Objective: To determine whether participating in childbirth classes is associated with pregnancy outcomes.Methods: A retrospective study was conducted to review the medical records of all nulliparous women who participated in childbirth classes during their pregnancy and delivered in the authors’ institute, between January 2014 and December 2017 (CB class group). The control group comprised nulliparous women who delivered in the same time period, but who did not participate in any education classes (Not attended CB class group). The controls were matched in a ratio of 1:1 for gestational age at delivery and neonatal birth weight.Results: Overall, 159 patients were included in each group. The class group was characterized with above average income (28 [23.9%] vs 19 [16.7%]; P=0.001) and higher education level (80 [64.0%] vs 60 [45.1%]; P=0.002), higher rate of normal vaginal delivery (128 [80.5%] vs 93 [58.5%]; P<0.001), and lower rate of vacuum extraction (12 [7.5%] vs 36 [22.6%]; P<0.001) compared to the Not attended CB class group. By logistic regression analysis, after controlling for obstetrics and socioeconomic variables, participation in childbirth classes was found to be independently associated with successful normal vaginal delivery (odds ratio 2.90; 95% confidence interval 1.13–7.38; P=0.024).Conclusion: Participation in childbirth classes has a positive impact on pregnancy outcome.

Background: The association between the number of vaginal examinations (VEs) performed during labor and the risk of infection is unclear. The literature regarding this issue is not consensual, and the available studies are relatively small. Therefore, we aimed to study the association between the number of VEs during labor, and maternal febrile morbidity, in a very large cohort. Methods: This is a retrospective cohort study. All women who delivered vaginally ≥37 weeks, at our institute, between 2008 and 2017 were included. Patients who underwent cesarean delivery or who were treated with prophylactic antibiotics, or had a fever ≥38.0 °C prior to the first VE were excluded. Cases of intrauterine fetal death, known malformations, or missing data were excluded as well. The cohort was divided according to the number of VEs performed: up to 4 VEs (n = 9716), 5–6 VEs (n = 4624), 7–8 VEs (n = 2999), and 9 or more VEs (n = 4844). The rates of intrapartum febrile morbidity (intrapartum fever and chorioamnionitis), postpartum febrile morbidity (postpartum fever and endometritis), and peripartum febrile morbidity (any of the mentioned complications) were compared. Results: Overall, 22,183 women were included in the study. On multivariate analysis, we found that performing 5 VEs or more during labor was independently associated with intrapartum febrile morbidity (5–6 VEs: aOR = 1.83, 95% CI (1.29–2.61), 7–8 VEs: aOR = 2.65 95% CI (1.87–3.76), 9 or more VEs aOR = 3.47 95% CI (2.44–4.92)), postpartum febrile morbidity (5–6 VEs: aOR = 1.29, 95% CI (1.09–1.86), 7–8 VEs: aOR = 1.94 95% CI (1.33–2.83), 9 or more VEs aOR = 1.91 95% CI (1.28–2.82)), and peripartum morbidity (5–6 VEs: aOR = 1.48, 95% CI (1.15–1.91), 7–8 VEs: aOR = 2.15 95% CI (1.66–2.78), 9 or more VEs: aOR = 2.57 95% CI (1.97–3.34)). Conclusion: The number of VEs performed during labor is directly correlated with febrile morbidity. Performing five or more VEs during labor is independently associated with febrile morbidity; For intrapartum and peripartum febrile morbidity the risk rises as more VEs are performed.

Objective: To study obstetric outcomes of emergency cerclage compared with elective cerclage. Study design: Retrospective cohort study of pregnancy outcomes of patients who underwent cervical cerclage, performed according to ACOG guidelines, between January 2006 and December 2014. Patients who underwent emergency cerclage, due to cervical shortening or cervical dilation (emergency cerclage group) were compared with patients who underwent history-indicated cerclage (elective cerclage group). Emergency cerclage was not performed in patients with uterine contractions, vaginal bleeding, or signs of chorioamnionitis. Procedure-related complications were defined as rupture of membranes or chorioamnionitis occurring after cerclage placement and before 24 weeks of gestation. Results: Overall, 154 patients with elective cerclage and 47 patients with emergency cerclage were included. Mean gestational age at cerclage operation was 13.1 ± 1 and 20.2 ± 3 weeks, respectively. There were no differences between the emergency cerclage group and the elective cerclage group regarding mean gestational age at delivery (36.1 ± 3 versus 35.6 ± 3, respectively, p = 0.7), rate of deliveries beyond 34 weeks of gestation (81.81% versus 78.72%, respectively, p = 0.67), rate of deliveries beyond 37 weeks of gestation (64.93% versus 59.57%, respectively, p = 0.6), cesarean deliveries (33.11% versus 39.13%, p = 0.48, respectively), or birthweight (2848 versus 2862 grams, respectively, p = 0.9). Regarding procedure-related complications, there were no differences between the elective and the emergency cerclage groups in the rate of chorioamnionitis (1.29% versus 4.34%, respectively, p = 0.22), or ruptured membranes (1.29% versus 4.34%, respectively, p = 0.22). Conclusion: Pregnancy outcomes of emergency cerclage are comparable with those of elective cerclage.

Purpose: To investigate neonatal outcome and placental pathology in pregnancies complicated with small for gestational age neonates (SGA), in relation to the severity of growth restriction. Methods: The medical records and placental histology reports of all neonates with a birth-weight (BW) ≤10th percentile, born between 24–42 weeks, during 2010–2015, were reviewed. Placental lesions were classified into maternal and fetal vascular malperfusion (MVM and FVM) lesions. Results were compared between neonates with BW <5th percentile (severe SGA group), neonates with BW between 5th–10th percentile (mild SGA group) and a control group of appropriate for gestational age (AGA) neonates. Composite neonatal outcome was defined as one or more of early complications. Results: Overall, 753 neonates were included, 238 in the severe SGA group, 266 in the mild SGA group, and 249 in the control group. The severe SGA group had higher rates of composite adverse neonatal outcome as compared with the mild SGA and control groups (37.2 versus 17.6%, versus 24.5%, respectively, p < .001). The SGA group was characterized by higher rates of placental MVM and FVM lesions, compared with controls (p < .001 for both). After controlling for confounders, using a multivariate regression analysis, the likelihood of detecting placental MVM and FVM lesions was increased as neonatal birthweight decreased. Conclusions: Worse neonatal outcome and more placental MVM and FVM lesions correlate with the severity of neonatal growth restriction in a “dose-dependent” manner.