• Maternal age and risk of cesarean section in women with induced labor at term-A Nordic register-based study.

      Bergholt, Thomas; Skjeldestad, Finn E; Pyykönen, Aura; Rasmussen, Steen C; Tapper, Anna-Maija; Bjarnadóttir, Ragnheiður I; Smárason, Alexander; Másdóttir, Birna B; Klungsøyr, Kari; Albrechtsen, Susanne; et al. (Wiley, 2019-10-04)
      INTRODUCTION: Over the last decades, induction of labor has increased in many countries along with increasing maternal age. We assessed the effects of maternal age and labor induction on cesarean section at term among nulliparous and multiparous women without previous cesarean section. MATERIAL AND METHODS: We performed a retrospective national registry-based study from Denmark, Finland, Iceland, Norway, and Sweden including 3 398 586 deliveries between 2000 and 2011. We investigated the impact of age on cesarean section among 196 220 nulliparous and 188 158 multiparous women whose labor was induced, had single cephalic presentation at term, and no previous cesarean section. Confounders comprised country, time-period, and gestational age. RESULTS: In nulliparous women with induced labor the rate of cesarean section increased from 14.0% in women less than 20 years of age to 39.9% in women 40 years and older. Compared with women aged 25-29 years, the corresponding relative risks were 0.60 (95% confidence interval [95% CI] 0.57 to 0.64) and 1.72 (95% CI 1.66 to 1.79). In multiparous induced women the risk of cesarean section was 3.9% in women less than 20 years rising to 9.1% in women 40 years and older. Compared with women aged 25-29 years, the relative risks were 0.86 (95% CI 0.54 to 1.37) and 1.98 (95% CI 1.84 to 2.12), respectively. There were minimal confounding effects of country, time-period, and gestational age on risk for cesarean section. CONCLUSIONS: Advanced maternal age is associated with increased risk of cesarean section in women undergoing labor induction with a single cephalic presentation at term without a previous cesarean section. The absolute risk of cesarean section is 3-5 times higher across 5-year age groups in nulliparous relative to multiparous women having induced labor.
    • Reproducibility and acceptability of ultrasound measurements of head-perineum distance

      Benediktsdottir, Sigurlaug; Salvesen, Kjell Å.; Hjartardottir, Hulda; Eggebø, Torbjørn M.; [ 1 ] Lund Univ, Dept Obstet & Gynecol Clin Sci, Lund, Sweden Show more [ 2 ] Landspitali Univ Hosp, Dept Obstet & Gynecol, Reykjavik, Iceland Show more [ 3 ] St Olavs Hosp, Ctr Fetal Med, Univ Trondheim Hosp, Trondheim, Norway Show more [ 4 ] Norwegian Univ Sci & Technol, Inst Clin & Mol Med, Trondheim, Norway; Department of Obstetrics and Gynecology; Clinical Sciences; Lund University; Lund Sweden; Center for Fetal Medicine; Trondheim University Hospital (St Olavs Hospital); Trondheim Norway; Department of Obstetrics and Gynecology; Landspitali University Hospital; Reykjavik Iceland; Center for Fetal Medicine; Trondheim University Hospital (St Olavs Hospital); Trondheim Norway (Wiley, 2018-01)
      INTRODUCTION: We aimed to test the reproducibility of head-perineum distance (HPD) measurements using two different ultrasound devices and five examiners, to compare ultrasound measurements and clinical assessments and to study if ultrasound examinations were acceptable for women in labor. MATERIAL AND METHODS: A reproducibility study was performed at Lund University Hospital, Sweden and Landspitali University Hospital, Iceland from February 2015 to February 2017. The study population comprised 40 healthy women in labor. HPD was measured with three replicate measurements from each woman with two different ultrasound devices, and the measurements were compared with clinical assessments. Acceptability was tested with a visual analog scale (VAS), and the mean VAS score from both ultrasound devices was compared with the VAS score from clinical palpation. RESULTS: The median time interval between start of examinations with devices was 10 min (range 1-26 min). The intra-observer repeatability coefficient was 4.3 mm and the intraclass correlation coefficient was 0.97 (95% CI 0.95-0.98). The intraclass correlation coefficient between the two devices was 0.86 (95% CI 0.74-0.93) and limits of agreement were -9.6 mm to 16.6 mm. However, we observed a significant mean HPD difference between devices (3.5 mm; 95% CI 1.4-5.6 mm). Clinical assessments and the mean measurements of HPD were correlated (r = 0.64, p < 0.01). We found significant differences in acceptability in favor of ultrasound. The mean VAS score for both ultrasound devices was 2.0 vs. 4.1 for clinical examination (p < 0.01). CONCLUSION: We found excellent intra-observer repeatability, good correlation but significant difference between devices. Women reported less discomfort with ultrasound than with clinical examinations.