The purpose of this study was to determine whether women who experienced perinatal mortality in their first delivery had, in their subsequent birth, a higher risk for adverse perinatal outcome.

OBJECTIVE:The present study was designed to investigate the influence of epidural analgesia on labor progress and outcome in nulliparous women.METHODS:A population-based study comparing women with and without epidural analgesia was conducted. Deliveries occurred during 1988-2006 at the Soroka University Medical Center. A multivariable logistic regression model with backward elimination was constructed to control for confounders.RESULTS:During the study period there were 39 498 deliveries; epidural analgesia was given in 9960 (25.2%) of these. Using a multivariable analysis with backward elimination, the following conditions were significantly associated with the use of epidural analgesia: advanced maternal age, oligohydramnios, premature rupture of membranes, induction of labor, and Jewish (vs. Bedouin) ethnicity. These patients were more likely to deliver by cesarean delivery (CD; OR = 1.4, 95% CI 1.3-1.5; p < 0.001) and vacuum extraction (OR = 1.5, 95% CI 1.4-1.7; p < 0.001). After controlling for possible confounders such as macrosomia, failed induction, hypertensive disorders, gestational diabetes, maternal age, labor dystocia, and ethnicity, epidural analgesia was not found to be an independent risk factor for CD but rather a protective factor (OR = 0.9, 95% CI 0.8-0.9; p = 0.038). When vacuum extraction was the outcome variable, epidural analgesia was documented as an independent risk factor (OR = 1.1, 95% CI 1.01-1.3; p = 0.04).CONCLUSIONS:Epidural analgesia in nulliparous parturients increases the risk for labor dystocia and accordingly is an independent risk factor for vacuum extraction. Nevertheless, it does not pose an independent risk for cesarean delivery.

The present study was designed to investigate the influence of epidural analgesia on mode of delivery in nulliparous women. A population-based study comparing women with and without epidural analgesia was conducted. A multivariable logistic regression model with backward elimination was constructed to control for confounders. During the study period there were 39,498 deliveries, and in 9,960 (25.2%) of these, epidural analgesia was introduced. Using a multivariable analysis with backward elimination, the following conditions were significantly associated with the use of epidural analgesia: advanced maternal age (OR=1.1; 95% CI 1.04-1.05; P<0.001), oligohydramnios (OR=1.2; 95% CI 1.1-1.4; P=0.004), PROM (OR=1.5; 95% CI 1.4-1.6; P<0.001), and induction of labor (OR=2.2; 95% CI 2.1-2.4; P<0.001). These patients were more likely to deliver by cesarean delivery (CD; 11.4% vs. 8.7%, P<0.001) and vacuum extraction (9.0% vs. 6.1%, P<0.001). However, after controlling for possible confounders such as failed induction, maternal age, etc, epidural analgesia was not found to be an independent risk factor for CD but rather a protective factor (P=0.038, Table). On the contrary, when vacuum extraction was the outcome variable, epidural analgesia was documented as an independent risk factor (P=0.04, Table).Tabled 1Mode of delivery in patients with epidural analgesiaCrude OR95% CIAdjusted OR95% CICesarean delivery1.41.31–1.550.90.81–0.95Vacuum extraction1.51.42–1.711.11.01–1.32 Open table in a new tab Epidural analgesia in nulliparous parturients is an independent risk factor for vacuum extraction. Nevertheless, it does not pose an independent risk for cesarean delivery.

This retrospective population-based cohort study analyzes the rate of uterine rupture after cesarean section in 165 women with known Mullerian anomalies in comparison to 5406 controls with normal uteri.

BACKGROUND:Fetal heart rate (FHR) monitoring is commonly used for fetal surveillance. Despite its widespread usage, there is still a disagreement about its value in predicting fetal distress.CASE:A 29-year-old woman in her first pregnancy was admitted for routine follow-up at 38 weeks gestation. The FHR tracing demonstrated severely reduced baseline variability. Due to non-reassuring FHR patterns accompanied by abnormal biophysical profile, the patient was scheduled for urgent Cesarean section. A newborn with congenital absence of the thyroid gland was delivered.CONCLUSION:Severe reduced baseline variability might be an early sign for fetal hypothyroidism. Future research in this area may examine large populations of neonates with thyroid abnormalities in order to determine if abnormal FHR tracing can better predict congenital hypothyroidism.