormal fetal heart rate, and meconium-stained amniotic fluid (MSAF).ResultsThe rates of postpartum outcomes significantly differed in maternal age groups, including switch to emergency CS (9.07% vs. 13.03% vs. 11.23%; P<0.001), puerperal morbidity (6.32% vs. 6.46% vs. 5.00%; P=0.035), and abnormal fetal heart rate (25.34% vs. 28.21% vs. 25.67%; P=0.017). Of the comparisons between labor time groups, it was found that participants with longer labor time were also significantly higher in the use of episiotomy/forceps (46.61% vs. 69.77%; P<0.001), bleeding amount (381.35±108.02 vs. 389.60±146.40 mL; P=0.004), oxytocin use (25.03% vs. 39.56%; P<0.001), puerperal morbidity (1.98% vs. 6.86%; P<0.001), abnormal fetal heart rate (20.07% vs. 25.15%; P<0.001), and MSAF (26.53% vs. 31.91%; P<0.001). Multivariate logistic regression analysis showed that as age increased, the ORs of switching to emergency CS (1.58 and 1.87, both P<0.001) and having abnormal fetal heart rate (1.20 and 1.38; both P<0.01) also increased. Participants with longer labor time groups the ORs of puerperal morbidity (2.33; P<0.001) and MSAF (1.13; P=0.023) also increased.ConclusionsWith the adjustment of covariates. Higher maternal age seems associated to the risk of switching to emergency CS and having abnormal fetal heart rate; longer total duration of labor seems associated to the risk of puerperal morbidity and MSAF.
| S-EPMC9652538 | biostudies-literature
Project description:ObjectiveThe aim of the study is to evaluate the association between amniotomy at various time points during labor induction and maternal and neonatal outcomes among term, nulliparous women.Study designSecondary analysis of a randomized trial of term labor induction versus expectant management in low-risk, nulliparous women (2014-2017) was conducted. Women met inclusion criteria if they underwent induction ≥38 weeks' gestation using oxytocin with documented time and type of membrane rupture. Women with antepartum stillbirth or fetal anomaly were excluded. The primary outcome was cesarean delivery. Secondary outcomes included maternal and neonatal complications. Maternal and neonatal outcomes were compared among women with amniotomy versus women with intact membranes and no amniotomy at six 2-hour time intervals: before oxytocin initiation, 0 to <2 hours after oxytocin, 2 to <4 hours after, 4 to <6 hours after, 6 to <8 hours after, and 8 to <10 hours after. Multivariable logistic regression adjusted for maternal age, body mass index, race/ethnicity, modified Bishop score on admission, treatment group, and hospital (as a random effect).ResultsOf 6,106 women in the parent trial, 2,854 (46.7%) women met inclusion criteria. Of these 2,340 (82.0%) underwent amniotomy, and majority of the women had amniotomy performed between 2 and <6 hours after oxytocin. Cesarean delivery was less frequent among women with amniotomy 6 to <8 hours after oxytocin compared with women without amniotomy (21.9 vs. 29.7%; adjusted odds ratio 0.61, 95% confidence interval 0.42-0.89). Amniotomy at time intervals ≥4 hours after oxytocin was associated with lower odds of labor duration >24 hours. Amniotomy at time intervals ≥2 hours and <8 hours after oxytocin was associated with lower odds of maternal hospitalization >3 days. Amniotomy was not associated with postpartum or neonatal complications.ConclusionAmong a contemporary cohort of nulliparous women undergoing term labor induction, amniotomy was associated with either lower or similar odds of cesarean delivery and other adverse outcomes, compared with no amniotomy.
| S-EPMC7572589 | biostudies-literature
Project description:PurposeTo evaluate the relationship between maternal left ventricular systolic function, utero-placental circulation, and risk of adverse neonatal outcomes in women with cardiac disease.Methods119 women managed in the pregnancy heart clinic (2019-2021) were identified. Women were classified by their primary cardiac condition. Adverse neonatal outcomes were: low birth weight (< 2500 g), small-for-gestational-age (< 10th birth-weight centile), pre-term delivery (< 37 weeks' gestation), and fetal demise (> 20 weeks' gestation). Parameters of left ventricular systolic function (global longitudinal strain, radial strain, ejection fraction, average S', and cardiac output) were calculated and pulsatility index was recorded from last growth scan.ResultsAdverse neonatal outcomes occurred in 28 neonates (24%); most frequently in valvular heart disease (n = 8) and cardiomyopathy (n = 7). Small-for-gestational-age neonates were most common in women with cardiomyopathy (p = 0.016). Early pregnancy average S' (p = 0.03), late pregnancy average S' (p = 0.02), and late pregnancy cardiac output (p = 0.008) were significantly lower in women with adverse neonatal outcomes than in those with healthy neonates. There was a significant association between neonatal birth-weight centile and global longitudinal strain (p = 0.04) and cardiac output (p = 0.0002) in late pregnancy. Pulsatility index was highest in women with cardiomyopathy (p = 0.007), and correlated with average S' (p < 0.0001) and global longitudinal strain (p = 0.03) in late pregnancy.ConclusionWomen with cardiac disease may not tolerate cardiovascular adaptations required during pregnancy to support fetal growth. Adverse neonatal outcomes were associated with reduced left ventricular systolic function and higher pulsatility index. The association between impaired systolic function and reduced fetal growth is supported by insufficient utero-placental circulation.
| S-EPMC10110658 | biostudies-literature
Project description:BackgroundLabor that progresses faster than anticipated may lead to unplanned out-of-hospital births. With the aim to improve planning of transportation to birthing institutions, this study investigated predictors of time to completion for the first stage of labor conditional on cervical opening (conditional time) in multiparous women at term.MethodsWe performed a retrospective analysis of partograms for women in Robson's group 3 who delivered at one hospital from 2003 to 2013. A generalized additive mixed model was fitted, accounting for possible non-linear relationships between the predictor variables and outcome, e.g. the time from each cervical measurement to full dilation, using multiple measurements for each woman. The following predictors were included: cervical dilation (cm), parity (1, 2, or ≥3 previous vaginal births), oxytocin infusion (no/yes), epidural (no/yes), maternal age (years), maternal height (cm), body mass index (BMI, kg/m2), birthweight (kg), spontaneous rupture of membranes (no/yes). A modified regression model with gestational age (days) instead of birthweight was used to predict conditional time to full cervical dilation for combinations of the most relevant predictors.ResultsA total of 1753 partograms were included in the analysis. The strongest predictors were birthweight, epidural and oxytocin use, and spontaneous rupture of membranes, along with cervical measurements. For birthweight, there was an almost 40% increase in time to full cervical dilation for each 1-kg increment. Conditional time was on average 23% longer in cases with epidural use and 53% longer in cases requiring oxytocin augmentation. Spontaneous rupture of the membranes shortened conditional time by 31%. Maternal age was not associated with the outcome, while increasing BMI and parity modestly reduced conditional time.ConclusionsHigher parity, lower fetal weight (gestational age), and spontaneous rupture of the membranes are associated with more rapid labor.
| S-EPMC5469060 | biostudies-literature
Project description:The mechanistic basis of the proposed relationship between maternal cardiac output and neonatal complications in pregnant women with heart disease has not been well elucidated.Pregnant women with cardiac disease and healthy pregnant women (controls) were prospectively followed with maternal echocardiography and obstetrical ultrasound scans at baseline, third trimester, and postpartum. Fetal/neonatal complications (death, small-for-gestational-age or low birthweight, prematurity, respiratory distress syndrome, or intraventricular hemorrhage) comprised the primary study outcome. One hundred and twenty-seven women with cardiac disease and 45 healthy controls were enrolled. Neonatal events occurred in 28 pregnancies and were more frequent in the heart disease group as compared with controls (n=26/127 or 21% versus n=2/45 or 4%; P=0.01). Multiple complications in an infant were counted as a single outcome event. Neonatal complications in the heart disease group were small-for-gestational-age/low birthweight (n=18), prematurity (n=14), and intraventricular hemorrhage/respiratory distress syndrome (n=5). Preexisting obstetric risk factors (P=0.003), maternal cardiac output decline from baseline to third trimester (P=0.017), and third trimester umbilical artery Doppler abnormalities (P<0.001) independently predicted neonatal complications and were incorporated into a novel risk index in which 0, 1, and >1 predictor corresponded to expected complication rates of 5%, 30%, and 76%, respectively.Decline in maternal cardiac output during pregnancy and abnormal umbilical artery Doppler flows independently predict neonatal complications. These findings will enhance the identification of higher risk pregnancies that would benefit from close antenatal surveillance.
| S-EPMC4845210 | biostudies-other
Project description:BACKGROUND:The safety of methods of labor induction in women with previous cesarean deliveries is still debated. We investigated perinatal outcomes associated with labor induction among women with a trial of labor after one cesarean delivery. METHODS:This retrospective study included 339 women with a trial of labor after one prior cesarean and a singleton term fetus in cephalic presentation in 2013-2016 in a French maternity unit. Labor induction was performed with oxytocin, artificial rupture of membranes and/or prostaglandin E2, according to the Bishop score. The primary outcome was a composite of uterine rupture, low Apgar score, neonatal resuscitation or admission to a neonatal unit. The secondary outcomes included cesarean delivery after onset of labor, postpartum hemorrhage and maternal hospital stay after delivery. We used logistic regression to estimate odds ratios adjusted (aOR) for potential confounders. RESULTS:In our sample, 67.3% of women had spontaneous labor and 32.7% were induced. More than half of the women received oxytocin during labor regardless of the mode of labor. The proportions of the composite outcome and of cesarean after onset of labor were higher in the induced group compared to the spontaneous group (26.1% vs 15.8%, p = 0.02 and 45.0% vs 27.6%, p<0.01, respectively). There were 9 uterine ruptures (2.6%) and this proportion was higher in the induced group compared to the spontaneous group, although this difference was not statistically significant (3.6% vs 2.2%, p = 0.48). After adjustment, labor induction was associated with higher risks of the composite outcome (aOR = 2.45, 95% CI: 1.29-4.65), cesarean after onset of labor (aOR = 2.06, 95% CI: 1.15-3.68) and maternal hospital stay after delivery ?6 days (aOR = 6.20, 95% CI: 3.25-11.81). No association was found with postpartum hemorrhage. CONCLUSION:Labor induction after one prior cesarean was associated with a higher risk of adverse perinatal outcome. Nevertheless, the higher proportion of uterine rupture did not differ significantly from that in the spontaneous labor group.
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