Induction of labour for suspected macrosomia at term in non-diabetic women: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Several randomized controlled trials (RCTs) compared induction of labour with expectant management in non-diabetic women with suspected fetal macrosomia. OBJECTIVE: To evaluate the effects of labour induction for suspected fetal macrosomia. SEARCH STRATEGY: Literature search in electronic databases. SELECTION CRITERIA: We included all RCTs of suspected fetal macrosomia comparing labour induction with expectant management in term pregnancy. DATA COLLECTION AND ANALYSIS: The primary outcome was the incidence of caesarean delivery. MAIN RESULTS: Four RCTs, including 1190 non-diabetic women with suspected fetal macrosomia at term, were analysed. Pooled data did not show a significant difference in incidence of caesarean delivery [relative risk (RR) 0.91, 95% confidence interval (CI) 0.76-1.09], operative and spontaneous vaginal delivery, shoulder dystocia, intracranial haemorrhage, brachial plexus palsy, Apgar score <7 at 5 min, cord blood pH <7, and mean birth weight comparing women who received induction of labour with those who were managed expectantly. The induction group had a significantly lower time to delivery (mean difference -7.55 days, 95% CI -8.20 to -6.89), lower rate of birth weight ≥4000 g (RR 0.50, 95% CI 0.42-0.59) and ≥4500 g (RR 0.21, 95% CI 0.11-0.39), and lower incidence of fetal fractures (RR 0.17, 95% CI 0.03-0.79) compared with expectant management group. CONCLUSION: Induction of labour ≥38 weeks for suspected fetal macrosomia is associated with a significant decrease in fetal fractures, and therefore can be considered as a reasonable optio

Preterm birth: incidence, risk factors and second trimester cervical length in a single center population. A two-year retrospective study

To report the incidence and the major risk factors (RFs) associated with preterm birth (PTB), combining both maternal RFs and cervical length (CL), and to understand if cervical length measurement is really useful in all the patients

Preterm birth: Incidence, risk factors and second trimester cervical length in a single center population. A two-year retrospective study

OBJECTIVE: To report the incidence and the major risk factors (RFs) associated with preterm birth (PTB), combining both maternal RFs and cervical length (CL), and to understand if cervical length measurement is really useful in all the patients. PATIENTS AND METHODS: The study population consisted of 2048 women admitted to the Department of Obstetrics and Gynecology, University Hospital of Messina, over a 2-year period. Preterm cases represented approximately 8.64% of our total population and, exactly, 65% were late preterm, 32% were preterm, and 3% were extremely preterm. RESULTS: An analysis of PTB sub-categories based on gestational age showed a stronger correlation between gestational age and CL among preterm and extremely preterm, while no correlation was found among late preterm. Between preterm cases and controls, there was a significant difference in pre-pregnancy weight and Body Mass Index (BMI). Moreover, a significant association between PTB and uterine anomalies, poli-oligodramnios and hypertension was found. CONCLUSIONS: We strongly suggest adding a transvaginal ultrasound CL universal screening to all pregnant women at the time of the second trimester ultrasound. We encourage further studies to identify new RFs of PTB and to define the mechanisms by which risk factors are related to PTB

Inpatient vs outpatient management and timing of delivery of uncomplicated monochorionic monoamniotic twin pregnancy: the MONOMONO study

65nonenoneSaccone G.; Berghella V.; Locci M.; Ghi T.; Frusca T.; Lanna M.; Faiola S.; Fichera A.; Prefumo F.; Rizzo G.; Bosi C.; Arduino B.; D'Alessandro P.; Borgo M.; Arduino S.; Cantanna E.; Simonazzi G.; Rizzo N.; Francesca G.; Seravalli V.; Miller J.L.; Magro-Malosso E.R.; Di Tommaso M.; Dall'Asta A.; Galli L.; Volpe N.; Visentin S.; Cosmi E.; Sarno L.; Caissutti C.; Driul L.; Anastasio H.; Di Mascio D.; Panici P.B.; Vena F.; Brunelli R.; Ciardulli A.; D'Antonio F.; Schoen C.; Suhag A.; Gambacorti-Passerini Z.M.; Baz M.A.A.; Magoga G.; Busato E.; Filippi E.; Suarez M.J.R.; Alderete F.G.; Ortuno P.A.; Vitagliano A.; Mollo A.; Raffone A.; Vendola M.; Navaneethan P.; Wimalasundera R.; Napolitano R.; Aquino C.I.; D'Agostino S.; Gallo C.; Maruotti G.M.; Flacco M.E.; Baschat A.A.; Venturella R.; Guida M.; Martinelli P.; Zullo F.Saccone, G.; Berghella, V.; Locci, M.; Ghi, T.; Frusca, T.; Lanna, M.; Faiola, S.; Fichera, A.; Prefumo, F.; Rizzo, G.; Bosi, C.; Arduino, B.; D'Alessandro, P.; Borgo, M.; Arduino, S.; Cantanna, E.; Simonazzi, G.; Rizzo, N.; Francesca, G.; Seravalli, V.; Miller, J. L.; Magro-Malosso, E. R.; Di Tommaso, M.; Dall'Asta, A.; Galli, L.; Volpe, N.; Visentin, S.; Cosmi, E.; Sarno, L.; Caissutti, C.; Driul, L.; Anastasio, H.; Di Mascio, D.; Panici, P. B.; Vena, F.; Brunelli, R.; Ciardulli, A.; D'Antonio, F.; Schoen, C.; Suhag, A.; Gambacorti-Passerini, Z. M.; Baz, M. A. A.; Magoga, G.; Busato, E.; Filippi, E.; Suarez, M. J. R.; Alderete, F. G.; Ortuno, P. A.; Vitagliano, A.; Mollo, A.; Raffone, A.; Vendola, M.; Navaneethan, P.; Wimalasundera, R.; Napolitano, R.; Aquino, C. I.; D'Agostino, S.; Gallo, C.; Maruotti, G. M.; Flacco, M. E.; Baschat, A. A.; Venturella, R.; Guida, M.; Martinelli, P.; Zullo, F

Weight discordance and perinatal mortality in monoamniotic twin pregnancy: analysis of MONOMONO, NorSTAMP and STORK multiple‐pregnancy cohorts

Objectives The primary objective was to quantify the risk of perinatal mortality in non‐anomalous monochorionic monoamniotic (MCMA) twin pregnancies complicated by birth‐weight (BW) discordance. The secondary objectives were to investigate the effect of inpatient vs outpatient fetal monitoring on the risk of mortality in weight‐discordant MCMA twin pregnancies, and to explore the predictive accuracy of BW discordance for perinatal mortality. Methods This analysis included data on 242 MCMA twin pregnancies (484 fetuses) from three major research collaboratives on twin pregnancy (MONOMONO, STORK and NorSTAMP). The primary outcomes were the risks of intrauterine (IUD), neonatal (NND) and perinatal (PND) death, according to weight discordance at birth from ≥ 10% to ≥ 30%. The secondary outcomes were the association of inpatient vs outpatient fetal monitoring with the risk of mortality in weight‐discordant pregnancies, and the accuracy of BW discordance in predicting mortality. Logistic regression and receiver‐operating‐characteristics‐curve analyses were used to analyze the data. Results The risk of IUD was significantly increased in MCMA twin pregnancies with BW discordance ≥ 10% (odds ratio (OR), 2.2; 95% CI, 1.1–4.4; P = 0.022) and increased up to an OR of 4.4 (95% CI, 1.3–14.4; P = 0.001) in those with BW discordance ≥ 30%. This association remained significant on multivariate logistic regression analysis for BW‐discordance cut‐offs ≥ 20%. However, weight discordance had low predictive accuracy for mortality, with areas under the receiver‐operating‐characteristics curve of 0.60 (95% CI, 0.46–0.73), 0.52 (95% CI, 0.33–0.72) and 0.57 (95% CI, 0.45–0.68) for IUD, NND and PND, respectively. There was no difference in the risk of overall IUD, single IUD, double IUD, NND or PND between pregnancies managed as an inpatient compared with those managed as an outpatient, for any BW‐discordance cut‐off. Conclusions MCMA twin pregnancies with BW discordance are at increased risk of fetal death, signaling a need for increased levels of monitoring. Despite this, the predictive accuracy for mortality is low; thus, detection of BW discordance alone should not trigger intervention, such as iatrogenic delivery. The current data do not demonstrate an advantage of inpatient over outpatient management in these cases