Liam Dunn

Gender specific intrapartum and neonatal outcomes for term babies.

OBJECTIVE The purpose of this study is to document the gender specific intrapartum and neonatal outcomes in term, singleton, appropriately grown babies. STUDY DESIGN De-identified, routinely collected data of all women meeting inclusion criteria between 2001 and 2011 were examined (n=9223). Inclusion criteria were public (non-insured), primiparous women who had delivered singleton, appropriately grown babies at term. In this retrospective cohort study, we estimated 95% confidence intervals. Outcomes measured were maternal demographics, mode of delivery, birthweight, APGAR score, cord blood acidemia, respiratory distress, any resuscitation requirement, nursery admission and stillbirth rates. RESULTS The sex ratio of male babies was 1.05:1 (4718 males; 4505 females, p=0.85). Male babies were more likely to be delivered by instrumental (p=0.004) or caesarean (p<0.001). Birthweight was found to be a significant influencing factor on mode of delivery. Even after adjusting for birthweight, male babies were more likely to be delivered by instrumental delivery (OR 1.24, p<0.001), as well as by emergency caesarean for failure to progress (OR 1.24, p=0.04) and fetal distress (OR 1.38, p<0.001). Male babies, despite having greater birthweights than female babies (p<0.001), were more likely to have lower APGAR scores at 5 min (p=0.004), require neonatal resuscitation (p<0.001), develop respiratory distress (p=0.005) and require nursery admission (p<0.001). No statistical difference between male and female babies was found for cord blood acidemia (p=0.58) or stillbirth (p=0.49). CONCLUSION This large cohort study demonstrates that term, appropriately grown male babies in primiparous pregnancies fare more poorly in the intrapartum and neonatal periods than female babies. Even when birthweight was accounted for, male babies still required higher rates of intervention in the intrapartum and neonatal periods. This suggests gender may play an independent role in influencing pregnancy outcomes, although the underlying contributing physiology is not definitively established. The gender of the baby perhaps should be considered when counselling parents in the antepartum period.

Sildenafil in Pregnancy: A Systematic Review of Maternal Tolerance and Obstetric and Perinatal Outcomes

Introduction: This systematic review evaluates maternal tolerance and obstetric and perinatal outcomes following sildenafil citrate (SC) use in human pregnancy. Data Sources: Scopus, PubMed, Cochrane Library, Web of Science, Embase, and Google Scholar were searched. Relevant full-text studies including case series and reports in English were included. Publications were excluded if the pregnancy was terminated or if SC was used only at conception. Results: Sixteen studies were included (n = 165). Indications for use and outcomes were variably reported. Maternal outcomes reported were headache (45.8%, 49/107), visual disturbances (17.3%, 14/81), dyspepsia/epigastric pain (15.8%, 15/95), and hypotension (0%, 0/39). There were more caesarean (83.3%, 55/66) than vaginal deliveries (16.7%, 11/66) and postpartum haemorrhage occurred in 3.9% (3/76) of women exposed to SC. Neonatal outcomes including nursery admission (67.3%, 35/52), Apgar scores <7 at 5 min (7.1%, 4/56), and cord arterial pH <7.1 (0%, 0/17) were reported. Stillbirths (4.3%, 3/69) and neonatal deaths (3.9%, 5/129) were comparable to SC-naïve groups. There were no congenital malformations (0%, 0/35). Conclusions: Despite limited data, overall there does not appear to be any severe adverse maternal side effects nor any increase in the rate of stillbirths, neonatal deaths, or congenital anomalies attributed to SC.

Maternal age is a risk factor for caesarean section following induction of labour

In Australia, more than 20% of women giving birth are 35 years or older. Advanced maternal age (AMA) is a risk factor for stillbirth, and many clinicians now recommend induction of labour (IOL) at around term gestation. The aim of this study is to determine if AMA is associated with emergency caesarean section (CS) following IOL.

Perinatal outcomes for women from developing countries

Women from Developing Country of origin: • lower BMI (21.9 v 24.4,p=0.04) • lower smoking rates (14.5% n=334 v 44.4% n=2511, p<0.001) Location: Mater Mothers’ Hospital Design: Retrospective 2001-2011 Inclusion Criteria: • Public (non-insured) • Primiparous • 18-40 years old • Singleton • Cephalic presentation Exclusion criteria: • Fetal anomaly • Birthweight <10th centile (2,500g) Babies born to mothers from Developing Countries compared to Australian born, had: • Lower birthweight (3427.3g v 3577.5g, p=0.01) • Less resuscitation (44.3% n=1023 v 48.4% n=2739, p=0.01) • Fewer nursery transfers (6.9% n=159 v 9.2% n=520 p<0.001) 0% Vacuum (FTP) Vacuum (ME) Forceps (FTP) Forceps (ME)