Véronique Othenin-Girard

Maternal Immunization Earlier in Pregnancy Maximizes Antibody Transfer and Expected Infant Seropositivity Against Pertussis

Guidelines recommend that pregnant women be vaccinated against pertussis between gestational weeks 26 and 36. We show that this narrow window can be widened, as optimal neonatal antibody concentrations and expected infant seropositivity rates are elicited between weeks 13 and 33.

Effects of recommended levels of physical activity on pregnancy outcomes

OBJECTIVE We sought to examine the relation between recommended levels of physical activity during pregnancy and pregnancy outcomes. STUDY DESIGN We conducted an observational study with energy expenditure, aerobic fitness, and sleeping heart rate measured in 44 healthy women in late pregnancy. Medical records were examined for pregnancy outcome. RESULTS Active women, who engaged in > or = 30 minutes of moderate physical activity per day, had significantly better fitness and lower sleeping heart rate compared to the inactive. Duration of second stage of labor was 88 and 146 minutes in the active vs inactive women, respectively (P = .05). Crude odds ratio of operative delivery in the inactive vs the active was 3.7 (95% confidence interval, 0.87-16.08). Birthweight, maternal weight gain, and parity adjusted odds ratio was 7.6 (95% confidence interval, 1.23-45.8). Neonatal condition and other obstetric outcomes were similar between groups. CONCLUSION Active women have better aerobic fitness as compared to inactive women. The risk for operative delivery is lower in active women compared to inactive, when controlled for birthweight, maternal weight gain, and parity. Further studies with larger sample size are required to confirm the association between physical activity and pregnancy outcomes.

Home-based versus hospital-based postnatal care: a randomised trial

Objective  To compare a shortened hospital stay with midwife visits at home to usual hospital care after delivery.

Maternal heart rate changes during labour.

OBJECTIVES Labour and delivery represent a considerable effort for pregnant women. Lack of aerobic fitness may limit pushing efforts during childbirth and represents increased cardiovascular strain and risk. Increasing prevalence of sedentary behaviour and lack of aerobic fitness may reduce heart rate reserve during labour. STUDY DESIGN We quantified maternal heart rate reserve (maximum heart rate minus resting heart rate) of 30 healthy pregnant women during labour and delivery and related it to habitual daily physical activity levels quantified during the third pregnancy trimester by the Pregnancy Physical Activity Questionnaire. RESULTS Heart rates during labour reached values similar to those observed during moderate to heavy physical exercise. During active pushing one out of five women reached heart rates more than 90% of their heart rate reserve (188 ± 7 beats per min). Half of the women reached more than 70% of heart rate reserve (172 ± 14 beats per min). Physically inactive women used more of their heart rate reserve as physically more active women (87 ± 20% vs. 65 ± 12%, upper and lower tertile respectively, p<0.05). CONCLUSIONS Use of heart rate reserve for the effort of labour is increased in physically inactive women and may potentially limit the intensity and duration of pushing efforts. Such higher cardiovascular strain in physically less active women may represent increased cardiovascular risk during labour.

Pertussis Antibody Transfer to Preterm Neonates After Second- Versus Third-Trimester Maternal Immunization

Abstract Preterm infants are most vulnerable to pertussis. Whether they might benefit from maternal immunization is unknown. Extending our previous results in term neonates, this observational study demonstrates that second- rather than third-trimester maternal vaccination results in higher birth anti–pertussis toxin titers in preterm neonates.

Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial

To evaluate the efficacy of the hands and knees position during the first stage of labour to facilitate the rotation of the fetal head to the occiput anterior position.

Maternal positioning to correct occipito-posterior fetal position in labour: a randomised controlled trial

BackgroundThe occipito-posterior (OP) fetal head position during the first stage of labour occurs in 10-34% of cephalic presentations. Most will spontaneous rotate in anterior position before delivery, but 5-8% of all births will persist in OP position for the third stage of labour. Previous observations have shown that this can lead to an increase of complications, such as an abnormally long labour, maternal and fetal exhaustion, instrumental delivery, severe perineal tears, and emergency caesarean section. Usual care in the case of diagnosis of OP position is an expectant management. However, maternal postural techniques have been reported to promote the anterior position of the fetal head for delivery. A Cochrane review reported that these maternal positions are well accepted by women and reduce back pain. However, the low sample size of included studies did not allow concluding on their efficacy on delivery outcomes, particularly those related to persistent OP position. Our objective is to evaluate the efficacy of maternal position in the management of OP position during the first stage of labour.Methods/designA randomised clinical trial is ongoing in the maternity unit of the Geneva University Hospitals, Geneva, Switzerland. The unit is the largest in Switzerland with 4,000 births/year. The trial will involve 438 women with a fetus in OP position, confirmed by sonography, during the first stage of the labour. The main outcome measure is the position of the fetal head, diagnosed by ultrasound one hour after randomisation.DiscussionIt is important to evaluate the efficacy of maternal position to correct fetal OP position during the first stage of the labour. Although these positions seem to be well accepted by women and appear easy to implement in the delivery room, the sample size of the last randomised clinical trial published in 2005 to evaluate this intervention had insufficient power to demonstrate clear evidence of effectiveness. If the technique demonstrates efficacy, it would reduce the physical and psychological consequences of complications at birth related to persistent OP position.Trial registrationClinicalTrials.gov, http://www.clinicaltrials.gov: (no. NCT01291355).

Population differences and the effect of vaginal progesterone on preterm birth in women with threatened preterm labor

Abstract Objective: Threatened preterm labor (tPTL) is a complication of pregnancy. Identification of women and clinical definition differs between countries. This study investigated differences in tPTL and effectiveness of vaginal progesterone to prevent preterm birth (PTB) between two countries. Methods: Secondary analysis of a randomized controlled trial (RCT) from Argentina and Switzerland comparing vaginal progesterone to placebo in women with tPTL (n = 379). Cox proportional hazards analysis was performed to compare placebo groups of both countries and to compare progesterone to placebo within each country. We adjusted for baseline differences. Iatrogenic onset of labor or pregnancy beyond gestational age of interest was censored. Results: Swiss and Argentinian women were different on baseline. Risks for delivery <14 days and PTB < 34 and < 37 weeks were increased in Argentina compared to Switzerland, HR 3.3 (95% CI 0.62–18), 54 (95% CI 5.1–569) and 3.1 (95% CI 1.1–8.4). In Switzerland, progesterone increased the risk for delivery <14 days [HR 4.4 (95% CI 1.3–15.7)] and PTB <37 weeks [HR 2.5 (95% CI 1.4–4.8)], in Argentina there was no such effect. Conclusion: In women with tPTL, the effect of progesterone may vary due to population differences. Differences in populations should be considered in multicenter RCTs.

Authors' reply re: Maternal positioning to correct occiput posterior fetal position during the fi rst stage of the labour: a randomised controlled trial

Sir, We thank Dr Shunji Suzuki for his interest in our study and his remarks. We have not assessed the pelvis shape in our trial. We analysed our main outcome according to ethnicity (reported to be associated with pelvic shape) and to the degree of fetal head descent at randomisation. There was no statistically significant difference between groups for occipito-anterior position of the fetal head 1 hour after the randomisation when stratifying for the ethnic origin (Caucasian 36/266, 14%; African 11/58, 19%; Asian 6/22, 27%; Hispanic 6/65, 9%) (P = 0.22), and for the station of the presenting part (above ischial spines, at ischial spines and below ischial spines) (P = 0.71). The analysis of the latter is limited by the small number of women with a fetus in low presentations. Another randomised trial evaluated the efficacy of maternal posturing according the fetal head station during labour in preventing persistent occiput posterior position and failed to demonstrate any maternal or neonatal benefit to a policy of maternal posturing for the management of occiput posterior position during labour, according the fetal head station. We are therefore unable to provide evidence for the hypothesis raised by Dr Suzuki.&