Preterm premature rupture of membranes: is there an optimal gestational age for delivery?
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Delivery, Obstetric↗
Biomedical subjects
Emmanuel Bujold
Publications and source records attributed to Emmanuel Bujold.
Suboptimal second-trimester ultrasonographic visualization of the fetal heart in obese women: should we repeat the examination?
OBJECTIVE: The purpose of this study was to determine whether a repeated antenatal ultrasound examination improves fetal cardiac visualization for the obese and nonobese population. METHODS: A computerized ultrasound database (October 1999-June 2003) was used to identify singleton pregnancies undergoing repeated prenatal ultrasound examinations because of initial suboptimal ultrasonographic visualization (SUV) of the 4-chamber view, outflow tracts, or both. Women with maternal diabetes, abnormal maternal serum screening results, or known fetal anomalies at the initial examination were excluded. Patients were classified by maternal body mass index (BMI): less than 30 kg/mg2 (nonobese), 30 to 34.9 kg/mg2 (class I obesity), 35 to 39.9 kg/mg2 (class II obesity), and 40 kg/mg2 or greater (morbid obesity). The association between maternal BMI and SUV of the fetal heart was analyzed. RESULTS: Three hundred seventy-two patients were abstracted from the database. The median gestational age was 19.0 weeks at the initial visit (range, 18.0-21.9 weeks) and 21.4 weeks at the second visit (range, 18.9-23.9 weeks). The median BMI was 32.6 kg/m2 (range, 16.4-58.7 kg/m2). Sixty-three percent of patients were obese (BMI >or=30). Cardiac anatomy continued to have SUV in 11% of the women. The rate of SUV was associated with the obesity class (1.5% for nonobese, 12% for obesity I, 17% for obesity II, and 20% for morbid obesity; P < .0001). A cardiac anomaly was found in 1 of 372 repeated examinations (arteriovenous canal defect) for a patient with BMI of 24.8 kg/m2. CONCLUSIONS: Repeated ultrasound examination for SUV of the fetal heart at a later gestational age dramatically reduces SUV. However, obese patients continue to have much higher rates of persistent SUV.
Adult↗
Trial of labor in patients with a previous cesarean section: does maternal age influence the outcome?
OBJECTIVE: This study was undertaken to evaluate the effect of maternal age on the rate of vaginal delivery and the rate of uterine rupture in patients undergoing a trial of labor (TOL) after a prior cesarean delivery. STUDY DESIGN: A cohort study of all women with a live singleton fetus undergoing a TOL after a previous low-transverse cesarean delivery was performed between 1988 and 2002 in a tertiary care center. Patients were divided into 3 groups according to maternal age: less than 30 years old, 30 to 34 years old, and 35 years or older. Women with no prior vaginal delivery and with at least 1 prior vaginal delivery were analyzed separately. The rate of vaginal delivery and the rate of symptomatic uterine rupture were calculated. Multivariate logistic regression analyses were performed to adjust for potential confounding variables. RESULTS: Of the 2493 patients who met the study criteria, there were 1750 women without a prior vaginal delivery (659, 721, and 370, respectively) and 743 women with a prior vaginal delivery (199, 327, and 217, respectively). The rate of uterine rupture was comparable between the groups (2.0%, 1.1%, 1.4%, P=.404 and 0%, 0.3%, 0.9%, P=.312). Successful vaginal delivery was inversely related to maternal age (71.9%, 70.7%, 65.1%, P=.063, and 91.5%, 91.1%, 82.9%, P=.005). After adjusting for confounding variables, maternal age equal to or greater than 35 years old was associated with a lower rate of successful vaginal delivery in patients without prior vaginal delivery (odds ratio [OR] 0.73, 95% CI: 0.56-0.94), and in patients with a prior vaginal delivery (OR: 0.47, 95% CI: 0.29-0.74). CONCLUSION: Patients who are 35 years or older are more prone to have a failed TOL after a prior cesarean delivery.
Adult↗
Cesarean delivery after successful external cephalic version of breech presentation at term: a comparative study.
OBJECTIVE: The purpose of this study was to evaluate the rate and indications of cesarean delivery after a successful external cephalic version. STUDY DESIGN: A case-control study was performed from patients who were delivered in a tertiary care center between 1987 and 2000. Each patient who underwent a successful external cephalic version (study group) was compared with the next woman with the same parity, who was delivered at term (control group). Nulliparous and multiparous women were analyzed separately. Chi-squared, Mann-Whitney, and Student t tests were used for statistical analysis. Multivariate logistic regression analysis was performed where appropriate. RESULTS: A total of 602 patients were included in this study. The rates of cesarean delivery in nulliparous women (29.8% vs 15.9%; P<.001) and in multiparous women (15.9% vs 4.7%; P<.001) were significantly higher when compared with the control group. Patients with successful external cephalic version were more likely to have a cesarean delivery for dystocia (nulliparous, 22.5% vs 11.9%; P=.01; multiparous, 10.9% vs 1.3%; P<.01). After an adjustment for confounding variables, a successful external cephalic version was associated with an increased rate of cesarean delivery at term (nulliparous: odds ratio, 2.04; 95% CI, 1.13-3.68; multiparous: odds ratio, 4.30; 95% CI, 1.76-10.54). CONCLUSION: The rate of cesarean delivery for dystocia is increased after a successful trial of external cephalic version in both nulliparous and multiparous women.
Adult↗
Evidence supporting a role for blockade of the vascular endothelial growth factor system in the pathophysiology of preeclampsia. Young Investigator Award.
OBJECTIVE: Soluble vascular endothelial growth factor receptor 1 (sVEGFR-1), which antagonizes VEGF functions, has been implicated in the pathophysiology of preeclampsia. The purpose of this study was to determine whether preeclampsia is associated with a change in the plasma concentration of sVEGFR-1, and, if so, whether such a change is correlated with the severity of the disease. METHODS: A cross-sectional study was conducted to determine the concentrations of sVEGFR-1 in plasma obtained from normal pregnant women (n=61) and patients with preeclampsia (n=61). Plasma concentrations of sVEGFR-1 were determined by enzyme-linked immunoassay. RESULTS: Preeclampsia had a higher median plasma concentration of sVEGFR-1 than normal pregnancy (P <.001). The median plasma concentration of sVEGFR-1 was higher in early-onset (< or =34 weeks) than late-onset (>34 weeks) preeclampsia (P=.005), and higher in severe than in mild preeclampsia (P=.002). In normal pregnancy, there was a correlation between plasma concentration of sVEGFR-1 and gestational age (r=0.5; P <.001). In contrast, there was a negative correlation between plasma concentration of sVEGFR-1 and gestational age at the onset of preeclampsia (r=-0.5; P <.001). CONCLUSION: Preeclampsia is associated with an increased plasma sVEGFR-1 concentration. The elevation of sVEGFR-1 concentration is correlated with the severity of the disease. These observations suggest the participation of VEGF and its soluble receptor in the pathophysiology of preeclampsia.
Adolescent↗
Does advanced ultrasound equipment improve the adequacy of ultrasound visualization of fetal cardiac structures in the obese gravid woman?
OBJECTIVE: This study was undertaken to determine the effect of advanced ultrasound equipment on the ability to visualize fetal cardiac structures in obese gravid women. STUDY DESIGN: Singleton pregnancies undergoing initial ultrasound examination between 14 weeks and 23 weeks 6 days were included. Patients were classified by body mass index (BMI) (nonobese [BMI < 30 kg/m(2)] and obese [BMI > or =30 kg/m(2)]). The rate of suboptimal ultrasound visualization (SUV) of the fetal heart (cardiac axis, cardiac position, 4-chamber, and outflow tracts views) was compared between patients examined by standard (HDI 3000) or advanced ultrasound equipment (HDI 5000) (ATL, Philips Medical Systems, Bothell, Wash). RESULTS: Over a 5-year period, 7029 singleton gestations met inclusion criteria; 2498 (35.5%) were clinically obese. There was no difference in gestational age, rate of low amniotic fluid volume, anterior placenta, or vertex fetal presentation between the groups. When the advanced ultrasound equipment was used, SUV of the fetal heart was lower in the nonobese population (20.8% vs 16.4%; P <.001), but not in the obese gravid women (38.1% vs 35.5%; P=.27). However, obese patients who were examined by advanced ultrasound equipment after 18 weeks had less SUV of the outflow tracts (28.5% vs 23.1%, P=.04) but not of the 4-chamber view. CONCLUSION: Despite advanced ultrasound equipment, maternal obesity significantly limits visualization of the fetal heart. However, the advanced ultrasound equipment may somewhat benefit obese gravid women examined after 18 weeks' gestation
Adolescent↗
Is abnormal labor associated with shoulder dystocia in nulliparous women?
OBJECTIVE: This study was undertaken to examine the relationship between labor abnormalities and shoulder dystocia in nulliparous women. STUDY DESIGN: Nulliparous women whose delivery was complicated by shoulder dystocia were studied and compared with a control group selected based on the best possible match for race, labor type (spontaneous or induced), and birth weight. The duration of first and second stage of labor, as well as the rates of labor progress, were calculated and compared between groups. RESULTS: During this 4-year study period, there were 8010 nulliparous singleton deliveries of which 65 (0.8%) were complicated by shoulder dystocia. Compared with controls, there was no difference in the rate of cervical dilation in the active phase of the first stage of labor. In the shoulder dystocia group, more patients had a second stage of labor greater than 2 hours (22% vs 3%; P <.05) and had operative vaginal deliveries (26% vs 1.5%; P <.001). In shoulder dystocia cases with birth weight greater than 4000 g, 33% had a second stage of labor greater than 2 hours. CONCLUSION: In our population, the combination of fetal macrosomia, second stage of labor longer than 2 hours and the use of operative vaginal delivery were associated with shoulder dystocia in nulliparous women.
Adult↗
Modified Bishop's score and induction of labor in patients with a previous cesarean delivery.
OBJECTIVES: The purpose of this study was to evaluate the association between preinduction modified Bishop's score and obstetric outcome, including successful vaginal birth after prior cesarean (VBAC) and uterine rupture in patients with a previous cesarean undergoing induction of labor. STUDY DESIGN: Medical records of all patients who had an induction of labor after a previous cesarean in our institution between 1988 and 2002 were reviewed. Patients were divided into 4 groups according to the modified Bishop's score (0 to 2, 3 to 5, 6 to 8, and 9 to 12). The rates of successful VBAC, symptomatic uterine rupture, and other obstetric outcomes were evaluated in each group. Multivariate regression analyses were performed to adjust for confounding factors. RESULTS: Out of 685 women included in the study, 187 (27.3%) had a modified Bishop's score <2, 276 (40.3%) of 3 to 5, 189 (27.6%) of 6 to 8, and 33 (4.8%) of 9 to 12. The rate of successful VBAC significantly correlated with the modified Bishop's score (57.5%, 64.5%, 82.5%, and 97.0%, respectively, P < .001). However, the rate of uterine rupture was not statistically significant between the groups (2.1%, 1.8%, 0.5%, 0.0%, P=.48). After adjusting for confounding variables, a modified Bishop's score >/=6 remained associated with successful VBAC (odds ratio [OR] 2.07, 95% CI 1.28-3.35, P < .001). CONCLUSION: The modified Bishop's score before induction of labor is an independent factor associated with successful VBAC.
Adult↗
Toll-like receptor-2 and -4 in the chorioamniotic membranes in spontaneous labor at term and in preterm parturition that are associated with chorioamnionitis.
OBJECTIVE: The Toll-like receptor-2 and -4 recognize microbial products that are associated with gram-positive and gram-negative bacteria, respectively. This study examined Toll-like receptor-2 and -4 expression in fetal membranes in response to labor at term and histologic chorioamnionitis. STUDY DESIGN: Immunohistochemistry and real-time quantitative reverse transcriptase-polymerase chain reaction were used to examine the chorioamnion from patients with (1) preterm labor and intact membranes, (2) preterm premature rupture of membranes who were delivered < or =34 weeks of gestation, and (3) women at term with or without labor. All groups were stratified on the basis of the presence of histologic chorioamnionitis. RESULTS: Toll-like receptor-2 expression was significantly higher in patients with chorioamnionitis than in patients without this condition (all P < .05). The Toll-like receptor-2 and -4 messenger RNA amounts were significantly higher in membranes from women at term with spontaneous labor than women who were not in labor ( P = .001 and .002, respectively). Toll-like receptor-2 expression was polarized to the basal surface of amniotic epithelial cells in patients without chorioamnionitis, but this distribution was lost in the presence of inflammation. CONCLUSION: Spontaneous labor at term and preterm delivery with histologic chorioamnionitis, regardless of the membrane status (intact or ruptured), are associated with an increased expression of Toll-like receptor-2 and -4 in the chorioamniotic membranes. These observations have implications for understanding the biologic nature of innate immunity.
Amnion↗
Cervical ripening with transcervical foley catheter and the risk of uterine rupture.
OBJECTIVE: To estimate whether the rate of uterine rupture in patients with a previous cesarean delivery is related to labor induction and/or cervical ripening using transcervical Foley catheter. METHODS: Charts of all patients who had a trial of labor after a previous cesarean delivery in our institution between 1988 and 2002 were reviewed. The rates of successful vaginal birth after cesarean delivery and uterine rupture in patients with spontaneous labor (control group) were compared with those of patients who underwent a labor induction by means of amniotomy with or without oxytocin and patients who underwent a labor induction/cervical ripening using a transcervical Foley catheter. Logistic regression analysis was performed to adjust for confounding variables. RESULTS: Of 2479 patients, 1807 had a spontaneous labor, 417 had labor induced by amniotomy with or without oxytocin, and 255 had labor induced by using transcervical Foley catheter. The rate of successful vaginal birth after cesarean delivery was significantly different among the groups (78.0% versus 77.9% versus 55.7%, P <.001), but not the rate of uterine rupture (1.1% versus 1.2% versus 1.6%, P =.81). After adjusting for confounding variables, the odds ratio (OR) for successful vaginal birth after cesarean delivery was 0.68 (95% confidence interval [CI] 0.41, 1.15), and the OR for uterine rupture was 0.47 (95% CI 0.06, 3.59) in patients who underwent an induction of labor using a transcervical Foley catheter when compared with patients with spontaneous labor. CONCLUSION: Labor induction using a transcervical Foley catheter was not associated with an increased risk of uterine rupture.
Adult↗
Effect of prior vaginal delivery or prior vaginal birth after cesarean delivery on obstetric outcomes in women undergoing trial of labor.
OBJECTIVE: We sought to study the effects of prior vaginal delivery or prior vaginal birth after cesarean delivery (VBAC) on the success of a trial of labor after a cesarean delivery. METHODS: An observational study of patients who underwent a trial of labor after a single low-transverse cesarean delivery. Patients with a previous cesarean delivery and no vaginal birth were compared with patients with a single vaginal delivery before or after the previous cesarean delivery. The rates of successful VBAC, uterine rupture, and scar dehiscence were analyzed. Multivariable regression was performed to adjust for confounding variables. RESULTS: Of 2,204 patients, 1,685 (76.4%) had a previous cesarean delivery and no vaginal delivery, 198 (9.0%) had a vaginal delivery before the cesarean delivery, and 321 (14.6%) had a prior VBAC. The rate of successful trial of labor was 70.1%, 81.8%, and 93.1%, respectively (P <.001). A prior VBAC was associated with fewer third- and fourth-degree lacerations (8.5% versus 2.5% versus 3.7%, P <.001) and fewer operative vaginal deliveries (14.7% versus 5.6% versus 1.9%, P <.001) but not with uterine rupture (1.5% versus 0.5% versus 0.3%, P =.12). Patients with a prior VBAC had, in addition, a higher rate of uterine scar dehiscence (21.8%) compared with patients with a previous cesarean delivery and no vaginal delivery (5.3%; P =.001). CONCLUSION: A prior vaginal delivery and, particularly, a prior VBAC are associated with a higher rate of successful trial of labor compared with patients with no prior vaginal delivery. In addition, prior VBAC is associated with an increased rate of uterine scar dehiscence.
Adult↗
Sublingual nitroglycerine as a tocolytic in external cephalic version: a comparative study.
OBJECTIVE: To study the effect of sublingual nitroglycerine as a tocolytic on the success rate of external cephalic version (ECV) in nulliparous and parous women. METHODS: A retrospective case-controlled study of all ECV cases from February 1996 to February 2000 in a single centre. The rates of successful ECV were compared between women who had their ECV before February 1998 (control group), those who had their ECV after February 1998 and received 0.8 mg sublingual nitroglycerine spray as a tocolytic agent, and those who had their ECV after February 1998 and received no tocolytic agents. Nulliparous and parous women were studied separately. Data were collected for parity, gestational age, maternal age, placental localization, and side effects. Chi-square and Kruskal-Wallis tests were performed for statistical comparison. RESULTS: Of 150 women who had their ECV after February 1998, 120 (80%) received sublingual nitroglycerine (group 1: cases using 0.8 mg sublingual nitroglycerine spray as a tocolytic agent) and were compared to the 30 patients who did not receive sublingual nitroglycerine or other tocolytics after February 1998 (group 2) and to 137 patients who had their ECV before February 1998 (control group). Of the women who received sublingual nitroglycerine, 5 (4%) had hypotension and 7 (6%) had headaches and/or nausea. The rate of successful ECV was 27% in group 1 versus 30% in group 2 (p = 0.86) versus 28% in the control group (p = 0.88) for nulliparous patients, and 67% versus 80% (p = 0.30) versus 51% (p = 0.09) respectively for parous women. However, the success rate was increased overall in parous women after the introduction of nitroglycerine as a tocolytic for ECV in February 1998 (71% vs. 51%, p = 0.02). CONCLUSION: Although the success rate of ECV has increased in recent years, the use of sublingual nitroglycerine as a tocolytic was not associated with this higher success rate. A randomized, controlled trial is needed.
Administration, Sublingual↗
Twin delivery after a previous caesarean: a twelve-year experience.
OBJECTIVES: To compare maternal and neonatal morbidities between trial of labour (TOL) and elective Caesarean section in women with twin pregnancies who have had a prior Caesarean. METHODS: An observational study was conducted of women with a prior Caesarean who delivered twins at 28 weeks gestation or greater in Ste-Justine Hospital between 1988 and 2001. Maternal and neonatal outcomes were compared between women who had a TOL (group 1) and those who had an elective Caesarean delivery (group 2). RESULTS: Twenty-six women and 52 fetuses were included in group 1 and compared to the 71 women and 142 fetuses in group 2. Maternal age, gestational age, and birth weight were comparable in both groups. In group 1, 22 (85%) out of 26 women delivered twin A vaginally and 19 (73%) delivered both vaginally. There was no significant difference in the umbilical artery cord pH, Apgar score, ventilatory support, and admission to the neonatal intensive care unit between the 2 groups. There was also no significant difference in the rate of postpartum maternal fever or decrease of serum hemoglobin between the 2 groups, but the median hospital stay was higher in the group with elective Caesarean (5.0 vs. 3.0 days, p <0.001). There were no uterine ruptures or other major complications in either group. CONCLUSION: There were no significant differences in maternal and neonatal morbidity outcomes between births by trial of labour and by elective Caesarean, in twin pregnancies after a prior Caesarean section. A trial of labour is associated with a shorter hospital stay.
Adult↗
Sublingual nitroglycerin versus intravenous ritodrine as tocolytic for external cephalic version: a double-blinded randomized trial.
OBJECTIVE: The purpose of this study was to compare the efficacy of sublingual nitroglycerin with that of intravenous ritodrine as a tocolytic agent for external cephalic version in nulliparous women. STUDY DESIGN: We performed a double-blinded, randomized trial. Nulliparous patients, between 36 and 40 weeks of gestation, were assigned randomly to receive either (1) an intravenous infusion of ritodrine (111 microg/min) for 20 minutes, followed by two puffs of sublingual placebo or (2) an intravenous infusion of sodium chloride 0.9% (placebo) for 20 minutes, followed by two puffs of sublingual 0.4 mg of nitroglycerin. Three minutes after the administration of the sublingual spray, an external cephalic version was attempted. The rate of successful external cephalic version and side effects was compared between groups. RESULTS: Of 74 randomly assigned patients, 38 patients received intravenous ritodrine, and 36 patients received sublingual nitroglycerin. Although not statistically significant, the rate of the successful external cephalic version was higher in the ritodrine group compared with the nitroglycerin group (45% vs 25%, P =.075). The rate of headaches was higher in patients who received nitroglycerin (28% vs 8%, P =.02). Mean blood pressure and maternal heart rate were lower in the nitroglycerin group 10 minutes after the administration of the medication. However, there was no significant difference in the rate of palpitations, hypotension, or fetal bradycardia between the two groups. CONCLUSION: When compared with intravenous ritodrine, sublingual nitroglycerin was associated with a higher rate of headache, lower blood pressure, and a trend toward a lower rate of successful external cephalic version.
Administration, Sublingual↗
Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes.
OBJECTIVE: The purpose of this study was to determine whether abnormal placentation (defined as the failure of physiologic transformation of spiral arteries) is present in patients with preterm labor and intact membranes who delivered a preterm neonate. STUDY DESIGN: A cross-sectional study was conducted to examine the histopathologic findings in the placental bed and placenta of patients with preterm labor and intact membranes (n=27), preeclampsia (n=43), and healthy pregnant women at term (n=103). Immunohistochemistry studies with cytokeratin 7 and periodic acid-Schiff were used to detect trophoblast and fibrinoid, respectively, and diagnose the failure of physiologic transformation of the spiral arteries. RESULTS: The mean percentage of spiral arteries with failure of physiologic transformation in the myometrium was significantly higher in patients with preterm labor and preeclampsia than in normal pregnant women at term (P=.0004 and P<.0001, respectively). Similar findings were observed in the decidual segment of spiral arteries within the placental bed (P=.001 and P<.0001). In contrast, the mean percentage of the spiral arteries with failure of physiologic transformation in the decidua of the basal plate was not significantly different between patients with preterm labor and normal pregnant women (P=.17). CONCLUSION: Failure of physiologic transformation of the spiral arteries in the myometrial and decidual segments of the placental bed is frequent in patients with preterm labor and intact membranes.
Adult↗
The relationship between amniotic fluid index and successful external cephalic version: a 14-year experience.
OBJECTIVE: This study was undertaken to assess the association between amniotic fluid index (AFI), success of external cephalic version (ECV), and obstetric outcome in patients undergoing ECV. STUDY DESIGN: A prospective observational study was performed that included all patients who had a trial of ECV from 1987 to 2000 in our center. Rates of success, fetal heart decelerations during trial at ECV, and cesarean deliveries were calculated. Groups were divided by an AFI performed immediately before ECV: AFI less than 10 cm, 10 to 15 cm, and more than 15 cm. RESULTS: In our group of 1361 patients undergoing ECV, the rate of success was related to the AFI in both parous women (49.1%, 63.5% and 72.1% [P<.001] for each AFI group, respectively) and nulliparous women (36.5%, 43.6%, and 57.3% [P<.001]). The rate of cesarean section delivery was related to AFI in nulliparous but not multiparous patients (P<.001). The rate of prolonged fetal heart rate decelerations was not significantly related to the AFI. CONCLUSION: The rate of successful ECV and cesarean section deliveries is related to the amniotic fluid volume. This information may be used to consent patient before a trial of ECV.
Amniotic Fluid↗
Sublingual nitroglycerin versus placebo as a tocolytic for external cephalic version: a randomized controlled trial in parous women.
OBJECTIVE: The purpose of this study was to evaluate the efficacy of sublingual nitroglycerin as a tocolytic agent for external cephalic version in parous women. STUDY DESIGN: A double-blinded randomized controlled trial was performed. Patients with parity of >or=1 at 36 to 40 weeks of gestation who were eligible for external cephalic version were included. Patients were randomized to receive either two sublingual sprays of 400 mug of nitroglycerin or two sprays of placebo 3 minutes before the trial of external cephalic version. Rates of successful external cephalic version and side effects were compared between groups. RESULTS: Of 99 patients in the study, 50 patients received sublingual nitroglycerin, and 49 patients received placebo. There were no differences in maternal age, gestational age, estimated fetal weight, amniotic fluid index, and placental location between the two groups. The success rate of external cephalic version was 48% in the nitroglycerin group compared with 63% in the placebo group (P=.13). There was a higher incidence of headaches in the nitroglycerin group (42% vs 4%, P<.001). CONCLUSION: Sublingual nitroglycerin was associated with a higher rate of headache and did not improve the rate of successful external cephalic version.
Administration, Sublingual↗
Neonatal morbidity associated with uterine rupture: what are the risk factors?
OBJECTIVE: The purpose of this study was to evaluate factors associated with severe metabolic acidosis or death in a situation of uterine rupture. STUDY DESIGN: A retrospective study was performed with review of charts and electronic monitoring strips. RESULTS: Between November 1988 and November 2000, a total of 23 cases of complete uterine rupture were identified from among 2233 trials of labor after a previous low transverse cesarean delivery. Nine neonates (39.1%) had severe metabolic acidosis (pH < 7.0); among these, hypoxic-ischemic encephalopathy was diagnosed in 3 neonates and another neonate died. Placental or fetal extrusion or both were associated with severe metabolic acidosis (P <.001) but not with the other factors (birth weight, induction of labor, use of oxytocin, use of epidural, and cervix dilatation). Two newborns with severe acidosis had impaired motor development even with an intervention time less than 18 minutes from the onset of prolonged deceleration to delivery. CONCLUSION: When uterine rupture occurs, placental or fetal extrusion was the most important factor associated with severe metabolic acidosis. Prompt intervention did not always prevent severe metabolic acidosis and neonatal morbidity.
Acidosis↗