Abnormal glucose challenge test in absence of oral glucose tolerance test – are there consequences?

This is a retrospective analysis of mothers with abnormal 1-hour, 50-grams glucose challenge test (GCT) who did not take a 3-hour, 100-gram oral glucose tolerance test (OGTT). This study group of women was compared to three control groups, based on an OGTT diagnostic test- normal OGTT, single pathological value and gestational diabetes mellitus. Overall- 4,185 women were included and sub-divided accordingly into four groups: Group A-340 (8.12%)- no OGTT; Group B-2,585 (61.77%)- Norm OGTT (All values normal); Group C- 564 (13.48%)- SinOGTT (single pathological value) and Group D- 696 (16.63%)- Gestational Diabetes Mellitus (GDM, ≥ 2 pathological values). Groups A, C and D had higher rates of intrapartum Caesarean Delivery (10.29%, 11.52% and 10.19% vs. 8.43%, p < .0001). Group A had highest rates of neonatal adverse outcomes, as neonatal intensive care unit (NICU) admission (12.4% vs. 8.4%, 11.0% and 10.0%, p = .039), small for gestational age (SGA) neonates (7.0% vs. 5.3%, 3.7% and 6.0%, p = .0092) and neonatal hypoglycaemia (3.5% vs. 1.3%, 3.2% and 2.9%, p = .007). A multivariable regression revealed that having an abnormal GCT without an OGTT was an independent risk factor for neonatal intensive care unit admission, neonatal hypoglycaemia and intrapartum caesarean delivery. We concluded that women with pathological GCT who did not complete OGTT have higher rates of obstetric adverse outcomes. They should be closely monitored during delivery and should not be overlooked.IMPACT STATEMENT What is already known on this subject? Adverse outcomes of gestational diabetes mellitus are well established. But, the group of women who fail to complete a confirmatory OGTT following a pathological GCT is not well described. What the results of this study add? Our results point out that women who fail to complete an OGTT, suffer from higher rates of obstetric complications, presumably attributed to disrupted glucose values, but also to poor prenatal care. What the implications are of these findings for clinical practice and/or further research? These women should not be overlooked. They should be closely monitored during labour and delivery

Risk of caesarean delivery after induction of labour stratified by foetal sex

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

Indications for Emergency Intervention, Mode of Delivery, and the Childbirth Experience.

Although the impact of emergency procedures on the childbirth experience has been studied extensively, a possible association of childbirth experience with indications for emergency interventions has not been reported.To compare the impacts on childbirth experience of 'planned' delivery (elective cesarean section and vaginal delivery) versus 'unplanned' delivery (vacuum extraction or emergency cesarean section); the intervention itself (vacuum extraction versus emergency cesarean section); and indications for intervention (arrest of labor versus risk to the mother or fetus).A total of 469 women, up to 72 hours post-partum, in the maternity ward of one tertiary health care institute completed the Subjective Childbirth Experience Questionnaire (score: 0-4, a higher score indicated a more negative experience) and a Personal Information Questionnaire. Intra-partum information was retrieved from the medical records. One-way analysis of variance and two-way analysis of variance, followed by analysis of covariance, to test the unique contribution of variables, were used to examine differences between groups in outcome. Tukey's Post-Hoc analysis was used when appropriate.Planned delivery, either vaginal or elective cesarean section, was associated with a more positive experience than unplanned delivery, either vacuum or emergency cesarean section (mean respective Subjective Childbirth Experience scores: 1.58 and 1.49 vs. 2.02 and 2.07, P <0.01). The difference in mean Subjective Childbirth Experience scores following elective cesarean section and vaginal delivery was not significant; nor was the difference following vacuum extraction and emergency cesarean section. Interventions due to immediate risk to mother or fetus resulted in a more positive birth experience than interventions due to arrest of labor (Subjective Childbirth Experience: 1.9 vs. 2.2, P <0.01).Compared to planned interventions, unplanned interventions were shown to be associated with a more negative maternal childbirth experience. However, the indication for unplanned intervention appears to have a greater effect than the nature of the intervention on the birth experience. Women who underwent emergency interventions due to delay of birth (arrest of labor) perceived their birth experience more negatively than those who underwent interventions due to risk for the mother or fetus, regardless of the nature of the intervention (vacuum or emergency cesarean section). The results indicate the importance of follow-up after unexpected emergency interventions, especially following arrest of labor, as negative birth experience may have repercussions in a woman's psychosocial life and well-being

The associations between insecure attachment, rooming‐in, and postpartum depression: A 2 months’ longitudinal study

Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming‐in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming‐in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1–4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming‐in conditions. In addition, women in partial rooming‐in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming‐in women. A situational factor such as full rooming‐in, which occurs at a critical time point for the mother–infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother’s PPD levels. Postpartum practices, such as rooming‐in, can be personalized and thus beneficial in moderating personal risk factors for PPD.RESUMENLa depresión posterior al parto (PPD) es la complicación más común de dar a luz y estudios recientes han intentado examinar los factores de riesgo asociados con el parto. La hipótesis del principal estudio fue que un factor situacional de protección en un período temporal sensible (permitirle a la madre mantener a su bebé con ella en el mismo cuarto después del parto) moderaría las asociaciones entre las dimensiones de afectividad insegura y PPD. Trescientas doce mujeres, en situación completa o parcial de tener a su bebé en el mismo cuarto, participaron en un estudio longitudinal en la sala de partos de un centro terciario de cuidado de salud. Del primer al cuarto día después del parto, se administró un cuestionario demográfico y la Escala de Experiencias en Relaciones Cercanas; la Escala de Edimburgo de Depresión Postnatal se administró a los dos meses posteriores al parto. Significativamente se asoció la PPD tanto con las dimensiones de afectividad de tipo ansiosas como las evasivas, pero no con las condiciones de compartir el mismo cuarto. Adicionalmente, las mujeres en situaciones parciales de compartir el mismo cuarto mostraron una correlación positiva entre las dimensiones de afectividad insegura y PPD, mientras que tal correlación no se encontró en el caso de las mujeres en situaciones de compartir el cuarto completamente. Un factor situacional tal como el compartir el cuarto completamente, lo cual ocurre en un punto temporal crítico para la relación madre‐infante, puede moderar la asociación entre las dimensiones de afectividad maternas evasivas o ansiosas y los niveles de PPD de la madre. Las prácticas del período posterior al parto, tales como el compartir el cuarto, pueden ser personalizadas y por tanto beneficiosas en cuanto a moderar los factores personales de riesgo de PPD.RÉSUMÉLa dépression postpartum (DPP) est la complication la plus commune de la maternité et les études récentes ont essayé d’examiner les facteurs de risque qui y sont liés. L’hypothèse principale de cette étude était qu’un facteur protecteur situationnel à une période sensible (rooming‐in total postpartum) modérerait les liens entre les dimensions d’attachement insécure et la DPP. Trois cent douze femmes, soit en rooming‐in partiel ou total, ont participé à une étude longitudinale à la maternité d’un centre de santé tertiaire. Un questionnaire démographique et l’Echelle d’Expériences dans les Relations Proches ont été donnés à 1–4 jours postpartum, l’Echelle de Dépression Postnatale d’Edinbourg à deux mois postpartum. La DPP a été liée de manière importante à des dimensions d’attachement à la fois anxieux et évitant, mais pas avec les conditions de rooming‐in. De plus, les femmes en rooming‐in partiel ont fait preuve d’une corrélation positive entre les dimensions de l’attachement insécure et la DPP, alors qu’aucune corrélation n’a été trouvée pour les femmes du groupe rooming‐in. Un facteur situationnel telle que le rooming‐in total, qui se passe à un moment critique pour la relation mère‐bébé, peut modérer le lien entre les dimensions d’attachement évitant maternel et de l’attachement anxieux et les niveaux de DPP de la mère. Les pratiques postpartum, tel que le rooming‐in, peuvent être personnalisées et donc s’avérer être un bénéfice pour la modération de facteurs de risque personnel pour la DPP.ZUSAMMENFASSUNGDie Zusammenhänge zwischen unsicherer Bindung, Rooming‐in und postpartaler Depression: Eine zweimonatige LängsschnittstudiePostpartale Depression (PPD) ist die häufigste Komplikation, die im Zusammenhang mit Geburten von Kindern auftritt. Neuere Studien haben versucht, die damit verbundenen Risikofaktoren zu untersuchen. Die Hypothese der Hauptstudie war, dass ein protektiver Situationsfaktor innerhalb eines kritischen Zeitraums (vollständiges Rooming‐in, d.h. die Möglichkeit, das Neugeborene nach der Geburt im Zimmer zu haben) den Zusammenhang zwischen unsicheren Bindungsdimensionen und PPD abschwächen kann. 312 Frauen, mit einem entweder vollständigen oder teilweisen Rooming‐in, nahmen an einer Längsschnittstudie auf der Entbindungsstation eines tertiären Gesundheitszentrums teil. Ein bis vier Tage nach der Geburt wurde ein demografischer Fragebogen und die Skala für Erfahrungen in engen Beziehungen ausgeteilt. 2 Monate nach der Geburt erfolgte eine Befragung mit der Edinburgh Skala für postnatale Depression. PPD war sowohl mit ängstlichen als auch mit vermeidenden Bindungsdimensionen signifikant assoziiert, jedoch nicht mit Bedingungen des Rooming‐ins. Frauen mit teilweisem Rooming‐in zeigten eine positive Korrelation zwischen unsicheren Bindungsdimensionen und PPD, während für Frauen mit vollständigem Rooming‐in keine solche Korrelation gefunden wurde. Ein Situationsfaktor wie das vollständige Rooming‐in, der zu einem kritischen Zeitpunkt für die Mutter‐Kind‐Beziehung auftritt, kann den Zusammenhang zwischen mütterlichen vermeidenden oder ängstlichen Bindungsdimensionen und den PPD‐Werten der Mutter abschwächen. Postpartale Praktiken wie das Rooming‐In können personalisiert werden und somit zur Minderung persönlicher PPD‐Risikofaktoren beitragen.抄録不安定型アタッチメント、母子同室、産後うつ病の間の関連性:2ヶ月の縦断研 究産後うつ病(PPD)は、出産によって起こる最も一般的な合併症で、最近では、そ れに関連した危険因子を探究しようと試みている研究が複数ある。本研究の主な 仮説は、繊細な時期での1つの予防的状況要因 (産後の完全母子同室) は、不安 定型アタッチメントとPPD間の関連性を抑えるのではないかということである。 完全あるいは一部母子同室の312人の女性が、三次保健センターの産科病棟での 縦断研究に参加した。人口統計学的質問紙と成人アタッチメントスタイル尺度( ECR)を産後1～4日に行い、エジンバラ産後うつ病質問票を産後2か月に行なった。 PPDは、 不安型アタッチメントと回避型アタッチメントの両方と有意に関連があ ったが、母子同室の状況とは関連がなかった。さらに、一部母子同室の女性は、 不安定型アタッチメントとPPD間に正の相関がみられた。一方、完全母子同室の 女性にはそのような相関は見られなかった。母子関係にとって重要な時点で起こ る、完全母子同室のような状況要因は、母親の回避型あるいは不安型アタッチメ ントの程度と母親のPPDのレベルとの間の関連性を抑えることができる。母子同 室のような産後の実践は、個人対象にすることが可能であろう。そして、それは PPDに関する個人的な危険因子を抑えるのに有益であると思われる。摘要产后抑郁症 (PPD) 是最常见的分娩并发症, 最近的研究试图探讨与之相关的危险因素。主要的研究假设是在一个敏感的时间段 (完整产后同住) 的保护性情境因素会缓和不安全型依恋维度与PPD之间的关联。312名女性, 无论是完整还是部分同住, 都参加了在三级保健中心产科病房进行的纵向研究。产后1–4天使用“人口统计调查问卷”和“亲密关系经历量表”测量, 产后2个月使用“爱丁堡产后抑郁量表”测量。PPD与焦虑型、回避型依恋维度显著相关, 但与同住条件无关。此外, 部分同住的女性在不安全型依恋维度和PPD之间显示出正相关, 而完整同住的女性则没有这种相关性。在母婴关系的关键时间点发生的情境因素 (例如完整同住) 可以缓和母亲回避型或焦虑型依恋维度与母亲PPD水平之间的关联。产后的做法 (例如同住) 可以是个性化的, 从而有利于降低PPD的个人风险因素。ملخصالعلاقة بين التعلق الغير الآمن، والإقامة في غرفة الولادة والاكتئاب ما بعد الولادة: دراسة طولية لمدة شهرين.الاكتئاب بعد الولادة (PPD) يعتبر من المضاعفات الأكثر شيوعا لما بعد الإنجاب، وقد حاولت الدراسات الحديثة تناول عوامل الخطر المرتبطة به. كانت فرضية الدراسة الرئيسية هي أن عاملًا وقائيًا في فترة زمنية حساسة (الإقامة الكاملة في غرفة بعد الولادة) من شأنه أن يتوسط العلاقة بين أبعاد التعلق الغير آمن واكتئاب ما بعد الولادة. اشترك في الدراسة ثلاثمائة واثنتي عشرة امرأة، في إقامة كاملة أو جزئية، وأقيمت هذه الدراسة الطولية في جناح الأمومة في مركز فرعي للرعاية الصحية. تم إدارة استبيان ديموغرافي ومقياس التجارب في العلاقات الوثيقة عند 1–4 أيام بعد الولادة، ومقياس أدنبرة لاكتئاب ما بعد الولادة عند شهرين بعد الولادة. ارتبط اكتئاب ما بعد الولادة بشكل كبير مع كل من أبعاد التعلق القلق والمتجنب ، ولكن ليس مع ظروف إقامة الغرفة. وبالإضافة إلى ذلك، أظهرت النساء في الإقامة الجزئية وجود ارتباط إيجابي بين أبعاد التعلق غير الآمن واكتئاب ما بعد الولادة، في حين لم يتم إيجاد مثل هذا الارتباط للنساء في مجموعة الإقامة الكاملة. وبذلك فإن العوامل الظرفية مثل الإقامة الكاملة في فترة زمنية حرجة في العلاقة بين الأم والرضيع يمكن أن تتوسط الارتباط بين أبعاد التعلق الأمومي القلق أو المتجنب ومستويات اكتئاب ما بعد الولادة. ويمكن أن تتخذ ممارسات ما بعد الولادة، مثل الإقامة في غرفة الولادة، طابعا شخصيا وبالتالي تكون مفيدة في تخفيف عوامل المخاطرة الشخصية لاكتئاب ما بعد الولادة.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166287/1/imhj21895_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166287/2/imhj21895.pd

Isolated hydramnios at term gestation and the occurrence of peripartum complications

Objective: To determine if hydramnios at term gestation is an independent risk factor for poor pregnancy outcome and perinatal death. Study design: The study population consisted of 60 702 patients with singleton gestation who delivered at term (&gt;37 weeks). Patients were classified into two groups according to the presence or the absence of hydramnios. Hydramnios was diagnosed in the presence of an amniotic fluid index greater than 25 cm or of a maximum vertical pocket of amniotic fluid of at least 8 cm or by subjective assessment. Logistic regression analysis was used to evaluate the unique contribution of hydramnios to fetal death and to perinatal and maternal morbidity. Results: The prevalence of hydramnios was 1211/60702 (2%). Patients with hydramnios had a higher incidence of complications than those with a normal amount of amniotic fluid: cesarean section (22.8 vs. 8.5%, P&lt;0.01), antepartum death (0.6 vs. 0.2%, P&lt;0.005), postpartum death (2.8 vs. 0.4%, P&lt;0.01), abruptio placenta (0.9 vs, 0.3%, P&lt;0.001), fetal distress (6.1 vs. 3.65%, P&lt;0.0015), meconium-stained amniotic fluid (17.8 vs. 15%, P&lt;0.001), low Apgar score at 5 min (2.95 vs. 1%, P&lt;0.01), malpresentation (6.8 vs. 2.9%, P&lt;0.01), clinical chorioamnionitis (0.3 vs. 0.1%, P&lt;0.05), prolapse of cord (2.2 vs. 0.3%, P&lt;0.01), and large-for- gestational-age infant (LGA) (23.8 vs. 8.1%, P&lt;0.01). When adjusted for confounding variables, the presence of hydramnios remained strongly associated with perinatal mortality (odds ratio 5.5 (95% Cl 3.2-9.3)) and neonatal and maternal morbidity (odds ratios 2.1 (Cl 1.1-3.7) and 2.3 (Cl 1.9-2.7), respectively). Conclusions: (1) Hydramnios at term is an independent risk factor for perinatal death; (2) Fetal surveillance is warranted in patients with hydramnios even in the absence of other known risk factors for adverse pregnancy outcome

Postpartum voiding dysfunction following vaginal versus caesarean delivery

In this prospective study, we evaluated postpartum voiding dysfunction stratified by mode of delivery – vaginal delivery versus elective caesarean delivery (CD). We recruited nulliparous women carrying singleton gestation at term admitted to delivery room or elective CD. Pre-labour voiding function was assessed by recording the post-voiding residual volume (PVRV) using a bladder scan. PVRV evaluation was repeated at least 12 hours following delivery and before discharge. PVRVs were considered abnormal if ≥150 mL. PVRVs were compared between vaginal and CD. Overall, 54 women were included. Of them, 34 (63%) delivered vaginally and 20 (37%) had an elective CD. Postpartum mean PVRVs were significantly higher compared to pre-labour PVRVs (215 vs. 133 mL, p<.001). Abnormal postpartum PVRV was significantly higher in vaginal delivery compared to CD (73.5% vs. 45%, p<.05). In conclusion, delivery adversely affects voiding function. Vaginal delivery is associated with more severe voiding dysfunction compared to elective CD.Impact Statement What is already known on this subject? Delivery is associated with voiding dysfunction. While most studies on postpartum voiding dysfunction were related to vaginal delivery, little is known on the effect of mode of delivery (vaginal versus caesarean delivery (CD)) on voiding dysfunction. What the results of this study add? In this study, we found that postpartum post-voiding residual volume is significantly higher than the pre-labour PVRV in women delivered vaginally. In addition, postpartum PVRV was significantly higher in women delivered vaginally compared to elective CD. What the implications are of these findings for clinical practice and/or further research? This study implicates that women with vaginal delivery are more prone to voiding dysfunction compared to elective CD. However, larger observational studies are warranted to confirm these results and evaluate whether this difference still exists beyond the post-partum period