Background: Currently pregnant women with abnormal glucose screening test (GCT), performed at 26?-?28 weeks gestation with a subsequent normal glucose tolerance test (GTT) receive routine care. Could these women be at...Background: Currently pregnant women with abnormal glucose screening test (GCT), performed at 26?-?28 weeks gestation with a subsequent normal glucose tolerance test (GTT) receive routine care. Could these women be at risk of adverse pregnancy? Objective: Compare rate of caesarean section (CS), induction of labour (IOL), macrosomia, admission to special care nursery and neonatal hypoglycaemia. Designs: Retrospective cohort study. Setting: Ipswich Hospital, Ipswich, Queensland. Participants: Pregnant women having had the test at the hospital laboratory. Methods: Charts review of outcome measures including induction of labour, caesarean section, macrosomia, RDS and short-term neonatal morbidity. Results: We reviewed 882 charts (441 cases and 441 controls). There was a higher IOL rate among cases 21.1% versus 16.6% (OR and 95% CI 1.45;1.03?-?2.06) and a higher CS rate, 30.4 versus 23.6 (OR and 95% CI 1.41;1.05?-?1.91). Compared to women with BMI 18.5 - 24.9, women with BMI of 30 and above had a significantly higher IOL rate (47.1% versus 22.6%), higher CS rate (47.2% versus 25.7%) and higher rate of macrosomic baby (79.2% versus 4.2%). There were more women amongst the cases who were older, smoked, had a BMI 30 and above and had previous history of GDM. After adjusting for maternal age, BMI and smoking status, there was still an increased odds of CS, IOL and macrosomia, but this did not reach statistical significance. Conclusion: Abnormal glucose screening test in the absence of gestational diabetes is associated with adverse pregnancy outcome. This is largely contributed by maternal obesity.展开更多
Incidence of caesarean section for breech presentation has increased markedly. External cephalic version (ECV) is effective in reducing non cephalic presentation at births and caesarean section (CS) for breech present...Incidence of caesarean section for breech presentation has increased markedly. External cephalic version (ECV) is effective in reducing non cephalic presentation at births and caesarean section (CS) for breech presentation. Success rates are good but there is increasing need for induction of labour (IOL) as well as for intrapartum CS for reasons that are not clear. The aim of this study was to report the experience with ECV at a single centre where ECVs were performed by or under the guidance of one senior clinician. This was a 7-year retrospective audit of 147 ECVs at a single centre in Queensland. ECV was successful in 53.7%, 34% in nulliparous and 69% in multiparous women. Of the few variables explored, nulliparity was the only variable that was associated with poor success. Among those with successful ECV, 32 (40.5%) had IOL. Intrapartum CS rate in women who had had a successful ECV was 16.5% compared to 11% for the hospital. There was no difference in early neonatal outcome between the groups. We have confirmed a success rate that is comparable with many other studies. Mothers with successful ECV do have a higher IOL and a higher CS rate especially in women whose labour is induced. We suggest a need to look at some novel methods to increase uptake further and to improve success rates in nulliparous women.展开更多
文摘Background: Currently pregnant women with abnormal glucose screening test (GCT), performed at 26?-?28 weeks gestation with a subsequent normal glucose tolerance test (GTT) receive routine care. Could these women be at risk of adverse pregnancy? Objective: Compare rate of caesarean section (CS), induction of labour (IOL), macrosomia, admission to special care nursery and neonatal hypoglycaemia. Designs: Retrospective cohort study. Setting: Ipswich Hospital, Ipswich, Queensland. Participants: Pregnant women having had the test at the hospital laboratory. Methods: Charts review of outcome measures including induction of labour, caesarean section, macrosomia, RDS and short-term neonatal morbidity. Results: We reviewed 882 charts (441 cases and 441 controls). There was a higher IOL rate among cases 21.1% versus 16.6% (OR and 95% CI 1.45;1.03?-?2.06) and a higher CS rate, 30.4 versus 23.6 (OR and 95% CI 1.41;1.05?-?1.91). Compared to women with BMI 18.5 - 24.9, women with BMI of 30 and above had a significantly higher IOL rate (47.1% versus 22.6%), higher CS rate (47.2% versus 25.7%) and higher rate of macrosomic baby (79.2% versus 4.2%). There were more women amongst the cases who were older, smoked, had a BMI 30 and above and had previous history of GDM. After adjusting for maternal age, BMI and smoking status, there was still an increased odds of CS, IOL and macrosomia, but this did not reach statistical significance. Conclusion: Abnormal glucose screening test in the absence of gestational diabetes is associated with adverse pregnancy outcome. This is largely contributed by maternal obesity.
文摘Incidence of caesarean section for breech presentation has increased markedly. External cephalic version (ECV) is effective in reducing non cephalic presentation at births and caesarean section (CS) for breech presentation. Success rates are good but there is increasing need for induction of labour (IOL) as well as for intrapartum CS for reasons that are not clear. The aim of this study was to report the experience with ECV at a single centre where ECVs were performed by or under the guidance of one senior clinician. This was a 7-year retrospective audit of 147 ECVs at a single centre in Queensland. ECV was successful in 53.7%, 34% in nulliparous and 69% in multiparous women. Of the few variables explored, nulliparity was the only variable that was associated with poor success. Among those with successful ECV, 32 (40.5%) had IOL. Intrapartum CS rate in women who had had a successful ECV was 16.5% compared to 11% for the hospital. There was no difference in early neonatal outcome between the groups. We have confirmed a success rate that is comparable with many other studies. Mothers with successful ECV do have a higher IOL and a higher CS rate especially in women whose labour is induced. We suggest a need to look at some novel methods to increase uptake further and to improve success rates in nulliparous women.
