Deceleration area and fetal acidemia

Aims: To compare the predictive ability for neonatal acidemia of individual components of intrapartum cardiotocography (CTG) described by National Institute of Child Health and Human Development (NICHD) system and deceleration area. Design: Case-control study. Setting: Spanish tertiary obstetrical hospital. Population: CTG patterns of 102 acidemic fetus (umbilical arterial cord gas pH =7.10, base deficit (BD>48) and 102 nonacidemic controls (umbilical arterial cord gas pH>7.10). Methods: Two reviewers blind to clinical and outcome data analyzed the last thirty minutes before delivery of 204 fetal heart rate (FHR) tracings, extracting those features defined by NICHD and certain measures of FHR decelerations, including deceleration area, not considered by this system. Outcome measures: The primary outcome was the predictive ability of NICHD features and non-NICHD deceleration measures for fetal acidemia. The secondary outcome was the impact of deceleration area in the last 30 min of labor on gasometry components (pH, BD and lactate). Results: Minimal variability (area under the curve (AUC) 0.74), total number of late (AUC: 0.75) and prolonged decelerations (0.77) were the three NICHD features with the greatest predictive ability for fetal acidemia in the last thirty minutes of labor. Total deceleration area demonstrated the highest discrimination power (AUC: 0.83) of all the analyzed elements. For each cm2 the area increases in the last 30 min of labor, pH decreases 0.08 units, BD increases 0.272 mEq/L and lactate 0.183 mEq/L. Conclusions: Total deceleration area showed the greatest predictive ability for fetal acidemia and its measure could help to estimate intrapartum fetal acid-base status

Double balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice?

Introduction: We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery. Materials and methods: We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score <5), a prior cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value <0.05 was considered statistically significant. Results: Most women improved their initial Bishop Score (89.5%) although only a 20.8% of them went into spontaneous active labour. Finally, 51.4% of the women achieved a vaginal delivery. Five cases of intrapartum uterine rupture (1.2%) occurred. After multivariate analysis, main risk factors for repeated cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066–2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066–6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959–6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004–1.006). The area under the curve was 0.789 (p < 0.001). Conclusions: Double-balloon catheter seems to be safe and effective for cervical ripening in women with a previous cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section

Integrated study of factors affecting fetal weight in singleton pregnancies. Nomogram and development of basic and advanced fetal growth customized models

We have performed a multivariate analysis to explore the influence on birth and ultrasound fetal weight estimation of traditional factors as biochemical data and maternal characteristics in combination with non- traditionally explored predictors as paternal height, Pregnancy-associated plasma protein A (PAPP-A), single umbilical artery or Free-beta Human Chorionic Gonadotropin (fß- HCG). The study was performed for a Spanish population (region of Aragon) in singleton pregnancies at term (37-42 weeks). Also, we have created a nomogram and in order to predict the occurrence of SGA (small for gestational age) and LGA (large for gestational age) cases we provide a multivariate predictive model of fetal weight that have been compared with other models in the prediction of ultrasound and birth weights. After study we have created a software application for automated calculation of percentile fetal weight, adjusting the variables when they were significant

Parto gemelar asincrónico: informe de un caso

ANTECEDENTES: El parto gemelar asincrónico consiste en diferir el nacimiento del segundo gemelo, cuando el del primero se produce de manera inevitable en etapas tempranas de la gestación. CASO CLÍNICO: Paciente de 39 años, con embarazo gemelar bicorial, logrado después de un tratamiento de fecundación in vitro. Atendida en el Hospital Universitario Miguel Servet por amenaza de parto prematuro. A su ingreso se comprobó la muerte del primer gemelo y se decidió extraerlo en la semana 23 + 2 semanas. Posteriormente se objetivó la retracción cervical, con dilatación de 2-3 cm y cese de la dinámica uterina. La bolsa amniótica del segundo gemelo permaneció íntegra, sin signos de pérdida del bienestar fetal, por lo que se intentó el parto asincrónico. Durante el intervalo entre ambos gemelos se administraron cuatro ciclos de fármacos tocolíticos con atosiban y maduración pulmonar fetal con corticoides por amenaza de parto prematuro. Finalmente, se retiró el cerclaje a las 34 + 2 semanas del embarazo, por dinámica uterina regular, aún con la administración de tocolíticos, produciéndose el parto del segundo gemelo. El recién nacido pesó 1810 g, con Apgar de 9 al mi- nuto y de 10 a los 5 minutos, y pH del cordón de 7.39. Su evolución fue favorable y permaneció en la unidad de cuidados intermedios neonatales durante 13 días, para darlo de alta con 2070 g. El estudio posmortem del primer gemelo no reportó expresión morfológica de la causa de muerte, ni se objetivaron signos de infección. El resultado del array fue normal y el cariotipo fue 46 XY. El estudio microbiológico de la placenta no demostró signos de corioamnionitis. La paciente fue dada de alta tres días posteriores al parto, con evolución satisfactoria y sin contratiempos durante el puerperio. CONCLUSIONES: El parto diferido del segundo gemelo es una alternativa para emba- razos gemelares debidamente seleccionados en los que el parto del primer gemelo se produjo en semanas de prematurez extrema y el feto superviviente puede continuar en gestación hasta alcanzar las semanas que le permitan el mejor pronóstico

Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice?

INTRODUCTION: We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery. MATERIALS AND METHODS: We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score <5), a prior cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value <0.05 was considered statistically significant. RESULTS: Most women improved their initial Bishop Score (89.5%) although only a 20.8% of them went into spontaneous active labour. Finally, 51.4% of the women achieved a vaginal delivery. Five cases of intrapartum uterine rupture (1.2%) occurred. After multivariate analysis, main risk factors for repeated cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066–2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066–6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959–6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004–1.006). The area under the curve was 0.789 (p < 0.001). CONCLUSIONS: Double-balloon catheter seems to be safe and effective for cervical ripening in women with a previous cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section

Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19 : a meta-analysis

IMPORTANCE Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have variously reported benefit, no effect, and harm. OBJECTIVE To estimate the association between administration of IL-6 antagonists compared with usual care or placebo and 28-day all-cause mortality and other outcomes. DATA SOURCES Trials were identified through systematic searches of electronic databases between October 2020 and January 2021. Searches were not restricted by trial status or language. Additional trials were identified through contact with experts. STUDY SELECTION Eligible trials randomly assigned patients hospitalized for COVID-19 to a group in whom IL-6 antagonists were administered and to a group in whom neither IL-6 antagonists nor any other immunomodulators except corticosteroids were administered. Among 72 potentially eligible trials, 27 (37.5%) met study selection criteria. DATA EXTRACTION AND SYNTHESIS In this prospectivemeta-analysis, risk of biaswas assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I-2 statistic. The primary analysis was an inverse variance-weighted fixed-effects meta-analysis of odds ratios (ORs) for 28-day all-cause mortality. MAIN OUTCOMES AND MEASURES The primary outcome measurewas all-cause mortality at 28 days after randomization. There were 9 secondary outcomes including progression to invasive mechanical ventilation or death and risk of secondary infection by 28 days. RESULTS A total of 10 930 patients (median age, 61 years [range of medians, 52-68 years]; 3560 [33%] were women) participating in 27 trials were included. By 28 days, there were 1407 deaths among 6449 patients randomized to IL-6 antagonists and 1158 deaths among 4481 patients randomized to usual care or placebo (summary OR, 0.86 [95% CI, 0.79-0.95]; P =.003 based on a fixed-effects meta-analysis). This corresponds to an absolute mortality risk of 22% for IL-6 antagonists compared with an assumed mortality risk of 25% for usual care or placebo. The corresponding summary ORs were 0.83 (95% CI, 0.74-0.92; P <.001) for tocilizumab and 1.08 (95% CI, 0.86-1.36; P =.52) for sarilumab. The summary ORs for the association with mortality compared with usual care or placebo in those receiving corticosteroids were 0.77 (95% CI, 0.68-0.87) for tocilizumab and 0.92 (95% CI, 0.61-1.38) for sarilumab. The ORs for the association with progression to invasive mechanical ventilation or death, compared with usual care or placebo, were 0.77 (95% CI, 0.70-0.85) for all IL-6 antagonists, 0.74 (95% CI, 0.66-0.82) for tocilizumab, and 1.00 (95% CI, 0.74-1.34) for sarilumab. Secondary infections by 28 days occurred in 21.9% of patients treated with IL-6 antagonists vs 17.6% of patients treated with usual care or placebo (OR accounting for trial sample sizes, 0.99; 95% CI, 0.85-1.16). CONCLUSIONS AND RELEVANCE In this prospectivemeta-analysis of clinical trials of patients hospitalized for COVID-19, administration of IL-6 antagonists, compared with usual care or placebo, was associated with lower 28-day all-cause mortality