No abstract

The purpose of this study was to determine the short-term outcome of newborns less than 30 weeks gestation when there is definite placental histologic chorioamnionitis. A retrospective analysis was performed of records of all neonates delivered at our institution from January 1989 through January 1999. This information was retrieved from our perinatal database and pathology database. The population was stratified according to the presence or absence of histologic chorioamnionitis. Statistical analysis was performed using student t-test and Mann-Whitney method. Logistic regression was used to control for potential confounding variables. There were 392 neonates less than 30 weeks gestation delivered during this time period. Complete placental histology was available for 342 patients (87.4%). Histologic chorioamnionitis was identified in 140 (40.9%) cases. Those with histologic chorioamnionitis delivered sooner (26.3 versus 27.5 weeks), were of lower birth weight (920.1 versus 1029.8 g), and had lower 5-minute Apgarscores. Neonatal septicaemia and pneumonia were strongly associated with underlying histologic chorioamnionitis. There was a significant reduction in the incidence of respiratory distress syndrome (RDS) when histologic chorioamnionitis was present. Severe histologic chorioamnionitis increases the risk of premature delivery and is strongly associated with neonatal sepsis. There is a significant reduction in the incidence of RDS and neonatal mortality.

Umbilical cord nuchal loops are associated with induction of labor, slow progress of labor, and shoulder dystocia.

WHAT'S KNOWN ON THIS SUBJECT: Head circumference (HC) at birth reflects brain development in utero. However, HC charts used in Canada are either dated, mixed-gender, nonrepresentative of lower gestational ages, or reflective of other populations in the world.WHAT THIS STUDY ADDS: We developed recent and genderspecific reference curves for HC at birth for singletons of 23 to 41 completed weeks' gestational age, which included a large number of very prematurely born infants, reflecting the current geotemporal Canadian population and advances in obstetric care. abstract BACKGROUND: The measurement of head circumference (HC) at birth reflects intrauterine brain development. HC charts currently used in Canada are either dated, mixed-gender, nonrepresentative of lower gestational ages (GAs), or reflective of other populations. METHODS:To create both birth weight and HC curves, we combined weight and HC data from the Canadian Neonatal Network (CNN) database (admissions in NICUs across Canada) with McGill' s Obstetrical Neonatal Database (MOND; all births at a tertiary hospital in Montreal, Canada). We included CNN data for GAs of 23 to 34 weeks (2003)(2004)(2005)(2006)(2007) and MOND data for GAs of 35 to 41 weeks (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). Nonsingletons, congenital anomalies, and measurements greater than 64 SD from the mean were excluded. Distributions of birth weight and HC at each GA were statistically (penalized spline regression) smoothed. Birth weight curves were compared with recent Canadian reference curves and HC curves with historical and/or frequently used curves. RESULTS:We included 39 896 births (3121 births at ,30 weeks' GA) to generate the curves. Current weight curves were similar to Canadian reference charts for both genders. Weight and HC measurements in boys were higher than in girls. When classified according to recent international references, the proportion of CNN-MOND infants at $32 weeks' GA with HCs ,10th percentile was significantly underestimated. When classified according to historical reference curves, a significant number of CNN-MOND infants of all GAs with HCs ,10th and .90th percentiles were misclassified. CONCLUSIONS:We developed recent gender-specific reference curves for HC at birth for singletons at 23 to 41 completed weeks' GA, which included a large number of very premature infants, reflecting the current geotemporal Canadian population. Pediatrics 2013;131: e1158-e1167

Objective To quantify the effects of pre-pregnancy body mass and gestational weight gain, above and beyond their known effects on birthweight, on the risk of primary and repeat caesarean delivery performed before or after the onset of labour.Design Hospital-based historical cohort study.Setting Canadian university-affiliated hospital.Population A total of 63 390 singleton term ( ‡37 weeks gestation) infants with cephalic presentation.Methods We studied prospectively archived deliveries at the Royal Victoria Hospital in Montreal, Canada, from 1 January 1978 to 31 March 2001 using multiple logistic regression models to estimate relative odds of caesarean delivery.Main outcome measure Caesarean delivery, primary or repeat and before or after the onset of labour.Results Pregravid obesity (body mass index ‡30 kg/m 2 ) increased the likelihood of primary caesarean delivery before (OR = 2.01, 95% CI 1.39-2.90) and after (OR = 2.12, 95% CI 1.86-2.42) the onset of labour. High net rate of gestational weight gain (>0.50 kg/week) increased the risk but only after labour onset (OR = 1.40, 95% CI 1.23-1.60). Among women with a previous caesarean, high weight gain modestly increased risk but only before labour (OR = 1.38, 95% CI 1.04-1.83), whereas obesity increased the risk of caesarean delivery both before (OR = 1.85, 95% CI 1.44-2.37) and after (OR = 1.96, 95% CI 1.11-3.47) labour onset. Increased risks of macrosomia accounted for the association between pregravid adiposity and repeat caesarean delivery performed after but not before the onset of labour.Conclusions Pregravid obesity increases the risk of caesarean delivery both before and after the onset of labour and both with and without a history of caesarean.