Dates fruit consumption during the last few weeks of pregnancy facilitates cervical dilatation and spontaneous labor

It is said that Mary gave birth to Jesus under a palm tree and ate date fruits to ease her labor pains. Almost 2000 years later scientist and researchers are turning towards dates to find safer alternatives for induction and augmentation of labor.

A prospective study carried out at the Jordan University of Science and Technology from 2007 to 2008 and published in 2011 in the Journal of Obstetrics and Gynaecology documented that consumption of 6 dates fruits (Phoenix dactylifera) per day for 4 weeks before the estimated due date resulted in significantly higher mean cervical dilatation at admission, intact membranes, and spontaneous labor. Spontaneous labor occurred in 96% of those who consumed dates, compared with 79% of women in the non-date fruit consumers (p = 0.024)

Results of a randomized controlled trial published in Iranian Journal of Nursing and Midwifery Research reports that consuming dates in late pregnancy shortens the labor significantly and eliminates the need of labor augmentation by oxytocin.

Another randomized trial published July 2017 in Journal of Obstetrics and Gynecology supports the findings of earlier studies and states that “dates consumption in late pregnancy is a safe supplement to be considered as it reduced the need for labor intervention without any adverse effect on the mother and child.”

Here is a very informative YouTube video about dates as the best food during late pregnancy by Dr. Michael Greger, M.D., FACLM. He is a physician, author, and internationally recognized speaker on many important public health issues and believes that food is medicine. Dr. Greger is the founder of the non-profit, science-based website NutritionFacts.org.

Abstract: Iranian Journal of Nursing and Midwifery Research
Abstract: Journal of Obstetrics and Gynaecology
Abstract: Journal of Obstetrics and Gynecology

Just wait a minute, and you save thousands of preterm babies a year

babycenter.com

   

November 17 is celebrated as World Prematurity Day and theme for this year is ‘let them thrive.’

According to WHO An estimated 15 million babies are born preterm every year – more than 1 in 10 babies around the world and this number is rising. Preterm birth complications are the leading cause of death for children under 5.

Well, the obstetricians and health care personal assisting in child birth could save thousands of lives by waiting 60 seconds before clamping the umbilical cord after birth instead of clamping it immediately reports the results of a systematic review and meta-analysis led by the University of Sydney's National Health and Medical Research Council Clinical Trials Centre.

The review will be published in forthcoming issue of American Journal of Obstetrics and Gynecology.

The researchers  looked into data from 18 randomized controlled trials that compared delayed vs early clamping amounting to total of 2834 infants born before 37 weeks' gestation. The cord was clamped after 60 seconds in infants allocated to delayed cord clamping group.

Infants who had their cord clamped after 1 minute faced a 32% reduced risk of mortality and 33 infants need to have delayed cord clamping to save one infant (number need to treat = 33).

Out of 18 trials, 3 trials consisted of about 1000 infants born before ≤28 weeks’ gestation. They had a 30% reduction in mortality and the number need to treat was 20.

The two groups were comparable for Apgar scores, intubation for resuscitation, admission temperature, mechanical ventilation, intraventricular hemorrhage, brain injury, chronic lung disease, patent ductus arteriosus, necrotizing enterocolitis, late-onset sepsis, or retinopathy of prematurity.

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Delay in cord clamping improved the hematocrit by 3% and 10% fewer babies required blood transfusion.

The side effects of delayed clamping were polycythemia and hyperbilirubinemia.

"The review shows for the first time that simply clamping the cord 60 seconds after birth improves survival," said the University of Sydney's Professor William Tarnow-Mordi, senior author.

"It confirms international guidelines recommending delayed clamping in all preterm babies who do not need immediate resuscitation."

"We estimate that for every thousand very preterm babies born more than ten weeks early, delayed clamping will save up to 100 additional lives compared with immediate clamping," said the University of Sydney's Associate Professor David Osborn, the review's lead author and a neonatal specialist at Royal Prince Alfred Hospital.

"This means that, worldwide, using delayed clamping instead of immediate clamping can be expected to save between 11,000 and 100,000 additional lives every year."

The study findings are in accordance with a second Australian study published in The New England Journal of Medicine. The Australian study enrolled about 1500 babies, from25 centers in 7 countries. The babies were born on an average 10 weeks early. Delayed cord clamping saved 3% more babies, as compared to immediate cord clamping (mortality was  6% vs 9%)(p=0.03).

Currently, WHO recommends waiting at least 60 seconds before cord clamping in premature and term babies.

ACOG also recommends, “a delay in umbilical cord clamping for all healthy infants for at least 30-60 seconds after birth given the numerous benefits to most newborns.” 

Full Text

ACOGrecommendations for delayed cord clamping

WHO recommendations for delayed cord clamping

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History of uterine evacuation is an independent risk factor for preterm birth: a systematic review and meta-analysis.

Preterm birth(PTB) is the birth of an infant before 37 weeks of pregnancy, according to WHO statistics an estimated 15 million babies born preterm out of whom 1 million succumb. PTB is also responsible for long term neurological complications in children like cerebral palsy, learning disabilities and visual and hearing problems.

The current global preterm birth rate is 5% to 18% and statistic shows a steady increase recently.More than 60% of preterm births occur in Africa and South Asia, India topping the list with 3 519 100 PTBs

Three forth of these births could be prevented, saving lives and money across the globe.

CDC data quotes that in the year 2014, every 1 in 10 infants was born preterm in US. For physician across the globe, PTB remains a challenge as the factors leading to preterm births are numerous, complex and not well understood. Among various contributing factors prior uterine surgery, especially those performed on cervix (induced termination of pregnancy (I-TOP) or spontaneous abortion (SAB)) has been implicated in its causation. Studies till now have shown mixed results.

The current research published in May 2016 issue of American Journal of Obstetrics and Gynecology evaluated the risk of PTB in women with a history of uterine evacuation for I-TOP or SAB.

For the data source electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, and Sciencedirect) were searched from their inception until January 2015. Women with prior history of uterine evacuation for either I-TOP or SAB, compared with a control group without a history of uterine evacuation were included in the study.

Total 36 case control studies involving 1,047,683 women (31 studies for I-TOP, 5 studies for SAB) met the inclusion criteria and were included in the analysis.

The primary outcome was relationship between prior evacuation and subsequent preterm births while the secondary outcome studied were low birthweight (LBW) and small for gestational age (SGA). 

Relationship between PTB and prior H/O surgical vs spontaneous evacuation was studied separately and combined both.

The study found that:

• When all procedures combined there were increased odds of having a preterm birth, LBW and SGA babies being born after a history of surgical evacuation.
• Vacuum evacuation and sharp curettage were associated with PTB when analyzed in combination. When analyzing separately sharp curettage was associated with higher risk.
• Medical termination was found quite safe and did not result in PTB in subsequent surgery.
• Women with a prior history of spontaneous abortion(SAB) have a higher risk of PTB, as compared to those with no history of SAB.
• A very important observation as a result of meta-analysis is evacuation before 14 weeks of pregnancy (Spontaneous or induced) was not associated with increased risk for PTB.
• Expectant management of missed abortion is an option with ending in spontaneous loss, but sometimes may end up in heavy bleeding requiring immediate evacuation.

References:

http://www.ncbi.nlm.nih.gov/pubmed/24625129

http://www.ncbi.nlm.nih.gov/pubmed/22682464

http://www.who.int/mediacentre/factsheets/fs363/en/

http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm