No abstract

Venous thromboembolism (VTE), which includes deep venous thrombosis (DVT) and pulmonary embolism, are among the leading causes of maternal morbidity and mortality, with an incidence of approximately 0.48-1.1 per 100 000 deliveries. [1][2][3] Pregnancy and the puerperium are well-established risk factors for VTE. [4][5][6] It is accepted that there is a 5-to 10-fold increased risk of thrombus formation during pregnancy and the postpartum period, 5-7 with an incidence of VTE in the range of 0.5-2 per 1000 pregnancies. [8][9][10] While the postnatal period is commonly considered to have the highest incidence of VTE, 11 some studies reported a higher antenatal incidence 8 or no difference. 12 In addition, some studies have suggested that the incidence appears to be decreasing over the last four decades, largely due to a decrease of events in the postpartum period. 8,13

Objective The American College of Gynecology (ACOG) recommendation does not limit air travel during pregnancy, yet the evidence for air travel effect on adverse pregnancy outcomes is limited and debatable. Study objectives were to examine the association between air travel during pregnancy and preterm birth together with decreased birth weight. Study design A retrospective cohort study. Methods The study evaluated 628,292 women who gave birth to singleton infants from 9/2000 to 9/ 2016 and classified them into "air travel during pregnancy" or not, based on flight insurance as proxy. Multiple linear regression models were utilized to examine the relationship between air travel during pregnancy and newborn's gestational age and birth weight, while accounting for socioeconomic status, diabetes, high-risk pregnancies, and smoking. Results A total of 41,677 (6.6%) births of women who air traveled during pregnancy was included, and 586,615 (93.4%) births of women who did not. Air travel during pregnancy was associated with a statistically significant (p<0.0001) but negligible increase in birth weight (9 gr. 95% CI: 4.8 to 14.5 gr.) and gestational age (0.36 days. 95%

Introduction Vacuum extraction (VE) is an important modality in modern obstetrics, yet sometimes results in maternal or neonatal adverse outcomes, which can cause a lifetime disability. We aimed to characterize potential risk factors for adverse outcomes that in retrospect would have led the physician to avoid the procedure. Materials and Methods Retrospective cohort of 3331 singleton pregnancies, ≥ 34 w delivered by VE. 263 deliveries (7.9%) incurred a VE-related feto-maternal adverse outcome, defined as one or more of the following: 3–4th-degree perineal laceration, subgaleal hematoma, intracranial hemorrhage, shoulder dystocia, clavicular fracture, Erb’s palsy or fracture of humerus. 3068 deliveries (92.1%) did not have VE-related adverse outcomes. Both groups were compared to determine potential risk factors for VE adverse outcomes. Results Multivariable regression found seven independent risk factors for VE-related feto-maternal adverse outcomes: Nulliparity – with an odds ratio (OR) of 1.82 (95% CI = 1.11–2.98, p = 0.018), epidural anesthesia (OR 1.99, CI = 1.42–2.80, p < 0.001), Ventouse-Mityvac (VM) cup (OR 1.86, CI = 1.35–2.54, p < 0.001), prolonged second stage as indication for VE (OR 1.54, CI = 1.11–2.15, p = 0.010), cup detachment (OR 1.66, CI = 1.18–2.34, p = 0.004), increasing procedure duration (OR 1.07 for every additional minute, CI = 1.03–1.11, p < 0.001) and increasing neonatal birthweight (OR 3.42 for every additional kg, CI = 2.33–5.02, p < 0.001). Occiput anterior (OA) position was a protective factor (OR 0.62, CI = 0.43–0.89, p = 0.010). Conclusions VE-related adverse outcomes can be correlated to clinical characteristics, such as nulliparity, epidural anesthesia, VM cup, prolonged second stage as indication for VE, cup detachment, prolonged procedure duration and increasing neonatal weight. OA position was a protective factor. This information may assist medical staff to make an informed decision whether to choose VE or cesarean delivery (CD).