Vacuum extraction effective in fetuses with ultrasound-confirmed occiput posterior position, suggests study
2025-01-23 - 2025-01
A new study published in the American Journal of Obstetrics and Gynecology showed that 95% of fetuses with an occiput posterior (OP) position verified by ultrasonography successfully undergo vacuum extraction (VE). About 5% of women in the second stage of labor are in the persistent occiput-posterior position, which increases the risk of labor complications such as a 50% chance of labor arrest during the second stage, a 60% chance of cesarean or instrumental vaginal delivery, and a nearly 20% chance of obstetric anal sphincter injuries.
The gold standard for determining the position of the fetus during labor is a digital vaginal examination. However, it has been demonstrated that clinical examinations are not always accurate in diagnosing occiput position, particularly when non-occiput anterior position is present and before an instrumental delivery is performed. Negative peripartum outcomes are linked to occiput-posterior position, labor arrest, the requirement for a surgical birth, and unsuccessful instrumental vaginal delivery. The most widely used method of instrumental delivery in the world is vacuum extraction. This study was set to examine the effects of VE in fetuses whose OP position was validated sonographically before the surgery. 3 academic maternity units enrolled singleton pregnancies at term with fetal OP position established by sonography before the vacuum extraction. Transperineal sonography was used to measure the head-perineum distance (HPD) and the angle of progression (AoP) at the fetal head station. The need for a cesarean birth, or failed VE, was the main result. Negative outcomes for the mother and/or the newborn were secondary outcomes, as was complicated VE, which was defined as failed VE or at least three of the following 6 parameters as neonatal trauma, postpartum hemorrhage, obstetric anal sphincter injuries, neonatal acidemia, admission to the neonatal intensive care unit, and Apgar <7 at 5 minutes.
VE was effective in 94 (96%), out of the 98 patients that were part of the trial. With an area-under-the-curve of 0.79, logistic regression analysis demonstrated that the head-perineum distance (HPD) measurement alone was independently linked with failed VE. Successful and unsuccessful VE were distinguished by an HPD cut-off value of 38.5 mm, which produced a specificity of 84.0% (79/94), sensitivity of 75.0% (3/4), LHR+ of 4.7, and LHR- of 0.3. Overall, this study showed that fetuses with sonographically detected persistent OP position in the second stage of labor had a high VE success rate and a low risk of maternal and fetal complications.
Multimodal Physical Therapy found Effective for Chronic Pelvic Pain, suggests research
2025-01-25 - 2025-01
Multimodal physical therapy was found to reduce pain intensity significantly in women with chronic pelvic pain (CPP), as reported by a recent study published in the American Journal of Obstetrics and Gynecology. Chronic pelvic pain is a complex condition affecting the quality of life in women, and its implications reach the domains of physical, psychological, and sexual health. The study was conducted by Ma?gorzata Starzec-Proserpio and colleagues.
The study used data from 38 randomized controlled trials involving 2168 women with a mean age of 35.1±8.6 years. The search for literature of electronic databases such as Medline, PubMed, Embase, and Cochrane Central Register of Controlled Trials was done in January 2023 and updated in December 2023. Randomized controlled trials were included for nonpharmacological conservative therapies against placebo, usual care, or other treatments that are not conservative in nature, such as surgical or pharmacological interventions.
Therapies considered were as follows:
• Multimodal physical therapy
• Psychological approaches
• Acupuncture
Tissue-based monotherapies such as electrophysical agents, manual stretching The studies with similar intervention and outcome were analyzed using a random effect model to perform the meta-analysis. Outcomes assessed included pain intensity, sexual function, psychological health, and physical functions as well as quality of life. The Physiotherapy Evidence Database scale and GRADE criteria were used to review the evidence quality and certainty.
Results
Of 5776 studies retrieved, 38 randomized controlled trials were included in the analysis.Multimodal Physical Therapy:
• Short-term: Pain intensity significantly reduced (standardized mean difference [SMD] ?1.69, 95% CI ?2.54, ?0.85; high certainty).
• Intermediate-term: Pain intensity also reduced (SMD ?1.82, 95% CI ?3.13, ?0.52; moderate certainty).
Predominantly Psychological Approaches:
• No significant effect on pain intensity (SMD ?0.18, 95% CI ?0.56, 0.20; moderate certainty).
• Slight improvement in sexual function (SMD ?0.28, 95% CI ?0.52, ?0.04; moderate certainty).
Acupuncture:
• Results showed no statistically significant effect on pain intensity (SMD 1.08, 95% CI ?1.38, 3.54), favoring control treatment.
Multimodal physiotherapy represents an effective, evidence-based approach in decreasing intensity of pain in females with CPP. Its inclusion into clinical practice has become necessary in order to promote better patient results.
External cephalic version safe and effective option for women with previous cesarean section, reveals research
2025-01-27 - 2025-01
Non-cephalic presentations are observed in 3% of pregnancies at term. Affected pregnant women may be presented with the choices of an elective cesarean section (CS), a vaginal breech delivery, or an external cephalic version (ECV). Recent research paper thoroughly investigates the success rate and complications associated with external cephalic version (ECV) in pregnant women who have previously undergone a cesarean section. Conducted as a retrospective cohort study at the “Virgen de la Arrixaca” Clinic University Hospital in Murcia, Spain, the study analyzed data from January 2014 to December 2023, including 911 women who were offered ECV, with 42 of them having a history of cesarean delivery.
Success Rates and Complications
The success rate of ECV in the group with prior cesarean sections was found to be 78.6%, with no significant difference compared to the 72.3% success rate in women without a previous cesarean (P = 0.371). The study calculated an adjusted odds ratio (aOR) of 1.18 for women with a previous cesarean, indicating no significant disadvantage when compared to those without. Additionally, the study highlights that multiparity, amniotic fluid volume, and transverse fetal lie were significant factors positively correlated with ECV success rates. The overall complication rate for ECV was relatively low at 9.5% among women with prior cesarean deliveries, with complications including non-reassuring fetal heart rates (7.1%) and major vaginal bleeding (2.4%). The findings reinforce the safety of ECV procedures even for women who have experienced a cesarean section. It emphasizes that the presence of a uterine scar should not deter healthcare providers from offering ECV to eligible patients with breech presentations at term. The complications related to ECV were comparable between those with and without previous cesarean sections, suggesting ECV is a viable option for women seeking vaginal delivery.
Limitations and Future Directions
The authors note that while the results are promising, limitations include the small sample size of women with prior cesarean sections and the retrospective nature of the study. The paper calls for more prospective studies to further validate these findings and establish protocols surrounding ECV in women with prior cesarean deliveries. Overall, this study contributes significant evidence supporting ECV as a safe practice for women with previous cesarean histories, aiding in the decision-making process for those desiring a vaginal birth after cesarean.
Key Points
- The study is a retrospective cohort analysis conducted at a Spanish hospital, examining the outcomes of external cephalic version (ECV) in 911 pregnant women, of whom 42 had previously undergone cesarean sections, over a period from January 2014 to December 2023.
- The success rate of ECV for the women with prior cesarean deliveries was 78.6%, comparable to the 72.3% success rate in those without a cesarean history, indicating that a previous c
First-of-its-kind national trial explores potential of antibiotics for lowering c-section rates in women with obesity
2025-01-28 - 2025-01
Pregnant women with obesity face an increased risk of complications, including the need for a cesarean section, which carries its own set of risks. A University of Oklahoma physician-researcher recently earned a $3.1 million National Institutes of Health grant to lead a multicenter national clinical trial studying whether antibiotics given at the beginning of labor induction result in a decrease in C-section. The trial is thought to be the first large-scale study of its kind in the United States.
“Today, 40% of American women are obese when they become pregnant, and they have health problems that make them more likely to require delivery before their due date, typically at 39 weeks. Sometimes, a C-section is necessary, but it can cause other problems, such as wound infections and a higher risk of bleeding. Because labor inductions have increased along with the rise in obesity, we need a way to minimize C-sections so the mother can have the lowest risk for complications. We are conducting this study with first-time mothers with obesity because they have the highest risk for a C-section,” said study principal investigator Stephanie Pierce, M.D., OU Health maternal-fetal medicine specialist and associate professor in the OU College of Medicine. Pierce was awarded the grant after the success of her pilot study demonstrating that antibiotics given at the start of labor induction to first-time pregnant women with obesity resulted in a 27% lower C-section delivery rate. That study was published in the American Journal of Obstetrics and Gynecology MFM (Maternal-Fetal Medicine). Pierce said that giving antibiotics during labor induction may decrease the level of inflammation in the mother’s body. Obesity causes chronic inflammation (a prolonged, low-level immune response), and labor itself is an inflammatory state. Research shows that too much inflammation may cause dysfunction of the uterine muscle, which can cause abnormalities in the labor process. In addition, antibiotics may treat any infections that are not showing symptoms like fever but nonetheless are affecting the labor process.
Antibiotics are frequently prescribed to patients ahead of many types of surgery, including C-sections, but giving antibiotics to women at the start of labor induction (prophylactically) is a brand-new area of study. In the trial, half of the participants will be randomly assigned to receive the antibiotics azithromycin or cefazolin through an IV; the other half will receive an IV placebo. While the overall aim of the study is to determine whether antibiotic prophylaxis leads to a decrease in C-sections, the research team will also analyze infection rates and complications in mother and baby 30 days after delivery. They will also collect umbilical cord and maternal blood samples for future investigations of the process by which antibiotics lower the probability of a C-section. In addition, the research team will collect stool samples from both mother and infant one mon
KGM Proposeses Obstetrics and Reproductive Nmedicine Unit at Queen Mary’s
2025-01-31 - 2025-01
Lucknow: King George's Medical University (KGMU) has submitted a proposal to the state govt for the establishment of a state-of-the-art obstetric fetal and reproductive medicine unit at Queen Mary's Hospital. The proposed facility aims to enhance obstetrics, gynecology, and neonatal care services.
KGMU spokesperson Prof Sudhir Singh confirmed that the proposal seeks govt approval to strengthen high-risk pregnancy management and neonatal intensive care. The unit will be divided into two sections—one dedicated to high-risk pregnancies, while routine obstetric cases will continue in the existing hospital setup.
The new facility will feature a maternal critical care unit (MCCU) with dedicated ICU beds for critical obstetric cases. Additionally, a neonatal intensive care unit (NICU) will be established to provide specialized care for high-risk newborns requiring intensive medical attention.
The proposed unit will be housed in a multi-story building, which will also include an underground parking facility, located just behind Queen Mary's Hospital.
Earlier, during KGMU's Foundation Day in Dec, vice-chancellor Prof Soniya Nityanand emphasised the need for the unit before deputy chief minister Brajesh Pathak, who assured that the govt would support its establishment.
Study Finds No Link Between Preterm Birth and Childhood Autism Diagnosis
2025-02-03 - 2025-02
Israel: A recent retrospective cohort study published in the International Journal of Gynecology & Obstetrics has investigated the potential association between preterm birth (PTB) and the development of autism spectrum disorder (ASD) in childhood. The findings, based on comprehensive data analysis, revealed no significant link between preterm birth and an increased risk of an ASD diagnosis, challenging previous assumptions about the relationship between the two conditions.
Preterm birth, defined as delivery before 37 weeks of gestation, has been linked to various health complications, including developmental delays and neurological disorders. Autism spectrum disorder, a developmental disorder characterized by challenges in social interaction, communication, and behaviour, has been a concern for many parents and healthcare professionals, particularly in the context of preterm birth. The relationship between preterm birth and autism spectrum disorder remains a topic of ongoing debate. To explore this, Sapir Ellouk, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel, and colleagues aimed to examine the link between PTB and ASD diagnoses in childhood. For this purpose, the researchers conducted a cohort study analysing data from community clinics and a tertiary hospital, covering deliveries from 2005 to 2017. They compared the incidence of autism spectrum disorder across different gestational age categories: extremely preterm (<28 weeks), very preterm (28–32 weeks), moderate to late preterm (32–37 weeks), and term (?37 weeks). Additional comparisons were made between all preterm births (<37 weeks) and term births (?37 weeks).
Cumulative ASD incidence was evaluated using Kaplan–Meier survival curves and a Cox proportional hazards model, adjusting for potential confounding factors.
The following were the key findings of the study:
• Among 114,975 pregnancies, 0.3% delivered at <28 weeks, 0.6% at 28–32 weeks, and 6% at 32–37 weeks, resulting in an overall preterm delivery rate of 6.9%.
• Univariable analysis revealed a significant association between preterm birth and autism spectrum disorder, with rates of 1.6% for <28 weeks, 0.3% for 28–32 weeks, 0.8% for 32–37 weeks, and 0.7% for term births.
• The crude ASD incidence was 0.8%, with an odds ratio (OR) of 1.21.
• However, adjusted results showed no significant association, with an adjusted hazard ratio of 0.74 for <28 weeks, 0.99 for 28–32 weeks, and 1.07 for 32–37 weeks.
• Kaplan–Meier analysis showed similar cumulative ASD incidence across all gestational age groups.
"Our retrospective cohort study found no significant association between preterm birth and the diagnosis of autism spectrum disorder in childhood," the researchers concluded.
Unplanned cesarean delivery linked to higher risk of postpartum depression
2025-02-04 - 2025-02
At the SMFM 2025 Pregnancy Meeting, Nicola F. Tavella, MPH, research director for Maternal Fetal Medicine in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, presented groundbreaking research on the relationship between postpartum depression and unplanned cesarean delivery. With postpartum depression affecting 10% to 15% of postpartum individuals, understanding its contributing factors is critical to improving maternal mental health outcomes. Tavella’s study analyzed a large national pregnancy dataset to explore how intrapartum experiences influence both postpartum depression development and patient engagement in postpartum care, particularly attendance at the 6-week follow-up visit. In this Q&A, Tavella discusses the study's key findings and their implications for clinical practice.
Nicola F. Tavella, MPH: A major source of biopsychosocial stress in obstetrics is the change in delivery planning, due to various clinical factors that may arise to complicate a planned vaginal birth. For those pregnant patients who intend, and desire to give birth vaginally, emergent need for cesarean delivery presents multifactorial stress; aside from undergoing an urgent unplanned surgical procedure, there is also the patient’s real-time adjustment away from their prior delivery plan. We hypothesized that this multifactorial stress puts these patients at greater risk for developing postpartum depression. Contemporary OB/GYN: Your study found that individuals who had an unplanned cesarean delivery were more likely to attend their 6-week postpartum visit. What factors do you think might drive this increased health care engagement despite the higher risk of PPD?
Tavella: While we cannot infer too much from this finding, since we did not have much detail regarding uptake of postpartum care, this finding may suggest that having an unplanned cesarean delivery confers a greater sense of intrapartum urgency and vulnerability, such that those patients make more concerted effort to attend their 6-week post-partum clinical visit..
Tavella: The regression models we used to examine associations between unplanned cesarean delivery and post-partum depression adjusted for the covariates are significantly different between groups, such as maternal age and household income. We did this precisely because these factors likely confound the relationship between mode of delivery and post-partum depression. Specifically, we know that patients of different ages, racial and ethnic identities, and socioeconomic resources have different birthing experiences and face different treatment from their clinical providers. These differences likely predispose certain patients groups to a greater likelihood of unplanned cesarean, as well as post-partum depression.
Tavella: These findings suggest that the birthing process—already incredibly complicated—can expose pregnant people to adverse psychosoc
