Risk factors for obstetric external anal sphincter injury are well known. Maternal and obstetric risk factors for internal anal sphincter injury are not extensively studied.

The rationale of this study was to evaluate the proportion of internal anal sphincter injury in women with external anal sphincter injury, diagnosed immediately after delivery.

This study will assess whether there are additional risks for obstetric internal anal sphincter injury.

Objectives

The primary aim was to assess the proportion of internal anal sphincter injury immediately in women with an external sphincter injury and to evaluate maternal and obstetric risk factors for internal anal sphincter injury in women with an external anal sphincter injury only.

A secondary aim was to relate the diagnostic methods used for obstetric perineal lacerations to the presence of an internal anal sphincter injury.

Study Design

A registry study with data from the Swedish Perineal Laceration Registry 2014–2018.

From the registry, the maternal and obstetric characteristics of 3,333 primiparous women with isolated external (N = 2,236) versus both external and internal (N = 1,097) anal sphincter injuries were studied, as were the methods used for examining the obstetric anal sphincter injuries.

Results

In 32.9 % (1,097/3,333) of primiparous women with an external anal sphincter injury, an internal anal sphincter injury was diagnosed immediately after delivery. A perineal palpatory thickness of less than 10 mm was a diagnostic sign for internal sphincter injury. Well-known risk factors associated with obstetric anal sphincter injuries could not be confirmed as independent risk factors for internal sphincter injury. When the infant is born with an arm beside the head, there is an almost two-fold increased risk for internal sphincter injury.

Conclusions

Our main finding is that 32.9 % of women with external anal sphincter injury also have an internal anal sphincter injury. A palpable perineal thickness of less than 10 mm, a degree 4-laceration and an infant born with a hand by the head increases the risk of internal sphincter injury and should be a clinical warning sign.

BACKGROUND: Excessive gestational weight gain is common and associated with adverse outcomes both in the short and long term. Although traditional lifestyle-based interventions have shown to mitigate excess gestational weight gain, little is known about whether mobile Health (mHealth) apps can promote healthy weight gain, diet, and physical activity during pregnancy.

OBJECTIVE: The primary aim of the HealthyMoms trial is to determine the effectiveness of a smartphone app (HealthyMoms) for mitigating excess gestational weight gain during pregnancy. Secondary aims are to determine the effectiveness of the app on dietary habits, physical activity, body fatness, and glycemia during pregnancy.

METHODS: HealthyMoms is a two-arm randomized controlled trial. Women are being recruited at routine visits at the maternity clinics in Linköping, Norrköping and Motala, Sweden. Women are randomized to the control or intervention group (n=150 per group). All women will receive standard care, and women in the intervention group will also receive the HealthyMoms smartphone app.

RESULTS: Recruitment of participants to the trial was initiated in October 2017, and 190 women have so far completed the baseline measurement. The baseline measures are estimated to be finalized in December 2019, and the follow-up measures are estimated to be completed in June 2020.

CONCLUSIONS: This project will evaluate a novel smartphone app intervention integrated with existing maternity health care. If successful, it has great potential to be implemented nationally in order to promote healthy weight gain and health behaviors during pregnancy.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13011.

To identify obstetrical risk factors for the diagnosis of neonatal hypoxic ischemic encephalopathy (HIE). A secondary aim was to determine the incidence of HIE.

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IntroductionIn 2006 the overall rates of instrumental deliveries (10%) and cesarean sections (CS) (20%) were high in our unit. We decided to improve quality of care by offering more women a safe and attractive normal vaginal delivery. The target group was primarily nulliparous women at term with spontaneous onset of labor and cephalic presentation. Material and methodsImplementation of a nine-item list of structured organizational and cultural change in Linkoping 2006-15. The nine items include monitoring of obstetric results, recruitment of a midwife coordinator, risk classification of women, introduction of three different midwife competence levels, improved teamwork, obstetrical morning round, fetal monitoring skills, obstetrical skills training, and public promotion of the strategy. ResultsThe CS rate in nulliparous women at term with spontaneous onset of labor decreased from 10% in 2006 to 3% in 2015. During the same period the overall CS rate dropped from 20% to 11%. The prevalence of children born at the unit with umbilical cord pH <7 and Apgar score <4 at 5 min were the same over the years studied. At present, 95.2% of women delivering at our unit are satisfied with their delivery experience. ConclusionsThe CS rates have declined after implementing the nine items of organizational and cultural changes. It seems that a specific and persistent multidisciplinary activity with a focus on the Robson group 1 can reduce CS rates without increased risk of neonatal complications.

Background: Continuous support by a midwife during childbirth has shown positive effects on the duration of active labour, use of pain relief and frequency of caesarean section (CS) in women without fear of childbirth (FOC). We have evaluated how continuous support by a specially assigned midwife during childbirth affects birth outcome and the subjective experience of women with severe FOC. Methods: A case-control pilot study with an index group of 14 women with severe FOC and a reference group of 28 women without FOC giving birth. In this study the index group received continuous support during childbirth. Results: The women with severe FOC more often had an induction of labour. The parous women with severe FOC had a shorter duration of active labour compared to the parous reference women (p = 0.047). There was no difference in caesarean section frequency between the two groups. Women with severe FOC experienced a very high anxiety level during childbirth (OR = 20.000, 95 % CI: 3.036-131.731). Conclusion: Women with severe FOC might benefit from continuous support by a midwife during childbirth. Midwives should acknowledge the importance of continuous support in order to enhance the experience of childbirth in women with severe FOC.

Fetma hos en gravid kvinna innebär ökad risk för missbildning hos fostret. Vid screeningultraljud upptäcks färre missbildningar än hos barn till normalviktiga kvinnor, men KUB-metoden för att upptäcka Downs syndrom är lika effektiv i alla BMI-grupper. Fetma hos kvinnan innebär ökad risk för gestationsdiabetes, preeklampsi, prematur förlossning och intrauterin fosterdöd. Öppningsskedet under förlossningen är förlängt hos kvinnor med BMI >30, men krystskedet är snabbt. Det finns ökad risk för atonisk postpartumblödning, vilket kan indicera profylaktisk behandling med uterotonika. Fetma hos kvinnan medför fler allvarliga komplikationer hos barnet under första levnadsveckan oavsett förlossningssätt.

Objective. To assess whether antenatal health care consumption is associated with maternal body mass index (BMI). Design. A register based observational study. Methods. The Swedish Medical Birth Register, the Maternal Health Care Register, and the Inpatient Register were used to determine antenatal health care consumption according to BMI categories for primiparous women with singleton pregnancies, from 2006 to 2008, . Pairwise comparisons among BMI groups are obtained post hoc by Tukey HSD test. Result. Obese women were more often admitted for in-patient care (), had longer antenatal hospital stays (), and were more often sick-listed by an obstetrician () during their pregnancy, compared to women with normal weight women. Preeclampsia was more than four times as common, hypertension five times as common, and gestational diabetes 11 times as common when comparing in-patient care, obese to normal weight women ( for all comparisons). Underweight mothers had longer stay in hospitals () and hydronephrosis and hyperemesis gravidarum were more than twice as common (both ). Conclusion. Obese and underweight mothers consumed significantly more health care resources and obese women were significantly more often sick-listed during their pregnancy when compared to pregnant women of normal weight.

Objective: The aims of this study was to use visits for contraceptive counselling as opportunities for examining womens actual life style habits with the main focus being placed on alcohol consumption but also to evaluate the womens opinions about discussing their alcohol and tobacco habits and their weight status. Methods: A total of 535/802 (67%) women completed a study-specific anonymous questionnaire after a contraceptive counselling visit with a midwife. Results: A majority of the women thought that a discussion concerning alcohol habits at a contraceptive counselling session was important (85.5%) and not intrusive (86.4%) neither embarrassing (81.7%). Women with high-risk drinking habits were younger, more often tobacco users and more often planning for childbirth in the future, compared with women who did not display high-risk drinking behaviour. A significantly higher percentage of women who practiced high-risk drinking thought that a discussion of alcohol was intrusive (10.9%) and embarrassing (46.7%), compared with women not practicing highrisk alcohol consumption. Most women (72.9%) stated that no other caregiver during the preceding year except the midwife had discussed drinking habits with them. The weight was a good thing that the midwife brought up for discussion according to 82.5% of the women but the discussions about weight was more often found embarrassing (18.4%) than the discussion about alcohol habits. Conclusion: Women who came for contraceptive counselling found the discussion concerning alcohol habits important, not intrusive or embarrassing and a good thing to be brought up by the midwife. (C) 2014 Elsevier B.V. All rights reserved.

Objective. To determine predictive risk factors for Apgar scores less than 7 at 5 minutes at two hospitals providing tertiary care and secondary care, respectively. Methods. A retrospective registry cohort study of 21126 births (2006-2010) using data from digital medical records. Risk factors were analyzed by logistic regression analyses. Results. AS(5min) less than 7 was multivariately associated with the following: preterm birth; gestational week 32 + 0-36 + 6, OR = 3.9 (95% CI 2.9-5.3); week 28 + 0-31 + 6, OR = 8 (5-12); week less than 28 + 0, OR = 15 (8-29); postterm birth, OR = 2.0 (1.7-2.3); multiple pregnancy, OR = 3.53 (1.79-6.96); previous cesarean section, OR = 3.67 (2.31-5.81); BMI 25-29, OR = 1.30 (1.09-1.55); BMI greater than= 30 OR = 1.70 (1.20-2.41); nonnormal CTG at admission, OR = 1.98 (1.48-2.66). greater than= 1-para was associated with a decreased risk for AS(5min) less than 7, OR = 0.34 (0.25-0.47). In the univariate logistic regression analysis AS(5min) less than 7 was associated with tertiary level care, OR = 1.48 (1.17-1.87); however, in the multivariate analysis there was no significant difference. Conclusion. A number of partially preventable risk factors were identified, preterm birth being the most evident. Further, no significant difference between the two hospital levels regarding the risk for low Apgar scores was detected.