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PubMed2006

Temporal trends of preterm birth subtypes and neonatal outcomes.

OBJECTIVE: To describe temporal trends of preterm birth subtypes, neonatal morbidity, and hospital neonatal mortality. METHODS: A database of 1.7 million births that occurred in 51 maternity hospitals in Latin America from 1985 to 2003 was studied. Subgroups of preterm births were classified according to the presence or absence of maternal medical or obstetric complications, spontaneous labor, preterm labor after premature rupture of membranes, induction of labor, or elective cesarean. Outcomes studied, for different periods, were prevalence of small for gestational age, neonatal morbidity, and neonatal mortality. RESULTS: Spontaneous preterm labor without maternal complications was the most frequent subtype of preterm birth (60%), followed by premature rupture of membranes without maternal complications. Preterm births due to elective induction and delivery by elective cesarean increased markedly in the last 20 years, from 10% in 1985-1990 to 18.5% in recent years. Neonates born after spontaneous labor without maternal complications had the lowest mortality rate, but their large numbers made them responsible for one half of the preterm mortality. The induction followed by elective cesarean subgroups accounted for 13.4% of the preterm deaths between 1985 and 1990 and increased to 21.2% between 1996 and 2003. CONCLUSION: Spontaneous labor in mothers without maternal complications is the most frequent cause of preterm births and is also the most important subgroup related to neonatal mortality. However, preterm births due to induction of labor or elective cesarean are increasing in Latin America and are becoming important contributors to neonatal mortality.

Adult↗
PubMed1981

Complications of pregnancy and labor in former oral contraceptive users.

Complications of pregnancy and delivery, and obstetric interventions, were studied in a sample of Israeli women questioned post-partum about contraceptive use. The 2,953 women who had used the pill were compared with 13,630 controls. There were no significant differences between users and controls in the frequencies of bleeding in pregnancy, premature rupture of membranes, placenta previa, placental abruption, fetal distress or asphyxia, ABO incompatibility, hydramnios, transverse lie, cephalopelvic disproportion, and persistent occipitoposterior or post-partum hemorrhage. New cases of hypertension, varicose veins, thrombophlebitis, urinary tract infection, and cervicitis were reported in primigravidae and multigravidae without past histories of these conditions; there were no differences between oral contraceptive users and controls other than an excess of cervicitis in primigravidae among former users. There was a slight decrease in normal deliveries in former oral contraceptive users due to an increase in inductions of labor. On the other hand, rates of forceps and vacuum deliveries, caesarian sections, and interventions in the third stage did not differ between former oral contraceptive users and controls. These results indicate that former oral contraceptive users can anticipate the same frequency of complications of pregnancy and labor as women who have used other, or no, methods of contraception.

Age Factors↗
PubMed1986

Proportional weight gain and complications of pregnancy, labor, and delivery in healthy women of normal prepregnant stature.

Detailed reproductive information was obtained through interview at early prenatal visits to hospital clinics, private medical groups, or health maintenance organizations for 4186 women delivered at Yale-New Haven Hospital. From these women, 1,396 were selected who had no preexisting chronic disease, were within their normal prepregnant weight for height as determined by Quetelet's Index (weight2/height2), and were delivered of single infants with no major congenital malformations between 37 and 42 weeks. These women were divided into four quartiles according to their proportional weight gain (weight gain/prepregnant weight): quartile 1 = gains less than or equal to 15%; quartile 2 = gains 16% to 25%; quartile 3 = gains 26% to 35%; quartile 4 = gains greater than 35%. Complications of pregnancy, labor, and delivery were recorded within 2 days of delivery. Compared with the women in quartile 2 those in quartile 4 were 3.8 times more likely to develop gestational hypertension and had a fourfold risk of becoming preeclamptic. They were also significantly more likely to require cesarean section. The size of the infant was a significant risk factor for prolonged second stage of labor in primigravid women (greater than 2 hours) but not in multigravid women (greater than 1 hour). Weight gains of more than 35% almost doubled the risk of a prolonged second stage of labor for multigravid women. High proportional gains were not associated with adverse neonatal outcomes. Clinicians should consider proportional weight gain when advising healthy women about weight gain during pregnancy.

Birth Weight↗
PubMed1975

Late sequelae of induced abortion: complications and outcome of pregnancy and labor.

The effects of previous induced abortion on pregnancy, labor and outcome of pregnancy were measured in a prospective study of 11,057 pregnancies to West Jerusalem mothers who were interviewed during pregnancy and who subsequently delivered a single live or stillborn infant. The 752 mothers who reported one or more induced abortions in the past were more likely, at the same interview, to report bleeding in each of the first 3 months of the present pregnancy. They were subsequently less likely to have a normal delivery and more of them needed a manual removal of the placenta or other intervention in the third stage of labor. In births following induced abortions, the relative risk of early neonatal death was doubled, while late neonatal deaths showed a 3- to 4-fold increase. There was a significant increase in the frequency of low birthweight, compared to births in which there was no history of previous abortion. There were increases in major and minor congenital malformations, but no significant changes in stillbirth or post-neonatal death rates, nor in mean birthweight or sex ratio. When the effects of other variables were taken into account, there were no significant changes in frequency following an induced abortion as to: ABO and rhesus isoimmunization, toxemia, hydramnios, premature rupture of membranes, induction of labor, breech or vacuum delivery, cesarean section, breech presentation, placenta previa, placental abruption, cord prolapse, cord anomalies, fetal distress or asphyxia, post-partum hemorrhage.

Abortion, Induced↗
PubMed1976

[The "narrow pelvis". Disproportion as a cause of complications for mother and infant during labor (author's transl)].

The modern examination methods for the recognition and supervision of high risk births in the area of perinatology have led to a real decrease in newborn morbity and mortality. Since, however, optimal conditions have not been reached at present, there is an urgent need for a wide reaching intensification of prospective diagnostic measures. The early recognition of disturbances in the mechanism of labor is the most important. The author shows on the basis of the most recent literature and his own experience that, even today, factors involved with the mechanics of labor play a chief role in disturbances during the course of labor which have unfavorable effects on the infant as well as the mother. The various irregularities were discussed in detail and supported with statistics. The importance of pelvic roentgenographic diagnosis was discussed in a separate section. The tremendous gains for mother and infant resulting from clarification were compared with the cited, but not confirmed, damage caused by these measures.

Birth Weight↗