Guy Martens

Perinatal outcome of pregnancies after assisted reproduction: A case-control study

PURPOSE A matched case-control study of all pregnancies obtained after either IVF or ICSI was conducted to investigate the perinatal outcome. METHODS Three hundred eleven singleton and 115 twin pregnancies obtained after assisted reproduction were studied. Controls were selected from a regional register and were matched for maternal age, parity, singleton or twin pregnancy, and date of delivery. RESULTS No significant difference was observed for gestational age at delivery, birth weight, incidence of congenital anomalies, and incidence of perinatal mortality between ART (singleton and twin) pregnancies and spontaneous controls. ART twin pregnancies showed a higher incidence of preterm deliveries than control pregnancies (52 vs 42%; P < 0.05) and needed more neonatal intensive care (47 vs 26%; P < 0.05). CONCLUSIONS From this case-control study it is concluded that the perinatal outcome of ART singleton pregnancies is not different from that in matched controls. ART twin pregnancies showed a higher incidence of preterm deliveries than control pregnancies and needed more neonatal intensive care.

Somali women and their pregnancy outcomes postmigration: data from six receiving countries

Objective  This study aimed to investigate pregnancy outcomes in Somali‐born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden.

Investigating the variations in survival rates for very preterm infants in 10 European regions: the MOSAIC birth cohort

Objective: To investigate the variation in the survival rate and the mortality rates for very preterm infants across Europe. Design: A prospective birth cohort of very preterm infants for 10 geographically defined European regions during 2003, followed to discharge home from hospital. Participants: All deliveries from 22 + 0 to 31 + 6 weeks’ gestation. Main outcome measure: All outcomes of pregnancy by gestational age group, including termination of pregnancy for congenital anomalies and other reasons, antepartum stillbirth, intrapartum stillbirth, labour ward death, death after admission to a neonatal intensive care unit (NICU) and survival to discharge. Results: Overall the proportion of this very preterm cohort who survived to discharge from neonatal care was 89.5%, varying from 93.2% to 74.8% across the regions. Less than 2% of infants <24 weeks’ gestation and approximately half of the infants from 24 to 27 weeks’ gestation survived to discharge home from the NICU. However large variations were seen in the timing of the deaths by region. Among all fetuses alive at onset of labour of 24–27 weeks’ gestation, between 84.0% and 98.9% were born alive and between 64.6% and 97.8% were admitted to the NICU. For babies <24 weeks’ gestation, between 0% and 79.6% of babies alive at onset of labour were admitted to neonatal intensive care. Conclusions: There are wide variations in the survival rates to discharge from neonatal intensive care for very preterm deliveries and in the timing of death across the MOSAIC regions. In order to directly compare international statistics for mortality in very preterm infants, data collection needs to be standardised. We believe that the standard point of comparison should be using all those infants alive at the onset of labour as the denominator for comparisons of mortality rates for very preterm infants analysing the cohort by gestational age band.

Effectiveness of extra-ovular injection of prostaglandin E2 in tyloseR gel to ripen the cervix prior to elective induction of labor at term

Ripening of the unfavorable cervix (Bishop score less than or equal to 4) was obtained in 92 clinically normal gravidae at term (68 nulliparae and 24 parous women), not in labor and with intact membranes, by injecting one or two doses (250 to 500 mug each) of prostaglandin (PG)E2 suspended in a viscous gel (5% Tylose) into the extra-ovular space. On average 7 to 8 hours after the injection the mean increase of the cervical score was 3.7 and 4.1 in the nulliparous and parous women, respectively. Complications associated with placement of the catheter were few. The method is simple, well tolerated and no untoward maternal or perinatal effects could be directly attributed to it. However, suitable criteria for predicting both the effect of the procedure and the optimal PG dose to be administered are still needed.

INDUCTION OF LABOUR WITH PROSTAGLANDIN E2 TABLETS

PGE2 tablets were administered for induction of labour to 47 clinically normal patients at term who, one hour after amniotomy, had less than 100 Montevideo Units of uterine activity. The dosage of PGE2 was individually adjusted and never exceeded 2.0 mg. two‐hourly. One multiparous patient was given oxytocin for acceleration of labour. The other 46 patients required no other oxytocic drugs.

Elective induction of labour increases caesarean section rate in low risk multiparous women

The aim of this study was to compare the risk of secondary caesarean section in induced versus spontaneous labour in the second delivery of low risk women who had a vaginal delivery in their first pregnancy. The data were retrospective cohort from an existing regional database, comparing term (between 37 and 42 gestational weeks) second deliveries in cephalic position in women who had previously given vaginal birth. Diabetes, hypertension and multiple pregnancy were excluded as were those with a birth weight less than 2500 g or more than 4500 g. The difference was not significant when induction was performed after 41 weeks. The results showed a total number of 29693 deliveries were included, 21243 in spontaneous labour and 8450 after induction of labour. In the spontaneous group 312 (1.5%) underwent secondary caesarean section, as compared to 237 (2.8%) in the induced group, p < 0.001, OR 1.93 (95% confidence interval 1.63–2.29). It was concluded that elective induction of labour in low risk women who have previously given vaginal birth is associated with an almost doubled rate of secondary caesarean section if performed before 41 weeks.

Perinatal Outcome of Twins Compared to Singletons of the Same Gestational Age: A Case-control Study

Our objective was to determine the perinatal outcome of first- and second-born twins compared to singletons, born at the same gestational age. To that end we conducted a case-control study in Flanders (Northern Belgium). During a 10-year period (01.01.1999-31.12.2008), the entire twin population - 11,154 first- and 11,118 second-born twins (cases) - was compared to 22,228 singletons (controls) with respect to fetal and neonatal (0-27 days) mortality. Only case and control infants of ≥ 500 grams were included, which explained the unequal number of first- and second-born twins. Mothers and their infants of cases and of controls were derived from the Flemish perinatal database and were matched for maternal age and parity, gestational age and gender of the offspring. The main outcome measures were fetal and neonatal mortality according to gestational age. The frequency of fetal death was statistically significantly less frequent in preterm born twins than in singletons, except at term where the reverse was seen in second-born twins compared to controls. After adjustment for congenital malformations, the results stayed unchanged. Below 28 weeks gestation, singletons had a significantly lower neonatal mortality rate than twins that persisted after adjustment for congenital malformations: the first-born twin versus singleton OR 1.71 (1.17-2.51) and second-born versus singleton OR 2.09 (1.43-3.05). Between 28 and 32 weeks, the second-born twin showed a survival advantage over the control singleton. Between 32 and 36 6/7 weeks both twins had a significantly higher survival rate than the corresponding singleton controls. However, after adjustment for congenital malformations, the aforementioned differences between 28 and 36 6/7 weeks disappeared. When at term, twins and singletons had a comparable, though very low, neonatal death rate. These results confirm previous published data. In conclusion, we demonstrated that the neonatal death rate was lower for twins between 32 and 36 weeks (from 28 weeks for the second born twin) when compared to a singleton of the same gestational age. After adjusting for congenital malformations, there was no statistical significant difference.

Fetal effects of cervical ripening with extra-amniotic prostaglandin E2 in gel

A gel containing 0.5 mg prostaglandin E2 (PGE2) was extra-amniotically instilled 90 clinically normal gravidae at term, for ripening of the cervix before elective induction of labor by amniotomy and intravenous PGE2. An acceptable increase in the Bishop score was noted to have occurred in 87/90 women, when assessed eight hours after administration of the gel; 14 of these women were then in established labor, which progressed uneventfully. Four of the 90 subjects required cesarean section for cephalopelvic disproportion. No adverse maternal or fetal effects of the procedure were detected under careful clinical, electronic and biochemical monitoring. However, epidural anesthesia adversely influenced the acid-base equilibrium of the fetus.

Indications for caesarean section in breech presentation

OBJECTIVE The study was conducted because of the still considerable controversies about the variation in obstetric management in breech presentation, in combination with the still increasing caesarean section rate for this type of presentation, as well as doubt concerning the assumed improvement in neonatal and maternal morbidity and mortality obtained by increasing section rate in breeches. STUDY DESIGN Two hundred and sixty eight consecutive breech presentations in two university hospitals were studied longitudinally and prospectively. In principle, vaginal delivery was attempted in all cases, under expert supervision and electronic monitoring, except in the presence of clear-cut contraindications. X-ray pelvimetry was not used. RESULTS The incidence of caesarean section was 34%. The trial of vaginal delivery succeeded in 64% of the nulliparas and in 60% of the non-frank breeches, without statistically significant differences in outcome measures compared with the multiparous women and the frank group, respectively. Hyperextension of the foetal head rarely occurred. CONCLUSION Several classic obstetric factors have a lower discriminating value for the route of delivery than is currently assumed. Progress of labour was an important factor in determining the route of delivery.

Ultrasound assessment of puerperal uterine involution

Echographic measurement of the early postpartum uterus was performed, mainly to investigate whether involution patterns correlate with parity, the administration of oxytocin during labor, and lactation. Our findings suggest that these factors do not have a marked effect on uterine involution.