Relevant bibliographies by topics / Fetal outcomes

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Fetal outcomes'

Author: Grafiati
Published: 4 June 2021
Last updated: 27 April 2022

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Journal articles on the topic "Fetal outcomes"

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Edwards, Morven S. "Adverse Fetal Outcomes." JAMA 311, no. 11 (March 19, 2014): 1115. http://dx.doi.org/10.1001/jama.2014.1889.

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Abbasalizadeh, Fatemeh, Shamsi Abbasalizadeh, Shamsi Ghaffari, Rabee Hesami, and Leyla Hesmai. "Fetal Arrhythmias and Related Fetal and Neonatal Outcomes." International Journal of Women's Health and Reproduction Sciences 4, no. 3 (September 5, 2015): 130–33. http://dx.doi.org/10.15296/ijwhr.2016.30.

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Camargo, Sávio F., Juliana D. Camargo, Daniel Schwade, Raíssa M. Silva, Maria da Conceição M. Cornetta, Ricardo N. Cobucci, and Eduardo C. Costa. "Movement Behavior during Pregnancy and Adverse Maternal–Fetal Outcomes in Women with Gestational Diabetes: A Pilot Case-Control Study." International Journal of Environmental Research and Public Health 18, no. 3 (January 27, 2021): 1114. http://dx.doi.org/10.3390/ijerph18031114.

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Gestational diabetes mellitus (GDM) is a major complication in pregnancy. GDM is associated with a higher risk for adverse maternal–fetal outcomes. Associations between movement behavior, including physical activity (PA) and sedentary behavior (SB), and maternal–fetal outcomes are still unclear. The objective of this study was to investigate associations between movement behavior and adverse maternal–fetal outcomes in women with GDM. A total of 68 women with GDM (20–35 weeks, 32.1 ± 5.8 years) were included in this pilot case-control study. The cases were defined by the presence of an adverse composite maternal–fetal outcome (preterm birth, newborn large for gestational age, and neonatal hypoglycemia). Controls were defined as no adverse maternal–fetal outcome. PA intensities and domains, steps/day (pedometer), and SB were analyzed. A total of 35.3% of participants showed adverse maternal–fetal outcomes (n = 24). The controls showed a higher moderate-intensity PA level than the cases (7.5, 95%CI 3.6–22.9 vs. 3.1, 95%CI 0.4–10.3 MET-h/week; p = 0.04). The moderate-intensity PA level was associated with a lower risk for adverse maternal–fetal outcomes (OR 0.21, 95%CI 0.05–0.91). No significant associations were observed for other PA and SB measures (p > 0.05). In conclusion, moderate-intensity PA during pregnancy seems to have a protective role against adverse maternal–fetal outcomes in women with GDM.
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Ge, Christina J., Amanda C. Mahle, Irina Burd, Eric B. Jelin, Priya Sekar, and Angie C. Jelin. "Fetal CHD and perinatal outcomes." Cardiology in the Young 30, no. 5 (April 20, 2020): 686–91. http://dx.doi.org/10.1017/s1047951120000785.

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AbstractObjective:To evaluate delivery management and outcomes in fetuses prenatally diagnosed with CHD.Study design:A retrospective cohort study was conducted on 6194 fetuses (born between 2013 and 2016), comparing prenatally diagnosed with CHD (170) to those with non-cardiac (234) and no anomalies (5790). Primary outcomes included the incidence of preterm delivery and mode of delivery.Results:Gestational age at delivery was significantly lower between the CHD and non-anomalous cohorts (38.6 and 39.1 weeks, respectively). Neonates with CHD had a significantly lower birth weights (p < 0.001). There was an approximately 1.5-fold increase in the rate of primary cesarean sections associated with prenatally diagnosed CHD with an odds ratio of 1.49 (95% CI 1.06–2.10).Conclusions:Our study provides additional evidence that the prenatal diagnosis of CHD is associated with a lower birth weight, preterm delivery, and with an increased risk of delivery by primary cesarean section.
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Fanaroff, A. A. "Fetal macrosomia and pregnancy outcomes." Yearbook of Neonatal and Perinatal Medicine 2010 (January 2010): 15–16. http://dx.doi.org/10.1016/s8756-5005(10)79203-9.

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Carney, Ellen F. "Fetal growth and renal outcomes." Nature Reviews Nephrology 10, no. 7 (May 27, 2014): 361. http://dx.doi.org/10.1038/nrneph.2014.97.

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Ju, H., Y. Chadha, T. Donovan, and P. OʼRourke. "Fetal Macrosomia and Pregnancy Outcomes." Obstetric Anesthesia Digest 30, no. 4 (December 2010): 231–32. http://dx.doi.org/10.1097/01.aoa.0000389609.94004.12.

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HOFFMAN, MATTHEW K., AUDREY A. MERRIAM, and DEBORAH B. EHRENTHAL. "Fetal Outcomes of Elective Delivery." Clinical Obstetrics and Gynecology 57, no. 2 (June 2014): 401–14. http://dx.doi.org/10.1097/grf.0000000000000030.

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JU, Hong, Yogesh CHADHA, Tim DONOVAN, and Peter O’ROURKE. "Fetal macrosomia and pregnancy outcomes." Australian and New Zealand Journal of Obstetrics and Gynaecology 49, no. 5 (October 2009): 504–9. http://dx.doi.org/10.1111/j.1479-828x.2009.01052.x.

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More, Vibha S. "Fever in pregnancy and its maternal and fetal outcomes." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 12 (November 23, 2017): 5523. http://dx.doi.org/10.18203/2320-1770.ijrcog20175273.

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Background: Contemporary obstetrics has witnessed improved maternal and fetal outcomes, owing to several advances. Any source of maternal hyperthermia that results in significant core temperature increase (>38.9°C), could potentially affect the fetus. Hence a study was planned to know the effect of fever on maternal and fetal outcome.Methods: This was a retrospective cohort analysis of case-records, of patients admitted in the Department of Obstetrics and Gynecology at tertiary care centre, Mumbai, between May 2007 and October 2009. The main parameters of assessment included incidence of fever in pregnancy, causes of fever, effect of episode(s) of fever on maternal and fetal outcomes, effect of specific infection on maternal and fetal outcomes, impact of fever on antepartum, intrapartum and postpartum phasesResults: The incidence of fever was 10.5%. the common cause of fever was malaria (15%), urinary tract infection (14%), viral (14%), respiratory tract infection (18%), and typhoid (7%). Seventy eight percent had fever in third trimester. The most common antenatal complication observed was preterm (13%), premature rupture of membrane (12%), oligohydramnios (8%), intrauterine growth retardation (26%). The rate of LSCS was 13% in study group and the most common indication was fetal distress and meconium stained amniotic fluid.Conclusions: In the present study on fever during pregnancy and its maternal and fetal outcomes, fever was associated with a definite impact on maternal and fetal outcomes. Preterm and IUGR were the most common fetal complications. Duration of fever was linearly associated with poor outcomes. Different causes of fever also had different impact on maternal and fetal outcome. Preterm IUGR, MSAF were more common with malaria and tuberculosis. Abortion was more commonly seen in first trimester fever, whereas preterm, PROM in the third trimester fever. Hence it is suggested that fever during pregnancy needs to be promptly investigated and treated to have a better outcome.
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Dissertations / Theses on the topic "Fetal outcomes"

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Cheong-See, Fi. "Predictors for adverse maternal and fetal outcomes in high risk pregnancy." Thesis, Queen Mary, University of London, 2017. http://qmro.qmul.ac.uk/xmlui/handle/123456789/25811.

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This thesis aims to undertake health technology assessments in high risk pregnancies through the following objectives: 1. In women with pre-eclampsia, a) To evaluate the association of maternal genotype and severe pre-eclampsia b) To assess the accuracy of tests in predicting adverse pregnancy outcomes c) To develop composite outcomes for reporting in trials on late onset pre-eclampsia 2. In women with multiple pregnancy, a) To study the association between chorionicity and stillbirth b) To identify the optimal timing of delivery in monochorionic and dichorionic twin pregnancies 3. In the field of prediction research in obstetrics a) To provide an overview of the existing prognostic models and their qualities b) To evaluate the methodological challenges and potential solutions in developing a prognostic model for complications in pre-eclampsia Methods The following research methodologies were used: Delphi survey, systematic reviews and meta-analyses. Results 1. a) Maternal genotype and severe pre-eclampsia: 57 studies evaluated 50 genotypes; increased risk of severe pre-eclampsia with thromobophilic genes. b) Accuracy of tests in predicting pre-eclampsia complications: 37 studies evaluated 13 tests. No single test showed high sensitivity and specificity. c) Delphi survey of 18/20 obstetricians and 18/24 neonatologists identified clinically important maternal and neonatal outcomes and maternal and neonatal composite outcomes were developed. 2. Prospective risk of stillbirth and neonatal deaths in uncomplicated monochorionic and dichorionic twin pregnancies: 32 studies were included. In dichorionic twin pregnancies, the risk of stillbirths was balanced against neonatal death at 37 weeks' gestation. In monochorionic pregnancies, there was a trend towards increase in stillbirths after 36 weeks but this was not significant. 3. a) From 177 studies included, 263 obstetric prediction models were developed for 40 different outcomes, most commonly pre-eclampsia, preterm delivery, mode of delivery and small for gestational age neonates. b) The obstetric prognostic model challenge of dealing with treatment paradox was explored and seven potential solutions proposed by expert consensus. Conclusion I have identified the strength of association for genes associated with complications in pre-eclampsia, components for composite outcomes for reporting in studies on pre-eclampsia, and the optimal timing of delivery for twin pregnancies. My work has highlighted the gaps in prediction research in obstetrics and the limitations of individual tests in pre-eclampsia.
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Ruby, Jeannine Alberts. "Nonobstetric laparoscopy versus laparotomy during pregnancy maternal and fetal outcomes /." [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-153253/.

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Allen, Rebecca Emma. "Prediction and prevention of preeclampsia and other adverse pregnancy outcomes." Thesis, Queen Mary, University of London, 2018. http://qmro.qmul.ac.uk/xmlui/handle/123456789/33944.

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Aim To assess current methods of prediction of adverse pregnancy outcomes, develop a prediction model and assess diet and life style in preventing preeclampsia. Methods Meta-analyses performed to assess the role of abnormal 1st trimester biomarker levels in predicting PE and the predictive accuracy of 2nd trimester UAD indices for stillbirth. A prospective observational study was performed to assess the efficacy of maternal characteristics, biomarkers, arteriography and UADs for predicting adverse pregnancy outcomes. Previously published 1st trimester PE prediction models were validated using data collected from the observational study. A systematic review on the effect of diet and life style based metabolic risk modifying interventions on PE was performed. Results The review of biomarkers found that abnormal levels were particularIy associated with early onset PE. The stillbirth review demonstrated a three-four fold increased risk of still birth with abnormal UAD. 1045 women were included for analysis in the prospective observational study. Our models' detection rate (false positive rate of 15%) was 72% for PE; 48% PIH; 30 % SGA < 10th centile; 57% SGA < 5th centile and 67% stillbirth. In the validation study the observed discrimination ability in the derivation studies ranged from 0.70 to 0.954. When validated against the study cohort, the AUC varied importantly, ranging from 0.504 to 0.833. Dietary interventions were shown to reduce the risk of PE by 33%, with no reduction in risk with mixed interventions or fatty acid supplementation. Conclusion The high heterogeneity of studies in the systematic reviews makes it difficult to draw firm conclusions regarding the use of biomarkers or UADs in screening for pregnancy complications. Our prospective study showed a role for haemodynamics as part of routine 1st trimester screening for assessing the risk of hypertensive disease in pregnancy.
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Wright, Erica, and n/a. "Gestational diabetes : a management approach to identify increased risk of an adverse pregnancy outcome." University of Canberra. Nursing, 1997. http://erl.canberra.edu.au./public/adt-AUC20061110.171500.

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Gestational diabetes (GDM) is a potentially serious disorder requiring timely diagnosis and management to prevent adverse maternal and fetal outcomes. Of increasing concern today, when treating the woman with GDM, is the need to provide every woman with an intensive management plan to optimise the likelihood of favourable pregnancy outcomes. Early identification of those women with GDM who require insulin therapy in addition to diet therapy would be beneficial in the planning and standardisation of clinical management protocols, to enhance pregnancy outcomes and increase cost benefits with improved allocation of resources. The aim of this study was to evaluate the ability of the fasting plasma glucose level (FPG) at diagnosis to predict an increased risk to the fetus and the need for insulin therapy in a pregnancy complicated by GDM. A prospective longitudinal study design and recruitment by convenience sample was used. Data were obtained from 327 women and their babies. Diagnosis of GDM was made by a 75 gram oral glucose tolerance test (OGTT) using Australasian Diabetes in Pregnancy Society (ADIPS) criteria with the exception of seven women diagnosed on a blood glucose level >11.1mmol/l. Following consent of the women data were collected by a self report questionnaire and the medical record system at three points; at first intervention, following delivery and at the postpartum OGTT. Demographic, social, medical, maternal and neonatal outcome data were collected. The management protocol was similar for all of the women. Following nutritional intervention any woman who could not meet the glycemic targets of <= 5mmol/l fasting and/or <= 6.5mmol/l two hours postprandial was commenced on insulin therapy. The women had a mean age of 32 years, body mass index (BMI) of 25.7 and parity of 2 (range 1-12). Diagnosis was made at an average of 30 weeks and 70 women required insulin therapy with a mean dose of 34 IU per day, commencing at a mean of 31 weeks gestation. Mean birthweight was 3400G. Of the babies 12% were >4000G. Congenital abnormalities occurred in 3%, neonatal morbidities in 2% and there was 1 death in utero. Logistic regression analysis found the following significant associations: Increasing maternal BMI was related to increasing FPG levels at diagnosis and the requirement of higher insulin doses. There was a negative linear relationship to weight gain. Ethnicity was associated with maternal BMI and ethnicity with BMI was associated with birthweight in the specific ethnic group. BMI with insulin therapy as a covariate and the FPG value at OGTT were predictive of persistent glucose intolerance in 14% of women postpartum. Each value of the OGTT was a significant predictor of the need for insulin therapy as a function of the week of gestation. The FPG level was the statistical model of best fit. A 50% probability for requiring insulin was reached with a FPG at diagnosis of 4.0 mmol/l if tested at 10 weeks gestation, 5.1mmol/l at 20 weeks and 6.1 mmol/l at 30 weeks (p<.001). These results support the substantive research aim of the study. The model has the power to predict the probability (risk) of requiring insulin therapy based on the maternal FPG level at the OGTT according to the week of gestation. The study results demonstrate that glucose intolerance is linked to a number of adverse maternal and fetal outcomes in a continuous and graded fashion. The degree of reversibility of maternal and fetal risk through therapeutic interventions such as nutrition therapy, blood glucose monitoring, exercise and active patient participation aimed at improving glucose tolerance is unknown. Therefore, the rationale for, and feasibility of, new treatment strategies such as the application of this statistical model as a management approach require large scale randomised intervention studies, oriented toward measuring maternal and fetal outcomes amongst different populations.
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Patek, Kyla J. "Posterior fossa anomalies diagnosed with fetal MRI: Associated anomalies and neurodevelopmental outcomes." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1305892532.

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Aḥmad, ʿĀʾishah. "The association between fetal position at the onset of labour and birth outcomes." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3723/.

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Fetal position throughout labour exerts considerable influence on labour and delivery, with a mal-positioned fetus during active labour known to contribute towards fetal and maternal morbidity. In response there is a move towards promoting the Left Occipito-Anterior (LOA) position at labour onset as optimal. It is thought that the LOA position encourages anterior rotation thus reducing the likelihood of mal-rotation. A systematic review was undertaken which highlighted an absence of scientific evidence. A prospective cohort study was therefore conducted with 1250 nulliparous women who were scanned to accurately determine fetal position, specifically the LOA position at the onset of labour and the association with delivery mode and other birth outcomes was examined. The LOA position at the onset of labour was not associated with mode of delivery, nor were any of the other positions (p=0.39). Pain relief, labour duration, augmentation, and Apgar scores did not show any association with the LOA or other positions. The only association found was that women with a fetus in the posterior position were more likely to use pethidine (p=0.008). This study has shown that the LOA fetal position at labour onset was not associated with improved outcomes and therefore should not be promoted as optimum.
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Bennini, Junior João Renato 1978. "Gastrosquise = ultrassonografia na estimativa do peso fetal e predição de desfechos perinatais = Gastroschisis: ultrasonography for fetal weight estimation and prediction of perinatal outcomes." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312556.

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Orientadores: Cleisson Fábio Andrioli Peralta, Ricardo Barini
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-24T09:18:09Z (GMT). No. of bitstreams: 1 BenniniJunior_JoaoRenato_D.pdf: 3747485 bytes, checksum: 5e1bebb4894e53ecc9d1bb5c186b29c1 (MD5) Previous issue date: 2014
Resumo: Introdução: A literatura é controversa sobre o papel de parâmetros ultrassonográficos pré-natais na predição do risco de morbidade e mortalidade perinatais nos casos de gastrosquise. O peso ao nascimento é descrito como um importante fator prognóstico e estudos relatam que fórmulas ultrassonográficas criadas especificamente para esses casos apresentam melhor desempenho na estimativa do peso fetal, mas não há consenso sobre qual a melhor. Objetivos: Avaliar o papel de parâmetros ultrassonográficos pré-natais na predição de desfechos perinatais em casos de gastrosquise. Criar uma nova fórmula ultrassonográfica para estimativa de peso fetal que não utilize medidas abdominais e compará-la à outras fórmulas com parâmetros ultrassonográficos bidimensionais (US2D) e tridimensionais (US3D) quando aplicadas em fetos com gastrosquise. Métodos: Para avaliar o desempenho de parâmetros ultrassonográficos pré-natais na predição de desfechos perinatais foi realizado um estudo de coorte retrospectiva envolvendo fetos com o diagnóstico de gastrosquise isolada. Para criar e validar a nova fórmula US2D foram utilizados dados referentes à gestantes e fetos normais coletados em um estudo prévio publicado pelo nosso grupo. Foi realizado um estudo retrospectivo transversal envolvendo fetos com gastrosquise, para comparar a nova fórmula US2D com diferentes fórmulas US2D e US3D já publicadas. Os sujeitos foram selecionados entre aqueles acompanhados na Divisão de Obstetrícia do CAISM / UNICAMP. O tamanho da amostra foi estimado em 56 pacientes para avaliar o desempenho de parâmetros ultrassonográficos pré-natais na predição de desfechos perinatais e 27 pacientes para comparar as fórmulas de estimativa de peso fetal. Os dados maternos, gestacionais e pós-natais foram descritos como freqüências relativas e absolutas, média ± desvio padrão (DP), mediana e limites. A normalidade dos dados contínuos foi testada utilizando-se o teste de Kolmogorov¿Smirnov. Testes t de amostras independentes e testes de qui-quadrado foram utilizados na comparação de dados contínuos e categóricos, respectivamente. Análises de regressão polinominal até o terceiro grau foram consideradas para criar a nova fórmula US2D de estimativa do peso fetal sem medidas abdominais. Cálculo do erro percentual médio ± DP, testes t unilaterais, testes t de amostras pareadas com correção de Bonferroni e testes de variância para amostras pareadas foram usados para avaliar e comparar a acurácia e precisão das fórmulas. A associação entre dados contínuos foi testada utilizando-se os coeficientes de correlação de Pearson ou Spearman e regressão logística univariada, conforme indicado. Valores de p < 0,05 foram considerados significativos. Resultados: Foram incluídos 44 casos de fetos com gastrosquise para avaliar a predição de desfechos perinatais por meio de parâmetros ultrassonográficos pré-natais. A presença de dilatação de alças intestinais intra-abdominais (DAI) fetais aumentou o risco de complicacões intestinais pós-natais e a presença de restrição de crescimento fetal (RCF) diminuiu o risco deste mesmo desfecho. Nenhum outro parâmetro ultrassonográfico pré-natal pode significativamente predizer os desfechos perinatais avaliados. Foram usados os dados referentes aos mesmos grupos de 150 fetos normais e 60 fetos normais do estudo prévio para respectivamente criar e validar a nova fórmula US2D, que foi a seguinte: peso fetal estimado (PFE) = 623.324 + 0.165 x DBP x CC x CF2 (DP: 12,25%). Na comparação entre as fórmulas US2D e entre as fórmulas US2D e US3D, foram utilizados 44 e 28 fetos com gastrosquise isolada, respectivamente. O melhor desempenho na estimativa do peso de fetos com gastrosquise foi obtido com o modelo US2D proposto por Siemer e colaboradores. Conclusões: Em fetos com gastrosquise o achado de DAI múltipla associa-se a complicações intestinais pós-natais e a presença de RCF possui um efeito protetor para este mesmo desfecho. A nova fórmula US2D sem medidas abdominais não melhorou a estimativa do peso ao nascimento dos fetos com gastrosquise da nossa população em relação às outras fórmulas US2D e US3D avaliadas. Na nossa amostra de pacientes com gastrosquise o modelo S2D de Siemer e colaboradores apresentou o melhor desempenho na estimativa de peso
Abstract: Background: The role of prenatal ultrasonographic parameters for the predicition of perinatal outcomes in fetuses with gastroschisis is still controversial. Birthweight is described as a prognostic factor and some studies report that ultrasonographic formulas especifically created for these cases have a better performance for fetal weight estimation, but there is no consensus about which is the best one. Objectives: To evaluate prenatal ultrasonographic parameters as predictors of adverse perinatal outcomes in fetuses with gastroschisis. To create a new birthweight predicting ultrasonographic model without abdominal measurements and compare this new formula with other two-dimensional (2DUS) and three-dimensional (3DUS) fetalweight predicting models already published when aplied to fetuses with gastroschisis. Methods: To evaluate the performance of prenatal ultrasonographic parameters as predictors of perinatal outcomes in fetuses with gastroschisis a retrospective cohort study was done. To create and validate the new 2DUS formula the same data from normal fetuses colected in a previous study of our group was used. A retrospective cross-sectional study encompassing fetuses with gastroschisis was carried out to compare the new 2DUS formula with other 2DUS and 3DUS formulas already published. The patients were selected among those followed at the Division of Obstetrics of the Center for Integral Assistance to Women¿s Health of the State University of Campinas (UNICAMP). The sample size was estimated in 56 patients to evaluate prenatal ultrasonographic predictors and perinatal outcomes and 27 patients to compare the fetal weigth estimating formulas. Maternal, pregnancy and postnatal data were described as absolute and percentual frequencies, mean ± standard deviation (SD), median and range. Continuous data were tested for their normal distribution using the Kolmogorov¿Smirnov test. Independent samples t tests and chi-square tests were used in the assessment of continuous and categorical variables, when appropriate. Polynomial stepwise regression analyses up to the third order were considered to generate a new 2DUS weight-predicting model without abdominal measurements. Calculation of the mean percentage error ± SD, one-sample t tests, paired samples t-tests with Bonferroni adjustment and correlated variance tests for paired samples were used to compare the performances of the formulas. The potential association between continuous data was tested by means of Pearson or Spearman¿s Correlation Coefficient and univariate logistic regression, as indicated. A two-tailed p-value of less than 0.05 was considered statistically significant. Results: Forty-four fetuses were included to evaluate the ultrasonographic prental parameters as predictors of perinatal outcomes. The presence of fetal multiple intra-abdominal bowel dilation (IBD) was associated with increased incidence of intestinal complications and the presence of fetal growth restriction (FGR) had a protective effect over this outcome. No other prenatal ultrasographic parameter could significantly predict the perinatal outcomes evaluated. It was used the same data from our previous study on 150 normal fetuses and 60 normal fetuses to respectively generate and validate the new 2DUS formula, that was: estimated fetal weight = 623.324 + 0.165 x BPD x HC x FDL2 (SD: 12.25). In the comparison between the 2DUS formulas and between the 2DUS and 3DUS formulas it was included 44 and 28 fetuses, respectively. The best performance for weight prediction in fetuses with gastroschisis was achieved using the model created by Siemer et al. Conclusions: In fetuses with gastroschisis the findings of multiple IBD increases the risk of postnatal bowel complications and the presence of FGR decreases the risk of this outcome. The new 2DUS formula without abdominal measurements did not improve fetal weight estimation in fetuses with gastroschisis of our population when compared to other 2DUS and 3DUS formulas evaluated. The 2DUS weight estimating model of Siemer et al had the best performance for this purpose
Doutorado
Saúde Materna e Perinatal
Doutor em Ciências da Saúde
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Tennant, Peter William George. "Pre-pregnancy obesity, pre-existing diabetes, and the risks of serious adverse fetal outcomes." Thesis, University of Newcastle upon Tyne, 2016. http://hdl.handle.net/10443/3447.

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The epidemics of obesity and diabetes are two of the leading threats to health in the 21st century. Maternal obesity complicates a large and increasing minority of pregnancies, and pre-existing diabetes is one of the most common maternal chronic health complications of pregnancy. This Doctoral Statement presents a portfolio of six published articles that draw on the North of England’s long-standing population-based registries of maternal and perinatal health to investigate the effects of pre-pregnancy obesity and diabetes on a range of serious adverse pregnancy outcomes. The first two articles examined a cohort of pregnant women who delivered in five of the region’s hospitals during 2003-2005 to explore the associations between maternal body mass index and the risks of, 1) congenital anomaly and 2) fetal and infant death. The next three examined a cohort of pregnant women with pre-existing diabetes who delivered during 1996-2008 to explore the effects of the condition on, 1) congenital anomaly, 2) birth weight, and 3) fetal and infant death. The final article examined women with pre-existing diabetes who had delivered two successive pregnancies to explore the influences of recurrent adverse pregnancy outcome. Maternal pre-pregnancy obesity and diabetes were both associated with increased risks of congenital anomaly, stillbirth, and infant death, with stronger effects for diabetes than obesity. In diabetes, peri-conception glycaemic control was strongly associated with birthweight and the risks of congenital anomaly, stillbirth, and infant death, and previous adverse outcome was associated with a doubled risk in the second pregnancy. For each article I provide a contemporary analysis of its contribution to the literature and critique of the methodology. The wider relevance of the research is also considered by discussing the evidence for causality, potential mechanisms, and implications for public health. Finally, I reflect on my individual contributions and my development towards an independent epidemiologist.
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Gunn, J. K. L., C. B. Rosales, K. E. Center, A. V. Nunez, S. J. Gibson, and J. E. Ehiri. "The effects of prenatal cannabis exposure on fetal development and pregnancy outcomes: a protocol." BMJ, 2015. http://hdl.handle.net/10150/617200.

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UA Open Access Publishing Fund
Introduction: The effects of exposure to marijuana in utero on fetal development are not clear. Given that the recent legislation on cannabis in the US is likely to result in increased use, there is a need to assess the effects of prenatal cannabis exposure on fetal development and pregnancy outcomes. The objective of this review is to assess the effects of prenatal exposure to cannabis on pregnancy outcomes (including maternal and child outcomes). Methods and analyses: Major databases will be searched from inception to the latest issue, with the aim of identifying studies that reported the effects of prenatal exposure to cannabis on fetal development and pregnancy outcomes. Two investigators will independently review all titles and abstracts to identify potential articles. Discrepancies will be resolved by repeated review, discussion and consensus. Study quality assessment will be undertaken, using standard protocols. To qualify for inclusion, studies must report at least one maternal or neonatal outcome post partum. Cross-sectional, case–control, cohort and randomised controlled trials published in English will be included. In order to rule out the effects of other drugs that may affect fetal development and pregnancy outcomes, studies will only be included if they report outcomes of prenatal exposure to cannabis while excluding other illicit substances. Data from eligible studies will be extracted, and data analysis will include a systematic review and critical appraisal of evidence, and meta-analysis if data permit. Meta-analysis will be conducted if three or more studies report comparable statistics on the same outcome. Ethics and dissemination: The review which will result from this protocol has not already been conducted. Preparation of the review will follow the procedures stated in this protocol, and will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ethical approval of data will not be required since the review will use data that are already available in the public domain through published articles and other reports.
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Ndovie, Lughano. "Maternal and fetal outcomes of induction of labour using oral misoprostol at New Somerset Hospital." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28074.

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Introduction: Induction of labour is commonly performed in clinical practice. Increasing rates of induction of labour worldwide has led to debate on whether elective induction improves the outcomes or simply leads to increased complications and healthcare costs. Maternal and neonatal complications and increased caesarean section (CS) rates associated with induction of labour are related to a variety of factors influencing the methods of induction. Misoprostol has been the drug of choice for induction of labour in developing countries for almost a decade. Different misoprostol regimens are used for induction of labour in different health facilities. New Somerset Hospital uses the standard protocol for induction of labour using misoprostol that the Western Cape Government adopted. This protocol has however not been audited. The main objective of the study was to determine the maternal and fetal outcomes of inductions of labour performed at New Somerset Hospital. Methods: This was a retrospective study conducted at New Somerset Hospital. We reviewed a random sample of medical records of patients who underwent induction of labour from 01 January 2014 to 31 December 2014. Ethics committee approval was granted by the Human Research Ethics Committee of the Faculty of Health Sciences of UCT. A total of 88 folders were sampled from 1029 women who had induction of labour. Results: There were a total of 6514 deliveries in 2014 of which 1029 had induction of labour, giving an induction rate of 15.8%. A total of 86 patients were included in the study. The mean age of the patients was 28.9 years (SD±6.586) with an age range of 16 to 44 years. The average gestational age at the time of induction of labour was 39.5 weeks with a range 35 to 42.6 weeks and 14.0% of the patients were HIV positive. The three main indications of induction of labour were hypertension in pregnancy (40.7%), prolonged pregnancy (27.9%) and pre-labour rupture of membranes (8.1%). Overall, 50 patients (58.1%) had vaginal delivery and 36 patients (41.9%) had caesarean delivery. There was a significant association between mode of delivery and time to delivery. Patients who delivered within 24 hours of commencement of induction of labour were more likely to have had a vaginal delivery (p = 0.005). The three main indications for caesarean delivery were fetal heart rate changes (n=30; 72.0%) followed by failed induction of labour (n=9; 21.0%) and cephalopelvic disproportion (n=3; 7.0 %). In terms of maternal outcomes, 2 patients (2.3%) had hyperstimulation of the uterus, 6 patients (7.0%) had postpartum hemorrhage, 8 patients (9.3%) had vaginal tears and 5 patients (5.9%) had an episiotomy performed during delivery. The mean birth weight was 3262.1g (SD±503.77) with a range of 1925 to 4515 grams. At five minutes the means Apgar score was 9.8(SD ± 0.62) with range of 6 to 10. A total of 38 babies (44.3%) had meconium stained liquor documented at delivery, three babies (3.4%) required neonatal resuscitation upon delivery. There were 10 (11.6%) babies that were admitted to NICU. Conclusion: In this study we found that the prevalence of induction of labour was 15.8%. Hypertension in pregnancy, prolonged pregnancy and pre-labour rupture of membranes are the three common indications for induction of labour. Successful vaginal delivery was achieved in 51.0% of the study population. The caesarean delivery rate was high, mostly due to CTG changes The current induction of labour protocol using oral misoprostol is associated with acceptable maternal and fetal outcomes.
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Books on the topic "Fetal outcomes"

1

Agarwal, Nikhil. Toxic exposure in America: Estimating fetal and infant health outcomes. Cambridge, MA: National Bureau of Economic Research, 2009.

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Su, Min. Factors affecting adverse fetal, neonatal, and maternal outcomes in the Term Breech Trial. Ottawa: National Library of Canada, 2003.

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Patrias, Karen. Effect of corticosteroids for fetal maturation on perinatal outcomes: January 1985 through December 1993, plus selected earlier citations : 715 citations. Bethesda, Md: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, Reference Section, 1994.

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Patrias, Karen. Effects of corticosteroids for fetal maturation on perinatal outcomes: January 1985 through December 1993, plus selected earlier citations : 715 citations. Bethesda, Md. (8600 Rockville Pike): U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, Reference Section, 1994.

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Dées, Molnár, Decsi Tamás, Hunty Anne, and SpringerLink (Online service), eds. Early Nutrition Programming and Health Outcomes in Later Life: Obesity and Beyond. Dordrecht: Springer Netherlands, 2009.

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Consensus, Development Conference on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes (1994 Bethesda Md ). Report of the Consensus Development Conference on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes, February 28, 1994-March 2, 1994, Bethesda, Maryland. Bethesda (Md.): National Cancer Institute, 1994.

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Bové, Frank James. Population-based surveillance and etiological research of adverse reproductive outcomes and toxic wastes. [New Jersey]: New Jersey Dept. of Health, 1992.

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Anesthesia and the fetus. Chichester, West Sussex: Wiley-Blackwell, 2013.

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Making women pay: The hidden costs of fetal rights. Ithaca, N.Y: Cornell University Press, 2000.

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Infertility and pregnancy loss: A guide for helping professionals. San Francisco: Jossey-Bass, 1988.

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Book chapters on the topic "Fetal outcomes"

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Morewitz, Stephen J. "Maternal, Fetal, and Neonatal Outcomes." In Domestic Violence and Maternal and Child Health, 97–106. Boston, MA: Springer US, 2004. http://dx.doi.org/10.1007/978-0-306-48530-5_7.

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Deter, Russell L. "Standards for Fetal Growth and Neonatal Growth Outcomes." In Fetal Growth Restriction, 1–19. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-030-00051-6_1.

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Fall, Caroline H. D. "Fetal Malnutrition and Long-Term Outcomes." In Maternal and Child Nutrition: The First 1,000 Days, 11–25. Basel: S. KARGER AG, 2013. http://dx.doi.org/10.1159/000348384.

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Davies-Tuck, Miranda, Mary-Ann Davey, Joel A. Fernandez, Maya Reddy, Marina G. Caulfield, and Euan Wallace. "Ethnicity, Obesity, and Pregnancy Outcomes on Fetal Programming." In Diet, Nutrition, and Fetal Programming, 185–98. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-60289-9_15.

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Di Mascio, Daniele, and Vincenzo Berghella. "Intrapartum Fetal Weight Assessment and Delivery Outcomes." In Intrapartum Ultrasonography for Labor Management, 453–58. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-57595-3_38.

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Prabhakaran, Poornima, and Prabhakaran Dorairaj. "Maternal Malnutrition, Foetal Programming, Outcomes and Strategies in India." In Diet, Nutrition, and Fetal Programming, 371–84. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-60289-9_27.

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Glass, Leila, and Sarah N. Mattson. "Fetal Alcohol Spectrum Disorders: Academic and Psychosocial Outcomes." In Pediatric Neurotoxicology, 13–49. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-32358-9_2.

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Grohmann, Eva, Andreas Tulzer, Wolfgang Arzt, and Gerald Tulzer. "Pulmonary Valvuloplasty: Fetal, Neonatal, and Follow-Up Outcomes." In Fetal and Hybrid Procedures in Congenital Heart Diseases, 91–94. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-40088-4_13.

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Sone, Hideko, and Tin-Tin Win-Shwe. "Maternal Malnutrition, Fetal Programming, Outcomes, and Implications of Environmental Factors in Japan." In Diet, Nutrition, and Fetal Programming, 411–28. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-60289-9_30.

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Singh, Aruna, and Pradip Kumar Saha. "Protocol for management of late second-trimester and term fetal death." In Recurrent Pregnancy Loss and Adverse Natal Outcomes, 53–60. Boca Raton: CRC Press, 2020.: CRC Press, 2020. http://dx.doi.org/10.1201/9780429435027-6.

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Conference papers on the topic "Fetal outcomes"

1

Zupan, R., M. Meuli, U. Möhrlen, L. Mazzone, F. Krähenmann, M. Hüsler, R. Zimmermann, and N. Ochsenbein-Kölble. "Reproductive outcomes after fetal myelomeningocele repair." In Kongressabstracts zur Tagung 2020 der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). © 2020. Thieme. All rights reserved., 2020. http://dx.doi.org/10.1055/s-0040-1717997.

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Yii, I. Y., L. Yang, H. K. Tan, L. K. Tan, J. Thumboo, and Y. J. Poh. "FRI0393 Maternal and fetal outcomes in systemic lupus erythematosus." In Annual European Congress of Rheumatology, EULAR 2018, Amsterdam, 13–16 June 2018. BMJ Publishing Group Ltd and European League Against Rheumatism, 2018. http://dx.doi.org/10.1136/annrheumdis-2018-eular.4941.

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Hematbhai, Satodiya Mohit. "One step versus two step screening for gestational diabetes mellitus." In 16th Annual International Conference RGCON. Thieme Medical and Scientific Publishers Private Ltd., 2016. http://dx.doi.org/10.1055/s-0039-1685382.

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Objective: To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step vs. two step as a screening procedure. Methodology: A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two step approach (ACOG recommendation), Group B comprised of women screened by one step method (IADPSG criteria). Women diagnosed with ‘gestational diabetes’ were followed in antenatal clinic and incidence of GDM, maternal and fetal outcome between two groups were analyzed using SPSS. Results: The incidence of GDM was almost double using one step approach versus two step which was 19.2% and 11.8% respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio = 2.43 95% CI = 1.01-5.79). Further fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A vs. 7.4% in group B. In the group B 15 patients (15.8%) patients with GDM (based on FBS ≥92 mg/dl at 1st ANC visit) showed clinical symptoms & blood sugars in hypoglycemic range on MNT requiring resumption of normal diet. Conclusion: The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS ≥92 mg/dl at 1st ANC visit as per IADPSG) suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.
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Hematbhai, Satodiya Mohit. "Oral Abstract." In 16th Annual International Conference RGCON. Thieme Medical and Scientific Publishers Private Ltd., 2016. http://dx.doi.org/10.1055/s-0039-1685353.

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Objective: To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step vs. two step as a screening procedure. Methodology: A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two step approach (ACOG recommendation), Group B comprised of women screened by one step method (IADPSG criteria). Women diagnosed with ‘gestational diabetes’ were followed in antenatal clinic and incidence of GDM, maternal and fetal outcome between two groups were analyzed using SPSS. Results: The incidence of GDM was almost double using one step approach versus two step which was 19.2% and 11.8%respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio = 2.43 95% CI = 1.01-5.79). Further fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A vs. 7.4% in group B. In the group B 15 patients (15.8%) patients with GDM (based on FBS ≥ 92 mg/dl at 1st ANC visit) showed clinical symptoms and blood sugars in hypoglycemic range on MNT requiring resumption of normal diet. Conclusion: The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS ≥ 92 mg/dl at 1st ANC visit as per IADPSG) suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.
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Bajaj, Kanika. "Poster Abstract." In 16th Annual International Conference RGCON. Thieme Medical and Scientific Publishers Private Ltd., 2016. http://dx.doi.org/10.1055/s-0039-1685361.

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Tuberous sclerosis (TS) is a genetic disorder that is inherited in an autosomal dominant fashion with variable clinical manifestations including seizures, mental retardation, renal failure and pneumothorax. The literature on TS in pregnancy is largely based upon case reports which have shown a 43% complication rate including oligohydramnios, polyhydramnios, IUGR, hemorrhage from ruptured renal tumors, PPROM, renal failure, placental abruption and perinatal demise. We reporting a case of 33 yr old female with gravida 3 para 2 and live 2 with period of gestation 9 months with tuberous sclerosis, with severe oligohydramnios with fetal cardiomegaly and mild pericardial effusion and pleural effusion. She had facial angiofibromas along with bilateral renal angiomyolipomas. The previous fetal outcomes were normal, with facial angiofibroma. We report such a unique case having all clinically diagnostic physical sings of tuberous sclerosis with good fetal outcomes.
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Köcher, Laura, Marios Rossides, Katarina Remaeus, Johan Grunewald, Anders Eklund, Susanna Kullberg, and Elizabeth Arkema. "Maternal and fetal outcomes in sarcoidosis pregnancy: a Swedish population-based cohort study." In ERS International Congress 2019 abstracts. European Respiratory Society, 2019. http://dx.doi.org/10.1183/13993003.congress-2019.oa5156.

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Alijotas-Reig, Jaume, Enrique Esteve-Valverde, Elisa Llurba, and Josep Mª Gris. "FRI0191 TREATMENT OF REFRACTORY POOR APL-RELATED OBSTETRIC OUTCOMES WITH TNF-ALPHA BLOCKERS: MATERNAL-FETAL OUTCOMES IN A SERIES OF 18 CASES." In Annual European Congress of Rheumatology, EULAR 2019, Madrid, 12–15 June 2019. BMJ Publishing Group Ltd and European League Against Rheumatism, 2019. http://dx.doi.org/10.1136/annrheumdis-2019-eular.1279.

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Winkelhorst, D., M. Oostweegel, L. Porcelijn, R. Middelburg, J. Zwaginga, D. Oepkes, J. van der Bom, M. de Haas, and E. Lopriore. "Treatment and Outcomes of Fetal/Neonatal Alloimmune Thrombocytopenia: A Nationwide Cohort Study on Newly Detected Cases." In 7th International Conference on Clinical Neonatology—Selected Abstracts. Thieme Medical Publishers, 2018. http://dx.doi.org/10.1055/s-0038-1647095.

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Cruz-Tan, CA Dela. "395 Maternal and fetal outcomes among filipino patients with systemic lupus erythematosus: a single centre study." In LUPUS 2017 & ACA 2017, (12th International Congress on SLE &, 7th Asian Congress on Autoimmunity). Lupus Foundation of America, 2017. http://dx.doi.org/10.1136/lupus-2017-000215.395.

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Chen, D., and Z. Zhan. "SAT0427 Predictive value of fetal umbilical artery doppler in adverse pregnancy outcomes in patients with lupus nephritis." In Annual European Congress of Rheumatology, EULAR 2018, Amsterdam, 13–16 June 2018. BMJ Publishing Group Ltd and European League Against Rheumatism, 2018. http://dx.doi.org/10.1136/annrheumdis-2018-eular.5030.

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Reports on the topic "Fetal outcomes"

1

Agarwal, Nikhil, Chanont Banternghansa, and Linda T. M. Bui. Toxic Exposure in America: Estimating Fetal and Infant Health Outcomes. Federal Reserve Bank of St. Louis, 2009. http://dx.doi.org/10.20955/wp.2009.016.

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Agarwal, Nikhil, Chanont Banternghansa, and Linda Bui. Toxic Exposure in America: Estimating Fetal and Infant Health Outcomes. Cambridge, MA: National Bureau of Economic Research, May 2009. http://dx.doi.org/10.3386/w14977.

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Fausett, M. B. CenteringPregnancy (CP): A Longitudinal Correlational Study Designed to Evaluate Maternal and Fetal Outcomes After Participation in CP. Fort Belvoir, VA: Defense Technical Information Center, January 2014. http://dx.doi.org/10.21236/ada602371.

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Viswanathan, Meera, Jennifer Cook Middleton, Alison Stuebe, Nancy Berkman, Alison N. Goulding, Skyler McLaurin-Jiang, Andrea B. Dotson, et al. Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Systematic Review of Perinatal Pharmacologic Interventions. Agency for Healthcare Research and Quality (AHRQ), April 2021. http://dx.doi.org/10.23970/ahrqepccer236.

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Background. Untreated maternal mental health disorders can have devastating sequelae for the mother and child. For women who are currently or planning to become pregnant or are breastfeeding, a critical question is whether the benefits of treating psychiatric illness with pharmacologic interventions outweigh the harms for mother and child. Methods. We conducted a systematic review to assess the benefits and harms of pharmacologic interventions compared with placebo, no treatment, or other pharmacologic interventions for pregnant and postpartum women with mental health disorders. We searched four databases and other sources for evidence available from inception through June 5, 2020 and surveilled the literature through March 2, 2021; dually screened the results; and analyzed eligible studies. We included studies of pregnant, postpartum, or reproductive-age women with a new or preexisting diagnosis of a mental health disorder treated with pharmacotherapy; we excluded psychotherapy. Eligible comparators included women with the disorder but no pharmacotherapy or women who discontinued the pharmacotherapy before pregnancy. Results. A total of 164 studies (168 articles) met eligibility criteria. Brexanolone for depression onset in the third trimester or in the postpartum period probably improves depressive symptoms at 30 days (least square mean difference in the Hamilton Rating Scale for Depression, -2.6; p=0.02; N=209) when compared with placebo. Sertraline for postpartum depression may improve response (calculated relative risk [RR], 2.24; 95% confidence interval [CI], 0.95 to 5.24; N=36), remission (calculated RR, 2.51; 95% CI, 0.94 to 6.70; N=36), and depressive symptoms (p-values ranging from 0.01 to 0.05) when compared with placebo. Discontinuing use of mood stabilizers during pregnancy may increase recurrence (adjusted hazard ratio [AHR], 2.2; 95% CI, 1.2 to 4.2; N=89) and reduce time to recurrence of mood disorders (2 vs. 28 weeks, AHR, 12.1; 95% CI, 1.6 to 91; N=26) for bipolar disorder when compared with continued use. Brexanolone for depression onset in the third trimester or in the postpartum period may increase the risk of sedation or somnolence, leading to dose interruption or reduction when compared with placebo (5% vs. 0%). More than 95 percent of studies reporting on harms were observational in design and unable to fully account for confounding. These studies suggested some associations between benzodiazepine exposure before conception and ectopic pregnancy; between specific antidepressants during pregnancy and adverse maternal outcomes such as postpartum hemorrhage, preeclampsia, and spontaneous abortion, and child outcomes such as respiratory issues, low Apgar scores, persistent pulmonary hypertension of the newborn, depression in children, and autism spectrum disorder; between quetiapine or olanzapine and gestational diabetes; and between benzodiazepine and neonatal intensive care admissions. Causality cannot be inferred from these studies. We found insufficient evidence on benefits and harms from comparative effectiveness studies, with one exception: one study suggested a higher risk of overall congenital anomalies (adjusted RR [ARR], 1.85; 95% CI, 1.23 to 2.78; N=2,608) and cardiac anomalies (ARR, 2.25; 95% CI, 1.17 to 4.34; N=2,608) for lithium compared with lamotrigine during first- trimester exposure. Conclusions. Few studies have been conducted in pregnant and postpartum women on the benefits of pharmacotherapy; many studies report on harms but are of low quality. The limited evidence available is consistent with some benefit, and some studies suggested increased adverse events. However, because these studies could not rule out underlying disease severity as the cause of the association, the causal link between the exposure and adverse events is unclear. Patients and clinicians need to make an informed, collaborative decision on treatment choices.
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McDonagh, Marian, Andrea C. Skelly, Amy Hermesch, Ellen Tilden, Erika D. Brodt, Tracy Dana, Shaun Ramirez, et al. Cervical Ripening in the Outpatient Setting. Agency for Healthcare Research and Quality (AHRQ), March 2021. http://dx.doi.org/10.23970/ahrqepccer238.

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Objectives. To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient setting (vs. inpatient, vs. other outpatient intervention) and of fetal surveillance when a prostaglandin is used for cervical ripening. Data sources. Electronic databases (Ovid® MEDLINE®, Embase®, CINAHL®, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) to July 2020; reference lists; and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) and cohort studies of cervical ripening comparing prostaglandins and mechanical methods in outpatient versus inpatient settings; one outpatient method versus another (including placebo or expectant management); and different methods/protocols for fetal surveillance in cervical ripening using prostaglandins. When data from similar study designs, populations, and outcomes were available, random effects using profile likelihood meta-analyses were conducted. Inconsistency (using I2) and small sample size bias (publication bias, if ≥10 studies) were assessed. Strength of evidence (SOE) was assessed. All review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center methods guidance. Results. We included 30 RCTs and 10 cohort studies (73% fair quality) involving 9,618 women. The evidence is most applicable to women aged 25 to 30 years with singleton, vertex presentation and low-risk pregnancies. No studies on fetal surveillance were found. The frequency of cesarean delivery (2 RCTs, 4 cohort studies) or suspected neonatal sepsis (2 RCTs) was not significantly different using outpatient versus inpatient dinoprostone for cervical ripening (SOE: low). In comparisons of outpatient versus inpatient single-balloon catheters (3 RCTs, 2 cohort studies), differences between groups on cesarean delivery, birth trauma (e.g., cephalohematoma), and uterine infection were small and not statistically significant (SOE: low), and while shoulder dystocia occurred less frequently in the outpatient group (1 RCT; 3% vs. 11%), the difference was not statistically significant (SOE: low). In comparing outpatient catheters and inpatient dinoprostone (1 double-balloon and 1 single-balloon RCT), the difference between groups for both cesarean delivery and postpartum hemorrhage was small and not statistically significant (SOE: low). Evidence on other outcomes in these comparisons and for misoprostol, double-balloon catheters, and hygroscopic dilators was insufficient to draw conclusions. In head to head comparisons in the outpatient setting, the frequency of cesarean delivery was not significantly different between 2.5 mg and 5 mg dinoprostone gel, or latex and silicone single-balloon catheters (1 RCT each, SOE: low). Differences between prostaglandins and placebo for cervical ripening were small and not significantly different for cesarean delivery (12 RCTs), shoulder dystocia (3 RCTs), or uterine infection (7 RCTs) (SOE: low). These findings did not change according to the specific prostaglandin, route of administration, study quality, or gestational age. Small, nonsignificant differences in the frequency of cesarean delivery (6 RCTs) and uterine infection (3 RCTs) were also found between dinoprostone and either membrane sweeping or expectant management (SOE: low). These findings did not change according to the specific prostaglandin or study quality. Evidence on other comparisons (e.g., single-balloon catheter vs. dinoprostone) or other outcomes was insufficient. For all comparisons, there was insufficient evidence on other important outcomes such as perinatal mortality and time from admission to vaginal birth. Limitations of the evidence include the quantity, quality, and sample sizes of trials for specific interventions, particularly rare harm outcomes. Conclusions. In women with low-risk pregnancies, the risk of cesarean delivery and fetal, neonatal, or maternal harms using either dinoprostone or single-balloon catheters was not significantly different for cervical ripening in the outpatient versus inpatient setting, and similar when compared with placebo, expectant management, or membrane sweeping in the outpatient setting. This evidence is low strength, and future studies are needed to confirm these findings.
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Computerised interpretation of fetal heart rate during labour does not improve outcomes. National Institute for Health Research, June 2017. http://dx.doi.org/10.3310/signal-000429.

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