Lisa Saul

Ethnic disparity in the success of vaginal birth after cesarean delivery

Objective. To estimate whether maternal race/ethnicity is independently associated with successful vaginal birth after cesarean delivery (VBAC). Study design. A retrospective cohort study from January 1, 1997 to July 30, 2002 of women with singleton pregnancies and a previous cesarean delivery. The odds ratio (OR) for successful VBAC as a function of ethnicity was corrected for age >35 years, parity, weight gain, diabetes mellitus, hospital site, prenatal care provider, gestational age, induction, labor augmentation, epidural analgesia, and birth weight >4000 g. Results. Among 54 146 births, 8030 (14.8%) occurred in women with previous cesarean deliveries. The trials of labor rates were similar among Caucasian (46.6%), Hispanic (45.4%), and African American (46.0%) women. However, there was a significant difference among ethnic groups for VBAC success rates (79.3% vs. 79.3% vs. 70.0%, respectively). When compared to Caucasian women, the adjusted OR for VBAC success was 0.37 (95% confidence interval (CI) 0.27–0.50) for African American women and 0.63 (95% CI 0.51–0.79) for Hispanic women. Conclusion. African American and Hispanic women are significantly less likely than Caucasian women to achieve successful VBAC.

A randomized, double-blinded, controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas

OBJECTIVE The objective of the study was to compare intravenous normal saline with and without dextrose on the course of labor in nulliparae. STUDY DESIGN In a double-blinded, controlled trial, term, nulliparae with singletons in active labor were randomized into 1 of 3 groups receiving either normal saline (NS), NS with 5% dextrose (D5NS), or NS with 10% dextrose (D10NS) at 125 mL/h. The primary outcome was total length of labor from onset of study fluid in vaginally delivered subjects. Maternal and neonatal outcomes were also analyzed. RESULTS Of 300 subjects enrolled, 289 met inclusion criteria and completed the study. In vaginally delivered subjects, significant differences were noted in the second stage (P = .01) and total length of labor (P = .02). No significant differences were observed in the cesarean section rates between the groups (P = .21). No differences were noted in maternal or neonatal secondary outcomes. CONCLUSION Administration of a dextrose solution, regardless of concentration, was associated with a shortened labor course in term vaginally delivered nulliparae subjects in active labor.

The Effect of Abdominal Wall Depth on Transabdominal Compared With Transvaginal Cervical Length Measurement

INTRODUCTION: The objective of this study was to determine the effect of the anterior abdominal wall depth on the correlation between transabdominal cervical length and transvaginal cervical length measurements. METHODS: A cross-sectional study included patients with singleton pregnancies between 18 and 24 weeks of gestation. Postvoid transabdominal cervical length and transvaginal cervical length measurements were obtained on each participants. Anterior abdominal wall depth was defined as the distance between the lower abdominal skin and the fascia in the midsagittal plane. Obstetric history and body mass index (BMI) were obtained. All transabdominal cervical length images were graded for quality using standardized grading criteria defined as visualization of the internal and external os, cervicovaginal junction, and cervical corpus. RESULTS: Ninety-five participants (mean gestational age 20+3 weeks) were included in the analysis. Mean BMI was 28.8 kg/m2 and the mean anterior abdominal wall depth was 18.5 mm (range 7.7–43.0 mm). No difference between the transabdominal cervical length and transvaginal cervical length was detected despite a large variation in anterior abdominal wall depth and BMI (Lin correlation 0.9761; Pearson correlation coefficient r=0.48, P<.001). Mean variation between transabdominal cervical length and transvaginal cervical length was −0.05 mm. Fifty-nine of the participants had at least three landmarks visualized on transabdominal imaging. Using general linear models, as the anterior abdominal wall depth increased, the number of visualized cervical landmarks on transabdominal imaging significantly decreased (P=.002). CONCLUSION: Anterior abdominal wall depth does not affect the correlation between transabdominal cervical length and transvaginal cervical length assessment. Irrespective of the anterior abdominal wall depth or BMI, there was moderate correlation between the two imaging modalities. With increasing anterior abdominal wall depth, the quality of transabdominal cervical length imaging decreased significantly. However, despite not visualizing all cervical landmarks, there is still a clinically significant correlation between transabdominal cervical length and transvaginal cervical length measurements.