This report introduces a method for ultrasound-guided transcervical forceps extraction (UTCE) of unruptured interstitial pregnancies; this method does not necessitate elective caesarean delivery for future pregnancies. This report also compares this technique with conventional methods. A retrospective review was conducted involving 16 women treated for interstitial pregnancies. Among these women, UTCE was successfully performed in six of 16 women, with only one woman requiring additional intervention; conventional treatment was performed in the other ten women. UTCE is a safe, effective and minimally invasive option for treating interstitial pregnancies and should be considered as an alternative treatment modality.

OBJECTIVE:

To explore the association between birthweight and ovulatory dysfunction in adulthood.

DESIGN:

Case-control study.

SETTING:

Northeast of Scotland University Hospital, hosting the regional fertility centre and maternity unit.

POPULATION:

A total of 18 846 mother-daughter record pairs from the Aberdeen Fertility Centre Data Set and the Aberdeen Maternity and Neonatal Databank (AMND). Cases were the daughters with ovulatory dysfunction attending the Aberdeen Fertility Centre between 1992 and 2007, Control group 1 included the daughters attending the fertility centre with confirmed ovulation, and Control group 2 included all women naturally fertile who gave birth in Aberdeen during the same period.

METHODS:

The electronic maternity records of the mothers of women in the three groups were retrieved from AMND and compared.

MAIN OUTCOME MEASURES:

Daughters' birthweight and standardised birthweight, characteristics of mothers and daughters at delivery and current daughters' characteristics.

RESULTS:

Cases, Control group 1 and Control group 2 included 466, 548 and 17 832 daughters, respectively. The mean birthweight (standard deviation) in grams was comparable between Cases 3203 (522), Control group 1, 3235 (482) P = 0.30, and Control group 2, 3226 (495) P = 0.31. The proportions of daughters born small for gestational age, large for gestational age, or preterm were comparable between the Cases group and each Control group, as was the mode of delivery and Apgar scores at 1 and 5 minutes. The age at delivery, body mass index, social class or pregnancy complications were comparable in the mothers of the Cases and each Control group.

CONCLUSIONS:

Ovulatory dysfunction does not appear to be related to birthweight or perinatal events.

OBJECTIVES:

To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes.

DESIGN:

Randomised controlled multicentre open-label trial.

SETTING:

Seven Danish tertiary hospitals from March 2009 to June 2011.

POPULATION:

Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section.

METHODS:

Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days).

MAIN OUTCOME MEASURES:

The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events.

RESULTS:

Among women scheduled for elective caesarean section at 38(+3)  weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39(+3)  weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups.

CONCLUSIONS:

This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.

OBJECTIVE:

To evaluate and compare the risk profile of sustaining obstetric anal sphincter injuries (OASIS) and associated risks in five risk groups (low to high), after the OASIS rate was reduced from 4.6% to 2.0% following an interventional programme. The main focus of the intervention was on manual assistance during the final part of second stage of labour.

DESIGN:

A multicentre interventional cohort study with before and after comparison.

SETTING:

Four Norwegian obstetric departments. SAMPLE: A total of 40 154 vaginal deliveries in 2003-09.

METHODS:

Pre-intervention and postintervention analyses. The associations of OASIS with possible risk factors were estimated using odds ratios obtained by logistic regression.

MAIN OUTCOME MEASURE:

Risk factors of OASIS.

RESULTS:

The risk of sustaining OASIS decreased by 59% (odds ratio [OR] 0.41; 95% confidence interval [95% CI] 0.36-0.46) after the intervention. Associations with obstetric risks for OASIS were largely unchanged after the intervention, including first vaginal delivery (OR 3.84; 95% CI 2.90-5.07), birthweight ≥4500 g (OR 4.42; 95% CI 2.68-7.27), forceps delivery (OR 3.54; 95% CI 1.99-6.29) and mediolateral episiotomy (OR 0.89; 95% CI 0.70-1.12). However, the highest reduction of OASIS, (65%), was observed in group 0 (low-risk) (OR 0.35; 95% CI 0.24-0.51), and a 57% (OR 0.43; 95% CI 0.35-0.52), 61% (OR 0.39; 95% CI 0.31-0.48), and 58% (OR 0.42; 95% CI 0.30-0.60) reduction in groups with one, two and three risk factors, respectively. No change was observed in the group with four risk factors.

CONCLUSION:

After the intervention the most significant decrease of OASIS was observed in low-risk births, although the main risk factors for OASIS remained unchanged.

Please cite this paper as: Silveira M, Barros F, Sclowitz I, Domingues M, Mota D, Fonseca S, Mitidieri A, Leston A, Knight H, Cheikh Ismail L, for the International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st) ). Implementation of the INTERGROWTH-21(st) Project in Brazil. BJOG 2013: DOI: 10.1111/1471-0528.12046. The Latin American site in the INTERGROWTH-21(st) Project was Pelotas, Brazil, with approximately 4000 births per year. The sample for the Newborn Cross-Sectional Study (NCSS) was drawn from four hospitals, covering 99% of births in the city. The Fetal Growth Longitudinal Study (FGLS) sample was recruited from one of the largest private ultrasound clinics in the city and 30 smaller, private, antenatal clinics serving middle to high socio-economic status women. Among this site's major challenges was the recruitment of women for FGLS from numerous different clinics. Several public relations activities were conducted to improve collaborative efforts between the research team and obstetricians, paediatricians and community leaders in Pelotas.

Please cite this paper as: Carvalho M, Vinayak S, Ochieng R, Choksey V, Musee N, Stones W, Knight H, Cheikh Ismail L, for the International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st) ). Implementation of the INTERGROWTH-21(st) Project in Kenya. BJOG 2013; DOI: 10.1111/1471-0528.12045. The African site in the INTERGROWTH-21(st) Project was Parklands, a wealthy suburb of Nairobi, Kenya, with a largely middle-to-high socio-economic status population. There are three hospitals with obstetric units in Parklands, with approximately 4300 births per year. The Newborn Cross-Sectional Study (NCSS) sample was drawn from all three hospitals, covering 100% of births in this target population. The Fetal Growth Longitudinal Study (FGLS) sample was recruited from antenatal clinics serving these hospitals, using the eligibility criteria in the INTERGROWTH-21(st) protocol. Special activities to raise awareness of the study included securing media coverage and distributing leaflets in antenatal clinic waiting rooms. FGLS required women to be recruited in the first trimester; therefore, a major challenge at this study site was the high background frequency of first antenatal consultations in the second trimester. The problem was overcome by the study awareness campaign, as a result of which more women started attending antenatal care earlier in pregnancy.

Please cite this paper as: Pan Y, Wu M, Wang J, Pang R, Knight H, Cheikh Ismail L, for the International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st) ). Implementation of the INTERGROWTH-21(st) Project in China. BJOG 2013; DOI: 10.1111/1471-0528.12044. The East Asian site in the INTERGROWTH-21(st) Project was Shunyi County, Beijing, China, which is an affluent suburb of north Beijing delivering approximately 7000 women annually. The Newborn Cross-Sectional Study (NCSS) sample was drawn from two hospitals, covering >85% of births in the county. The Fetal Growth Longitudinal Study sample (FGLS) was recruited from the antenatal clinic of Shunyi Maternal & Child Health Hospital, the larger of the two institutions. Special activities to promote the study in this population included: (1) the distribution of health education materials about the importance of antenatal care and (2) the organisation of seminars by the study team to brief key stakeholders at the two hospitals about the goals of the research. One of the major challenges at this site in the early stages of the study was a reluctance to have an early ultrasound dating scan (<14(+0)  weeks of gestation). This challenge was overcome after a thorough evaluation of the literature regarding the benefits of an early ultrasound scan for dating purposes, as a result of which there was a formal change in hospital policy.

The Middle Eastern site in the INTERGROWTH-21(st) Project was Muscat, the capital city of Oman, with approximately 10 500 births per year. The sample for the Newborn Cross-Sectional Study (NCSS) was drawn from two hospitals covering 96% of the region's births. The Fetal Growth Longitudinal Study (FGLS) sample was recruited from four primary health facilities serving Khoula Hospital, using the eligibility criteria in the INTERGROWTH-21(st) protocol. Special activities to encourage participation in this population included local advocacy campaigns to encourage early antenatal booking and ultrasound dating in the population. The major challenges at the site were the recruitment of sufficient numbers of women at an early gestational age, and the timely measurement of all newborns within 12 hours of birth. Many individuals and institutions collaborated effectively over a period of several years on these studies, which required careful planning and close monitoring for their successful implementation.

Please cite this paper as: Roseman F, Knight H, Giuliani F, Lloyd S, Di Nicola P, Laister A, Roseman S, Kennedy K, Burnham O, Patel B, Puglia F, Blakey I, Cheikh Ismail L, for the International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st) ). Implementation of the INTERGROWTH-21(st) Project in the UK. BJOG 2013; DOI: 10.1111/1471-0528.12033. There are approximately 10 000 births per year in the county of Oxfordshire in the UK, which is one of the two European sites for the International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st) ) Project. The samples for both components of the project - the Fetal Growth Longitudinal Study (FGLS) and Newborn Cross-Sectional Study (NCSS) - were drawn from the John Radcliffe Hospital, a major university hospital with a large regional role that covers more than 75% of deliveries in the county. Special activities to encourage participation in this population included the formation of a research coalition to streamline recruitment in the Maternity Unit and the distribution of study information leaflets to women using the hospital's antenatal care service. This was a demanding project and several challenges were overcome to reach recruitment targets and to maintain high standards of data quality. Amongst the major challenges for FGLS at this study site was the level of ineligibility because of maternal age, smoking and body mass index (BMI) ≥ 30. The major challenge for the NCSS field teams was to ensure that all anthropometric data were collected before the early discharge of uncomplicated deliveries, often within 6 hours of birth. It is evident from our experience in implementing this project that, when large-scale clinical studies are meticulously planned and avoid major disruption to routine clinical care, they are well received by hospital staff and can contribute to the improvement of the overall standard of clinical care.