Association of abnormal first stage of labor duration and maternal and neonatal morbidity

Blankenship, Stephanie A.; Raghuraman, Nandini; Delhi, Anjana; Woolfolk, Candice; Wang, Yong; Macones, George A.; Cahill, Alison G.

doi:10.1016/j.ajog.2020.06.053

Cited by 39 publications

(46 citation statements)

References 30 publications

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“…We appreciate the comments of Ragusa et al regarding our recent publication. 1,2 With our retrospective study design, we do not suggest causality but rather demonstrate an association of abnormal first stage of labor duration with maternal and neonatal morbidity.…”

Section: Awareness Of Time In Labor Does Not Preclude Investigation Of Other Factors Contributing To Maternal and Neonatal Morbiditymentioning

confidence: 62%

Awareness of time in labor does not preclude investigation of other factors contributing to maternal and neonatal morbidity

Blankenship

Raghuraman

Cahill

2021

American Journal of Obstetrics and Gynecology

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Section: Awareness Of Time In Labor Does Not Preclude Investigation Of Other Factors Contributing To Maternal and Neonatal Morbiditymentioning

confidence: 62%

Awareness of time in labor does not preclude investigation of other factors contributing to maternal and neonatal morbidity

Blankenship

Raghuraman

Cahill

2021

American Journal of Obstetrics and Gynecology

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“…2 identified a longer duration of active pushing among HIE cases compared to controls. Similarly, Blankenship et al 46 reported an increased risk of maternal and neonatal morbidity in pregnancies with first stage labour length above the 90 th percentile. It is certainly plausible that overall longer length of labour may cumulatively increase the duration of intrapartum hypoxia and increase the likelihood of hypoxic cerebral injury.…”

Section: Discussionmentioning

confidence: 89%

Perinatal antecedents of moderate and severe neonatal hypoxic ischemic encephalopathy: an Australian birth cohort study

Stoke

Schreiber

Hocking

et al. 2022

Preprint

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Objective: The aim of this study was to investigate key antecedents of moderate and severe neonatal hypoxic ischemic encephalopathy (HIE) in a large contemporary Australian birth cohort. Design: A retrospective cohort study of all births meeting the inclusion criteria between 2016-2020. Setting: The Mater Mothers’ Hospital, Brisbane, Australia. This is a quarternary perinatal center and Australia’s largest maternity hospital. Population: All non-anomalous, singleton liveborn infants, >35+0 weeks gestation. Methods: Univariate and multivariate firth logistic regression were used to account for imbalanced frequency classes. Main outcome measure: Neonatal moderate and severe HIE. Results: Overall, 133/46041 (0.29%) infants were diagnosed with HIE, and 56 (0.12%) were diagnosed with moderate/severe HIE. Nulliparity, type 1 diabetes mellitus and maternal intensive care unit admission were associated with increased odds of moderate/severe HIE. Intrapartum risk factors included emergency cesarean birth, emergency cesarean for non-reassuring fetal status or failure to process, intrapartum hemorrhage, and an intrapartum sentinel event (shoulder dystocia, cord prolapse, uterine rupture, placental abruption). Neonatal risk factors included male sex, birth at late preterm gestation (35+0 – 36+6 weeks), Apgar score <4 at 5 minutes, severe respiratory distress requiring ventilatory support and severe acidosis at birth. Conclusions: This cohort study identified a series of potentially modifiable maternal and obstetric risk factors for HIE. Risk factors for HIE do not appear to have changed significantly despite recent advances in obstetric care. Key words: pregnancy, fetus, fetal distress, intrapartum hypoxia, hypoxic ischemic encephalopathy, cerebral palsy Funding source: The authors acknowledge research support by the Mater Foundation.

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“…24 Recently, the mean maternal age and ratio of nulliparous cases are increasing in Japan. 25 These cases are more likely to present with LD 14,26,27 and underline the necessity of obstetrical management not only because LD increases maternal morbidity, such as postpartum transfusion, third-or fourth-degree perineal lacerations, and emergency cesarean or operative vaginal delivery, 28 but also because intrauterine in ammation could affect the offspring's health in the long term. Therefore, obstetricians need to pay increased attention to cases with a potential risk for LD to prevent intrauterine in ammation.…”

Section: Discussionmentioning

confidence: 97%

Labor Dystocia and Risk of Histological Chorioamnionitis and Funisitis: A Study from a Single Tertiary Referral Center

Kyozuka

Murata

Fukuda

et al. 2020

Preprint

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Background: Intrauterine inflammation affects short- and long-term neonatal outcomes. Histological chorioamnionitis and funisitis are acute inflammatory responses in the fetal membranes and umbilical cord, respectively. Although labor dystocia includes a potential risk of intrauterine inflammation, the risk of labor dystocia in histological chorioamnionitis and funisitis has not been evaluated yet. This study aimed to examine the association between labor dystocia and risk of histological chorioamnionitis and funisitis.Methods: In this retrospective cohort study, the patients who underwent histopathological examinations of the placenta and umbilical cord at Fukushima Medical University Hospital, Japan, between 2015 and 2020, were included. From the dataset, the pathological findings of the patients with labor dystocia and spontaneous preterm birth were reviewed. Based on the location of leukocytes, the inflammation in the placenta (histological chorioamnionitis) and umbilical cord (funisitis) was graded as 0–3. Multiple logistic regression analysis was performed to evaluate the risk of histological chorioamnionitis, histological chorioamnionitis stage ≥2, funisitis, and funisitis stage ≥2.Result: Of 317 women who met the study criteria, 83 and 144 women had labor dystocia and spontaneous preterm birth, respectively, and 90 women were included as controls. Labor dystocia was a risk factor for histological chorioamnionitis (adjusted odds ratio, 6.3; 95% confidential interval, 1.9-20.5), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 6.0; 95% confidence interval, 1.7-21.8), funisitis (adjusted odds ratio, 9.4; 95% confidence interval, 1.8-48.2), and funisitis stage ≥2 (adjusted odds ratio, 23.5; 95% confidence interval, 2.3-23.8). Spontaneous preterm birth was also a risk factor for histological chorioamnionitis (adjusted odds ratio, 3.7; 95% confidence interval, 1.7-7.8), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 3.0; 95% confidence interval, 1.2-7.9), and funisitis (adjusted odds ratio, 4.5; 95% confidence interval, 1.2-16.8). However, the adjusted odds ratio was smaller in spontaneous preterm births than in labor dystocia. Conclusion: Labor dystocia is a risk factor for severe histological chorioamnionitis and funisitis. Further studies are required to evaluate the effects of histological chorioamnionitis and funisitis on long-term neonatal outcomes.

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Association of abnormal first stage of labor duration and maternal and neonatal morbidity

Cited by 39 publications

References 30 publications

Awareness of time in labor does not preclude investigation of other factors contributing to maternal and neonatal morbidity

Awareness of time in labor does not preclude investigation of other factors contributing to maternal and neonatal morbidity

Perinatal antecedents of moderate and severe neonatal hypoxic ischemic encephalopathy: an Australian birth cohort study

Labor Dystocia and Risk of Histological Chorioamnionitis and Funisitis: A Study from a Single Tertiary Referral Center

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