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Claire G, Diane K, Olivier S. Neonatal morbidity and mortality for preterm in breech presentation regarding the onset mode of labor. Arch Gynecol Obstet 2023; 307:729-738. [PMID: 35474495 DOI: 10.1007/s00404-022-06526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/11/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To assess severe neonatal morbidity and mortality in induced labor in preterm breech deliveries, compared to spontaneous labor. METHODS This is a retrospective study conducted in a tertiary university center in France. Women with single live breech pregnancy between 28 + 0 and 36 + 6 weeks gestation were included. We excluded situations with medical contraindication to vaginal delivery and fetal malformations. We compared women with an unfavorable cervix, who had an indication for deliver and could receive cervical ripening to induce labor, to women in spontaneous labor. The primary outcome was a composite criterion of severe neonatal morbidity and mortality including perinatal death, traumatic event during delivery, Apgar score at 5-min < 4, moderate or severe encephalopathy, seizures within the first 24 h, Intra-Ventricular Hemorrhage grade 3 or 4, necrotizing enterocolitis grade 2 or 3. RESULTS We included 212 patients: 64 in the induced labor group and 136 in the spontaneous labor group. In the induced labor group, 45.3% of patients delivered vaginally, and 86% in spontaneous labor group. The neonatal morbidity and mortality rate were similar in both groups: 4.7% in the induced labor group, and 5.2% in the spontaneous labor group, p = 0.889, aOR = 1.5 (0.28-8.28). CONCLUSION Nearly half of the patient who received induction of labor delivered vaginally. The onset mode of labor does not appear to have an effect on severe neonatal morbidity and mortality in preterm breech fetuses. Induction of labor could be an option for patients in this setting.
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Affiliation(s)
- Guerini Claire
- Service de Gynécologie Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Korb Diane
- Service de Gynécologie Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France. .,Centre for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université de Paris, Paris, France.
| | - Sibony Olivier
- Service de Gynécologie Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
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2
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Rotem R, Hirsch A, Barg M, Mor P, Michaelson-Cohen R, Rottenstreich M. Trial of labor following cesarean in preterm deliveries: success rates and maternal and neonatal outcomes: a multicenter retrospective study. Arch Gynecol Obstet 2022:10.1007/s00404-022-06746-3. [PMID: 36068361 DOI: 10.1007/s00404-022-06746-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate the rates of vaginal birth after cesarean (VBAC) among parturients attempting preterm trial of labor following a cesarean delivery (TOLAC) vs. term TOLAC. METHODS A multicenter historic cohort study was conducted at two university-affiliated centers between August 2005 and March 2021. Parturients in their second delivery, attempting TOLAC after a single low segment transverse cesarean delivery were included. We retrospectively examined computerized medical records of all preterm (< 37 weeks) and term (37-42 weeks) births. Multifetal gestations and postterm deliveries (≥ 42 weeks) were excluded. A univariate analysis was conducted, followed by a multivariate analysis. RESULTS 4865 second deliveries following previous cesarean were identified: 212 (4.4%) preterm and 4653 (95.6%) term. Hypertensive disorders, diabetes and fertility treatments were significantly more prevalent in the preterm group. VBAC rate was significantly lower in preterm group (57.5 vs 79.7%., p < 0.01), including both spontaneous and vaginal-assisted deliveries. In multivariate analysis, preterm TOLAC was independently associated with TOLAC failure [adjusted odds ratio 2.24, [95% confidence interval 1.62-3.09]. Overall, maternal outcomes were favorable. Rates of uterine rupture, re-laparotomy and postpartum hemorrhage were comparable between groups. Neonatal outcomes were less favorable among the preterm group; however, preterm vs. term TOLAC was not associated with low 5 min Apgar score (aOR 1.76, 95% CI 0.92-3.40). CONCLUSION In our study, VBAC rates were lower in preterm compared to term deliveries. Maternal outcomes were comparable. Neonatal outcomes were less favorable in the preterm group, more likely due to prematurity than delivery mode.
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Affiliation(s)
- Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, POB 3235, 91031, Jerusalem, Israel
| | - Ayala Hirsch
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, POB 3235, 91031, Jerusalem, Israel
| | - Moshe Barg
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, POB 3235, 91031, Jerusalem, Israel
| | - Pnina Mor
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, POB 3235, 91031, Jerusalem, Israel.,Medical Genetics Institute, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Rachel Michaelson-Cohen
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, POB 3235, 91031, Jerusalem, Israel. .,Medical Genetics Institute, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel.
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, POB 3235, 91031, Jerusalem, Israel.,Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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3
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Mendez-Figueroa H, Bicocca MJ, Bhalwal AB, Wagner SM, Chauhan SP, Fishel Bartal M. Preterm Cesarean Delivery for Nonreassuring Fetal Heart Rate Tracing: Risk Factors and Predictability of Adverse Outcomes. Eur J Obstet Gynecol Reprod Biol 2022; 276:207-212. [DOI: 10.1016/j.ejogrb.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/08/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
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Recent Review of Germinal Matrix Hemorrhage-Intraventricular Hemorrhage in Preterm Infants. Neonatal Netw 2022; 41:100-106. [PMID: 35260427 DOI: 10.1891/11-t-722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/25/2022]
Abstract
Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) is a particular type of intracranial hemorrhage that affects the preterm population. GMH-IVH originates from bleeding within the highly vascular area near the center of the brain known as the germinal matrix. The pathogenesis of GMH-IVH is unclear; it is likely related to hemodynamic changes and fluctuations in cerebral blood flow within a fragile developing brain. Cranial ultrasound is the primary diagnostic test and reveals the degree of GMH-IVH based on a grading system. Management includes prevention of preterm delivery with meticulous antenatal and postnatal preventative strategies. This article discusses current evidence specific to the pathogenesis, risk factors, diagnosis, grading scales, and management approaches with GMH-IVH in preterm infants.
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5
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Affiliation(s)
- Andrei S Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM U1153 EPOPé, INRA, Paris, France
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- Department of Neonatal Medicine, Maternité Port-Royal, Association Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Marina Mendonça
- Department of Psychology, University of Warwick, Coventry, UK
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nicole Thiele
- European Foundation for Care of the Newborn Infant, Munich, Germany
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- National Institute for Health Research, University College London Hospital Biomedical Research Centre, London, UK
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6
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Ehrhardt H, Desplanches T, van Heijst AFJ, Toome L, Fenton A, Torchin H, Nuytten A, Mazela J, Zeitlin J, Maier RF. Mode of Delivery and Incidence of Bronchopulmonary Dysplasia: Results from the Population-Based EPICE Cohort. Neonatology 2022; 119:464-473. [PMID: 35526524 DOI: 10.1159/000524337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/24/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Bronchopulmonary dysplasia (BPD) represents a tremendous disease burden following preterm birth. The strong association between compromised gas exchange after birth and BPD demands particular focus on the perinatal period. The mode of delivery can impact on lung fluid clearance and microbial colonization, but its impact on BPD and potential trade-off effects between death and BPD are not established. METHODS A total of 7,435 live births (24+0 to 31+6 weeks postmenstrual age) in 19 regions of 11 European countries were included. Principal outcomes were death and BPD at 36 weeks. We estimated unadjusted and adjusted associations with mode of delivery using multilevel logistic regression to account for clustering within units and regions. Sensitivity analyses examined effects, taking into consideration regional variations in C-section rates. RESULTS Compared to vaginal delivery, delivery by C-section was not associated with the incidence of BPD (OR 0.92, 95% CI: 0.68-1.25) or the composite outcome of death or BPD (OR 0.94, 95% CI: 0.74-1.19) after adjustment for perinatal and neonatal risk factors in the total cohort and in pregnancies for whom a vaginal delivery could be considered. Sensitivity analyses among singletons, infants in cephalic presentation, and infants of ≥26+0 weeks of gestation did not alter the results for BPD, severe BPD, and death or BPD, even in regions with a high C-section rate. CONCLUSIONS In our population-based cohort study, the mode of delivery was not associated with the incidence of BPD. The intention to reduce BPD does not justify a C-section in pregnancies where a vaginal delivery can be considered.
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Affiliation(s)
- Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Thomas Desplanches
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), INSERM, Université de Paris, Paris, France.,Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon University Hospital, Dijon, France
| | - Arno F J van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Estonia University, Tallinn, Estonia.,Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Alan Fenton
- Newcastle Neonatal Service, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Héloïse Torchin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), INSERM, Université de Paris, Paris, France.,Department of Neonatal Pediatrics, Cochin Port Royal Hospital, APHP, Paris, France
| | - Alexandra Nuytten
- Department of Neonatology, Jeanne de Flandre Hospital, CHU Lille, University of Lille, Lille, France.,ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, CHU Lille, University of Lille, Lille, France
| | - Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), INSERM, Université de Paris, Paris, France
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
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7
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Norman JE, Lawton J, Stock SJ, Siassakos D, Norrie J, Hallowell N, Chowdhry S, Hart RI, Odd D, Brewin J, Culshaw L, Lee-Davey C, Tebbutt H, Whyte S. Feasibility and design of a trial regarding the optimal mode of delivery for preterm birth: the CASSAVA multiple methods study. Health Technol Assess 2021; 25:1-102. [PMID: 34751645 DOI: 10.3310/hta25610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Around 60,000 babies are born preterm (prior to 37 weeks' gestation) each year in the UK. There is little evidence on the optimal birth mode (vaginal or caesarean section). OBJECTIVE The overall aim of the CASSAVA project was to determine if a trial to define the optimal mode of preterm birth could be carried out and, if so, determine what sort of trial could be conducted and how it could best be performed. We aimed to determine the specific groups of preterm women and babies for whom there are uncertainties about the best planned mode of birth, and if there would be willingness to recruit to, and participate in, a randomised trial to address some, but not all, of these uncertainties. This project was conducted in response to a Heath Technology Assessment programme commissioning call (17/22 'Mode of delivery for preterm infants'). METHODS We conducted clinician and patient surveys (n = 224 and n = 379, respectively) to identify current practice and opinion, and a consensus survey and Delphi workshop (n = 76 and n = 22 participants, respectively) to inform the design of a hypothetical clinical trial. The protocol for this clinical trial/vignette was used in telephone interviews with clinicians (n = 24) and in focus groups with potential participants (n = 13). RESULTS Planned sample size and data saturation was achieved for all groups except for focus groups with participants, as this had to be curtailed because of the COVID-19 pandemic and data saturation was not achieved. There was broad agreement from parents and health-care professionals that a trial is needed. The clinician survey demonstrated a variety of practice and opinion. The parent survey suggested that women and their families generally preferred vaginal birth at later gestations and caesarean section for preterm infants. The interactive workshop and Delphi consensus process confirmed the need for more evidence (hence the case for a trial) and provided rich information on what a future trial should entail. It was agreed that any trial should address the areas with most uncertainty, including the management of women at 26-32 weeks' gestation, with either spontaneous preterm labour (cephalic presentation) or where preterm birth was medically indicated. Clear themes around the challenges inherent in conducting any trial emerged, including the concept of equipoise itself. Specific issues were as follows: different clinicians and participants would be in equipoise for each clinical scenario, effective conduct of the trial would require appropriate resources and expertise within the hospital conducting the trial, potential participants would welcome information on the trial well before the onset of labour and minority ethnic groups would require tailored approaches. CONCLUSION Given the lack of evidence and the variation of practice and opinion in this area, and having listened to clinicians and potential participants, we conclude that a trial should be conducted and the outlined challenges resolved. FUTURE WORK The CASSAVA project could be used to inform the design of a randomised trial and indicates how such a trial could be carried out. Any future trial would benefit from a pilot with qualitative input and a study within a trial to inform optimal recruitment. LIMITATIONS Certainty that a trial could be conducted can be determined only when it is attempted. TRIAL REGISTRATION Current Controlled Trials ISRCTN12295730. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 61. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Julia Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Nina Hallowell
- Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Ruth I Hart
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Odd
- Division of Population Medicine, School of Medicine, University of Cardiff, Cardiff, UK
| | | | | | | | | | - Sonia Whyte
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Maternal and Fetal Health, University of Edinburgh, Edinburgh, UK
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8
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Pierre C, Leroy A, Pierache A, Storme L, Debarge V, Depret S, Rakza T, Garabedian C, Subtil D. Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study. PLoS One 2021; 16:e0258303. [PMID: 34669715 PMCID: PMC8528279 DOI: 10.1371/journal.pone.0258303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 09/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background The effect on neonatal mortality of mode of delivery of a fetus in breech presentation at an extremely preterm gestational age remains controversial. Objective To compare mortality associated with planned vaginal delivery (PVD) of fetuses in breech presentation with that of fetuses in breech presentation with a planned cesarean delivery (PCD). Material and methods Retrospective study reviewing records over a 19-year period in a level 3 university referral center of singleton infants born between 25+0 and 27+6 weeks of gestation, alive on arrival in the delivery room, and weighing at least 500 grams at birth. Infants in the first group were in breech presentation with PVD and the second in breech presentation with PCD. The principal endpoint was neonatal death. Results During the study period, we observed 113 breech presentations with PVD, and 80 breech presentations with PCD. Although not significant after adjustment, neonatal mortality in the breech PVD group was more than twice that of the breech PCD group (19.5 vs 7.8%, P = 0.031, ORa = 2.6, 95% CI 0.8–9.3, NNT = 8). This higher neonatal mortality in the breech PVD group was exclusively associated with a higher risk of death in the delivery room (12.4 vs 0.0% P = 0.001, OR not calculable, NNT = 8). In these extremely preterm breech presentations with PVD, neonatal mortality in the delivery room was associated with entrapment of the aftercoming head, cord prolapse, and a short duration of labor. Conclusion For deliveries between 25+0 and 27+6 weeks’ gestation, vaginal delivery in breech presentation is associated with a higher risk of death in the delivery room.
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Affiliation(s)
- Clémentine Pierre
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, Lille, France
- Univ. Lille, EA 2694, METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- * E-mail:
| | - Audrey Leroy
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, Lille, France
| | - Adeline Pierache
- Univ. Lille, CHU Lille, Département de Biostatistiques, Lille, France
| | - Laurent Storme
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, Lille, France
- Univ. Lille, EA 2694, METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Véronique Debarge
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, Lille, France
- Univ. Lille, EA 2694, METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Sandrine Depret
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, Lille, France
| | - Thameur Rakza
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, Lille, France
- Univ. Lille, EA 2694, METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Charles Garabedian
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, Lille, France
- Univ. Lille, EA 2694, METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Damien Subtil
- Univ. Lille, CHU Lille, Hôpital Jeanne de Flandre, Pôle Femme Mère Nouveau-né, Lille, France
- Univ. Lille, EA 2694, METRICS, Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
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9
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Paixao ES, Bottomley C, Pescarini JM, Wong KLM, Cardim LL, Ribeiro Silva RDC, Brickley EB, Rodrigues LC, Oliveira Alves FJ, Leal MDC, Costa MDCN, Teixeira MG, Ichihara MY, Smeeth L, Barreto ML, Campbell OMR. Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil. PLoS Med 2021; 18:e1003791. [PMID: 34637451 PMCID: PMC8509988 DOI: 10.1371/journal.pmed.1003791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. METHODS AND FINDINGS We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. CONCLUSIONS In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.
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Affiliation(s)
- Enny S. Paixao
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- * E-mail:
| | - Christian Bottomley
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Julia M. Pescarini
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Kerry L. M. Wong
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luciana L. Cardim
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro Silva
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Nutrition School, Federal University of Bahia, Salvador, Brazil
| | - Elizabeth B. Brickley
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Laura C. Rodrigues
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Maria do Carmo Leal
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria da Conceicao N. Costa
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Maria Gloria Teixeira
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Liam Smeeth
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mauricio L. Barreto
- Center for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Oona M. R. Campbell
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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10
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Wolf HT, Weber T, Schmidt S, Norman M, Varendi H, Piedvache A, Zeitlin J, Huusom LD. Mode of delivery and adverse short- and long-term outcomes in vertex-presenting very preterm born infants: a European population-based prospective cohort study. J Perinat Med 2021; 49:923-931. [PMID: 34280959 DOI: 10.1515/jpm-2020-0468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/14/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare mortality, morbidity and neurodevelopment by mode of delivery (MOD) for very preterm births with low prelabour risk of caesarean section (CS). METHODS The study was a population-based prospective cohort study in 19 regions in 11 European countries. Multivariable mixed effects models and weighted propensity score models were used to estimate adjusted odds ratios (aOR) by observed MOD and the unit's policy regarding MOD. Population: Singleton vertex-presenting live births at 24 + 0 to 31 + 6 weeks of gestation without serious congenital anomalies, preeclampsia, HELLP or eclampsia, antenatal detection of growth restriction and prelabour CS for fetal or maternal indications. RESULTS Main outcome measures: A composite of in-hospital mortality and intraventricular haemorrhage (grade III/IV) or periventricular leukomalacia. Secondary outcomes were components of the primary outcome, 5 min Apgar score <7 and moderate to severe neurodevelopmental impairment at two years of corrected age. The rate of CS was 29.6% but varied greatly between countries (8.0-52.6%). MOD was not associated with the primary outcome (aOR for CS 0.99; 95% confidence interval [CI] 0.65-1.50) when comparing units with a systematic policy of CS or no policy of MOD to units with a policy of vaginal delivery (aOR 0.88; 95% CI 0.59-1.32). No association was observed for two-year neurodevelopment impairment for CS (aOR 1.15; 95% CI 0.66-2.01) or unit policies (aOR 1.04; 95% CI 0.63-1.70). CONCLUSIONS Among singleton vertex-presenting live births without medical complications requiring a CS at 24 + 0 to 31 + 6 weeks of gestation, CS was not associated with improved neonatal or long-term outcomes.
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Affiliation(s)
- Hanne Trap Wolf
- Department of Gynaecology and Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Tom Weber
- Department of Gynaecology and Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Stephan Schmidt
- Department of Obstetrics, University Hospital, Philipps University, Marburg, Germany
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Aurélie Piedvache
- Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Lene Drasbek Huusom
- Department of Gynaecology and Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
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11
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Coelho GDP, Ayres LFA, Barreto DS, Henriques BD, Prado MRMC, Passos CMD. Acquisition of microbiota according to the type of birth: an integrative review. Rev Lat Am Enfermagem 2021; 29:e3446. [PMID: 34287544 PMCID: PMC8294792 DOI: 10.1590/1518.8345.4466.3446] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/29/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: to analyze scientific evidence regarding the relationship between the type of birth and the microbiota acquired by newborns. Method: this integrative review addresses the role of the type of delivery on newborns’ microbial colonization. A search was conducted in the Medical Literature Analysis and Retrieval System Online/PubMed and Virtual Health Library databases using the descriptors provided by Medical Subject Headings (MeSH) and Health Science Descriptors (DeCS). Results: infants born vaginally presented a greater concentration of Bacteroides, Bifidobacteria, and Lactobacillus in the first days of life and more significant microbial variability in the following weeks. The microbiome of infants born via C-section is similar to the maternal skin and the hospital setting and less diverse, mainly composed of Staphylococcus, Streptococcus, and Clostridium. Conclusion: the maternal vaginal microbiota provides newborns with a greater variety of colonizing microorganisms responsible for boosting and preparing the immune system. Vaginal birth is the ideal birth route, and C-sections should only be performed when there are medical indications.
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Affiliation(s)
| | | | | | - Bruno David Henriques
- Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem, Viçosa, MG, Brasil
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12
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Morgan AS, Waheed S, Gajree S, Marlow N, David AL. Maternal and infant morbidity following birth before 27 weeks of gestation: a single centre study. Sci Rep 2021; 11:288. [PMID: 33431902 PMCID: PMC7801674 DOI: 10.1038/s41598-020-79445-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
Delivery at extreme preterm gestational ages (GA) [Formula: see text] weeks is challenging with limited evidence often focused only on neonatal outcomes. We reviewed management and short term maternal, fetal and neonatal outcomes of births for 132 women (22 + 0 to 26 + 6 weeks' GA) with a live fetus at admission to hospital and in labour or at planned emergency Caesarean section: 103 singleton and 29 (53 live fetuses) twin gestations. Thirty women (23%) had pre-existing medical problems, 110 (83%) had antenatal complications; only 17 (13%) women experienced neither. Major maternal labour and delivery complications affected 35 women (27%). 151 fetuses (97%) were exposed to antenatal steroids, 24 (15%) to tocolysis and 70 (45%) to magnesium sulphate. Delivery complications affected 11 fetuses, with 12 labour or delivery room deaths; survival to discharge was 75% (117/156), increasing with GA: 25% (1/4), 75% (18/24), 69% (29/42), 73% (33/45) and 88% (36/41) at 22, 23, 24, 25 and 26 weeks GA respectively (p = 0.024). No statistically important impact was seen from twin status, maternal illness or obstetric management. Even in a specialist perinatal unit antenatal and postnatal maternal complications are common in extreme preterm births, emphasising the need to include maternal as well as neonatal outcomes.
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Affiliation(s)
- Andrei S Morgan
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Hôpital Tenon, Rue de la Chine, 75020, Paris, France.,SAMU 93-SMUR Pédiatrique, CHI André Gregoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Montreuil, France.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Saadia Waheed
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Shivani Gajree
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Neil Marlow
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK
| | - Anna L David
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK. .,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK. .,Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.
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13
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Lodha A, Ediger K, Creighton D, Tang S, Lodha A, Wood S. Caesarean section and neonatal survival and neurodevelopmental impairments in preterm singleton neonates. Paediatr Child Health 2021; 25:93-101. [PMID: 33390746 DOI: 10.1093/pch/pxz051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/14/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Evidence is lacking regarding the benefit of caesarean section (CS) for long-term neurodevelopmental outcomes in singleton preterm neonates. Therefore, uncertainty remains regarding obstetrical best practice in the delivery of premature neonates. Objective Our objective was to determine the association between the mode of delivery and neurodevelopmental outcomes in preterm singleton neonates who were delivered by vaginal route (VR), CS with labour (CS-L), or CS without labour (CS-NL). Methods Singleton neonates of less than 29 weeks' gestation born January 1995 through December 2010 and admitted to our NICU and then assessed at neonatal follow-up clinic were studied. The primary outcome was neurodevelopmental impairment (NDI) defined as cerebral palsy, cognitive delay, major or minor visual impairment, or hearing impairment or deafness at 36 months' corrected age. Results In this retrospective cohort study of 1,452 neonates, 1,000 were eligible for the study and 881 (88.1%) were available for follow-up. There was no significant difference in mortality between VR group, CS-L group, and CS-NL group. At 3 years, there was no significant difference between the three groups in terms of NDI. The odds of composite outcome of mortality or NDI for neonates born via CS-NL versus VR, and CS-L versus VR were 0.90 (95% confidence interval [CI]: 0.59 to 1.37) and 1.08 (95% CI: 0.72 to 1.61), respectively. Propensity score-based matched-pair analyses did not show a significant association between the composite outcome and CS with or without labour. Conclusions CS was not associated with increased survival or decreased risk of NDI in premature singleton neonates born at less than 29 weeks' gestation.
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Affiliation(s)
- Abhay Lodha
- Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Alberta Health Services, Calgary, Alberta.,Department of Pediatrics, Foothills Medical Center, Calgary, Alberta.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta
| | - Krystyna Ediger
- Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Alberta Health Services, Calgary, Alberta.,Department of Pediatrics, Foothills Medical Center, Calgary, Alberta
| | - Dianne Creighton
- Alberta Health Services, Calgary, Alberta.,Department of Pediatrics, Foothills Medical Center, Calgary, Alberta
| | | | - Arijit Lodha
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta
| | - Stephen Wood
- Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Alberta Health Services, Calgary, Alberta.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta.,Department of Obstetrics & Gynaecology, Foothills Medical Center, Calgary, University of Calgary, Calgary, Alberta.,O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta
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14
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AlQurashi MA. Impact of Mode of Delivery on the Survival Rate of Very Low Birth Weight Infants: A Single-Center Experience. Cureus 2020; 12:e11918. [PMID: 33304710 PMCID: PMC7721068 DOI: 10.7759/cureus.11918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Worldwide cesarean birth had increased over the past three decades and in the USA, the overall rate of cesarean birth has increased from 23.8% in 1989 to 31.9% in 2018. Moreover, the substantial increase of preterm infants delivered by cesarean section had reached anywhere from 45% to 72% for gestational age <33 weeks. There is a considerable debate on whether cesarean section confers a survival advantage for preterm infants. Published data on the relationship between mode of delivery and survival rate were inconsistent and there is a lack of large randomized controlled trials (RCTs) that have investigated this important clinical concern. Thus, the aim of this study is to evaluate the impact of cesarean section on the survival rate of very low birth weight (VLBW) infants. METHODS This was a retrospective cohort study of ≤32 weeks VLBW infants born alive and admitted to Neonatal Intensive Care Unit (NICU) at King Abdulaziz Medical City-Jeddah (KAMC-Jeddah) between January 1, 1994, and December 31, 2019. The primary outcome of interest was the survival rate to discharge of VLBW infants delivered by cesarean section compared to delivered vaginally. Relevant demographic and clinical variables were assessed and its association to survival to discharge of VLBW infants were analyzed. RESULTS Of the 1055 ≤32 weeks VLBW infants included in the study, 559 (53%) were delivered by cesarean section, and 496 (47%) were delivered vaginally. Cesarean delivery had increased from 44.2% to 66% between 1994-1998 and 2014-2019, respectively. The rise of cesarean delivery compared with the vaginal delivery was more profound for gestational age ≤26 weeks and birth weight ≤800 g. The VLBW infants delivered by cesarean section had a higher survival rate when compared to infants delivered vaginally (87.29% vs 71.77%, P<0.001). The survival advantage was statistically significant in extremely low birth weight (ELBW) infants (801-1000 g) and infants with birth weight ≤800 g, 86.73% vs 73.62%, P=0.018 and 58.02% vs 40.52, P=0.001, respectively. Moreover, VLBW infants ≤26 weeks gestational age delivered by cesarean section had a higher survival rate of 69.15% vs 44.5%, P<0.001. CONCLUSION This study demonstrates that cesarean birth is associated with higher survival for VLBW infants with birth weight ≤800 g and ELBW infants and gestational age ≤26 weeks compared to vaginal birth.
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Affiliation(s)
- Mansour A AlQurashi
- Neonatology Division, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
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15
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Vargas S, Rego S, Clode N. Cesarean Section Rate Analysis in a Tertiary Hospital in Portugal According to Robson Ten Group Classification System. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:310-315. [PMID: 32604433 PMCID: PMC10418145 DOI: 10.1055/s-0040-1712127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/23/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The Robson 10 group classification system (RTGCS) is a reproducible, clinically relevant and prospective classification system proposed by the World Health Organization (WHO) as a global standard for assessing, monitoring and comparing cesarean section (CS) rates. The purpose of the present study is to analyze CS rates according to the RTGCS over a 3-year period and to identify the main contributors to this rate. METHODS We reviewed data regarding deliveries performed from 2014 up to 2016 in a tertiary hospital in Portugal, and classified all women according to the RTGCS. We analyzed the CS rate in each group. RESULTS We included data from 6,369 deliveries. Groups 1 (n = 1,703), 2 (n = 1,229) and 3 (n = 1,382) represented 67.7% of the obstetric population. The global CS rate was 25% (n = 1,594). Groups 1, 2, 5 and 10 were responsible for 74.2% of global CS deliveries. CONCLUSION As expected, Groups 1, 2, 5 and 10 were the greatest contributors to the overall CS rate. An attempt to increase the number of vaginal deliveries in these groups, especially in Groups 2 and 5, might contribute to the reduction of the CS rate.
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Affiliation(s)
- Sara Vargas
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Susana Rego
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Nuno Clode
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
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16
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Tietzmann MR, Teichmann PDV, Vilanova CS, Goldani MZ, Silva CHD. Risk Factors for Neonatal Mortality in Preterm Newborns in The Extreme South of Brazil. Sci Rep 2020; 10:7252. [PMID: 32350375 PMCID: PMC7190611 DOI: 10.1038/s41598-020-64357-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/07/2020] [Indexed: 11/08/2022] Open
Abstract
Neonatal mortality still remains a complex challenge to be addressed. In Brazil, 60% of neonatal deaths occur among preterm infants with a gestational age of 32 weeks or less (≤32w). The aim of this study was to evaluate the factors involved in the high mortality rates among newborns with a gestational age ≤32w in a socioeconomically developed southern city in Brazil. Data on retrospective births and deaths (2000-2014) were analyzed from two official Brazilian national databases. The risk of neonatal death for all independent variables (mother's age and schooling, prenatal visits, birth hospital, delivery method, gestational age, and the newborn's sex, age, and birth year, gemelarity, congenital anomalies and birthplace) was assessed with a univariable and a multivariable model of Cox's semiparametric proportional hazards regression (p < 0.05). Data of 288,904 newborns were included, being 4,514 with a gestational age ≤32w. The proportion of these early newborns remained stable among all births, while the neonatal mortality rate for this group tended to decrease (p < 0.001). The adjusted risk was significantly for lower birthweight infants (mean 659.13 g) born from Caesarean (HR 0.58 [95% CI 0.47-0.71]), but it was significantly higher for heavier birth weight infants (mean 2,087.79) also born via Caesarean section (HR 3.71 [95% CI 1.5-9.15]). Newborns with lower weight seemed to benefit most from Cesarean deliveries. Effort towards reducing unacceptably high surgical deliveries must take into account cases that the operations may be lifesaving for mother and/or the baby.
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Affiliation(s)
- Marcos Roberto Tietzmann
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | - Pedro do Valle Teichmann
- Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil.
| | - Cassia Simeão Vilanova
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | - Marcelo Zubaran Goldani
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
- Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
- Pediatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-007, Brazil
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | - Clécio Homrich da Silva
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
- Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
- Pediatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-007, Brazil
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
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17
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Jiang HL, Lu C, Wang XX, Wang X, Zhang WY. Cesarean section does not affect neonatal outcomes of pregnancies complicated with preterm premature rupture of membranes. Chin Med J (Engl) 2020; 133:25-32. [PMID: 31923101 PMCID: PMC7028204 DOI: 10.1097/cm9.0000000000000582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is associated with high neonatal morbidity and mortality. However, the influences of cesarean section (CS) on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated. The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM. METHODS A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st, 2011 to December 31st, 2011. A total of 2756 singleton pregnancies complicated with PPROM were included. Adverse neonatal outcomes including early neonatal death, birth asphyxia, respiratory distress syndrome (RDS), pneumonia, infection, birth trauma, and 5-min/10-min Apgar scores were obtained from the hospital records. Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression. Numerical variables were compared by multiple linear regressions. RESULTS In total, 2756 newborns were involved in the analysis. Among them, 1166 newborns (42.31%) were delivered by CS and 1590 newborns belonged to vaginal delivery (VD) group. The CS proportion of PPROM obviously increased with the increase of gestational age (χ = 5.014, P = 0.025). Compared with CS group, VD was associated with a higher risk of total newborns mortality (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.102-5.118; P = 0.027), and a lower level of pneumonia (OR, 0.32; 95% CI, 0.126-0.811; P = 0.016). However, after multivariable adjustment and stratification for gestational age, only pneumonia was significantly related with CS in 28 to 34 weeks group (OR, 0.34; 95% CI, 0.120-0.940; P = 0.038). There were no differences regarding to other adverse outcomes in the two groups, including neonatal mortality, birth asphyxia, Apgar scores, RDS, pneumonia, and sepsis. CONCLUSIONS The proportion of CS of pregnant women with PPROM was very high in China. The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.
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Affiliation(s)
- Hai-Li Jiang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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18
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Jarde A, Feng YY, Viaje KA, Shah PS, McDonald SD. Vaginal birth vs caesarean section for extremely preterm vertex infants: a systematic review and meta-analyses. Arch Gynecol Obstet 2019; 301:447-458. [DOI: 10.1007/s00404-019-05417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/07/2019] [Indexed: 11/30/2022]
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Marshall S, Lang AM, Perez M, Saugstad OD. Delivery room handling of the newborn. J Perinat Med 2019; 48:1-10. [PMID: 31834864 PMCID: PMC7771218 DOI: 10.1515/jpm-2019-0304] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/07/2019] [Indexed: 01/24/2023]
Abstract
For newly born babies, especially those in need of intervention at birth, actions taken during the first minute after birth, the so-called "Golden Minute", can have important implications for long-term outcomes. Both delivery room handling, including identification of maternal and infant risk factors and provision of effective resuscitation interventions, and antenatal care decisions regarding antenatal steroid administration and mode of delivery, are important and can affect outcomes. Anticipating risk factors for neonates at high risk of requiring resuscitation can decrease time to resuscitation and improve the prognosis. Following a review of maternal and fetal risk factors affecting newborn resuscitation, we summarize the current recommendations for delivery room handling of the newborn. This includes recommendations and rationale for the use of delayed cord clamping and cord milking, heart rate assessment [including the use of electrocardiogram (ECG) electrodes in the delivery room], role of suctioning in newborn resuscitation, and the impact of various ventilatory modes. Oxygenation should be monitored by pulse oximetry. Effects of oxygen and surfactant on subsequent pulmonary outcomes, and recommendations for provisions of appropriate thermoregulatory support are discussed. Regular teaching of delivery room handling should be mandatory.
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Affiliation(s)
- Stephanie Marshall
- Ann and Robert H. Lurie, Children’s Hospital of Chicago, Chicago, IL, USA
| | - Astri Maria Lang
- Department of Neonatology, Division of Child Health, and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Marta Perez
- Ann and Robert H. Lurie, Children’s Hospital of Chicago, Chicago, IL, USA
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20
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Mode of delivery and pregnancy outcomes in preterm birth: a secondary analysis of the WHO Global and Multi-country Surveys. Sci Rep 2019; 9:15556. [PMID: 31664121 PMCID: PMC6820722 DOI: 10.1038/s41598-019-52015-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/12/2019] [Indexed: 11/12/2022] Open
Abstract
Many studies have been conducted to examine whether Caesarean Section (CS) or vaginal birth (VB) was optimal for better maternal and neonatal outcomes in preterm births. However, findings remain unclear. Therefore, this secondary analysis of World Health Organization Global Survey (GS) and Multi-country Survey (MCS) databases was conducted to investigate outcomes of preterm birth by mode of delivery. Our sample were women with singleton neonates (15,471 of 237 facilities from 21 countries in GS; and 15,053 of 239 facilities from 21 countries in MCS) delivered between 22 and <37 weeks of gestation. We assessed association between mode of delivery and pregnancy outcomes in singleton preterm births by multilevel logistic regression adjusted for hierarchical data. The prevalences of women with preterm birth delivered by CS were 31.0% and 36.7% in GS and MCS, respectively. Compared with VB, CS was associated with significantly increased odds of maternal intensive care unit admission, maternal near miss, and neonatal intensive care unit admission but significantly decreased odds of fresh stillbirth, and perinatal death. However, since the information on justification for mode of delivery (MOD) were not available, our results of the potential benefits and harms of CS should be carefully considered when deciding MOD in preterm births.
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21
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Nelson RL, Go C, Darwish R, Gao J, Parikh R, Kang C, Mahajan A, Habeeb L, Zalavadiya P, Patnam M. Cesarean delivery to prevent anal incontinence: a systematic review and meta-analysis. Tech Coloproctol 2019; 23:809-820. [PMID: 31273486 DOI: 10.1007/s10151-019-02029-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cesarean delivery (CD), is increasingly recommended as a mode of delivery that prevents the anal incontinence (AI) that arises in some women after vaginal delivery (VD). The assessment of the efficacy of CD in this regard was the subject of this systematic review. METHODS Searches were conducted in Medline, EMBASE and the Cochrane Library. Both randomized (RCTs) and non-randomized trials (NRTs) comparing the risk of sustained fecal and/or flatus incontinence after VD or CD were sought from 1966 to 1 January, 2019. Studies were eligible if they assessed AI more than 6 months after birth, and had statistical adjustment for at least one of the three major confounders for AI: age, maternal weight or parity. In addition, each study was required to contain more than 250 participants, more than 50 CDs and more than 25 cases of AI. Data after screening and selection were abstracted and entered into Revman for meta-analysis. Analyses were done for combined fecal and flatus incontinence (comAI), fecal incontinence (FI), gas incontinence (GI), CD before or during labor, time trend of incontinence after delivery, assessment of both statistical and clinical heterogeneity, parity and late incident AI. RESULTS Out of the 2526 titles and abstracts found, 24 eligible studies were analyzed, 23 NRTs and one RCT. These included women with 29,597 VDs and women with 6821 CDs. Among the primary outcomes, VD was found not to be a significant predictor of postpartum comAI compared to CD in 6 studies, incorporating 18,951 deliveries (OR = 0.74; 0.54-1.02). VD was also not a significant predictor of FI in 14 studies, incorporating 29,367 deliveries, (OR = 0.89; 0.76-1.05). VD was not a significant predictor of GI in six studies, incorporating 6724 deliveries (OR = 0.96; 0.79-1.18). The strength of the grading of recommendations, assessment, development and evaluations (GRADE) evidence for each of these was low for comAI and moderate for FI and GI (upgrade for lack of expected effect). Time trend FI showed incontinence at 3 months often resolved at 1 year. Other secondary analyses assessing parity, delayed incidence of FI, clinical and statistical heterogeneity, spontaneous VD only, late risk of incidence of AI, and CD in or prior to labor all had similar results as in the primary outcomes. CONCLUSIONS There are three components of pelvic floor dysfunction that are thought to be caused by VD and hopefully prevented by CD: AI, urinary incontinence and pelvic floor prolapse. Of these, AI was not found to be reliably prevented by CD in this review.
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Affiliation(s)
- R L Nelson
- Epidemiology/Biometry Division, University of Illinois School of Public Health, Chicago, IL, USA.
| | - C Go
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - R Darwish
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - J Gao
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - R Parikh
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - C Kang
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - A Mahajan
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - L Habeeb
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - P Zalavadiya
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - M Patnam
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
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Fischer T, Mörtl M, Reif P, Kiss H, Lang U. Statement by the OEGGG with Review of the Literature on the Mode of Delivery of Premature Infants at the Limit of Viability. Geburtshilfe Frauenheilkd 2018; 78:1212-1216. [PMID: 30655647 PMCID: PMC6294639 DOI: 10.1055/a-0669-1480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 12/03/2022] Open
Abstract
In 2017, the Austrian Society for Paediatric and Adolescent Medicine (ÖGKJ) published a guideline on the primary care of premature infants at the limit of viability. In this guideline, it is recommended that a Caesarean section be preferred as mode of delivery with regard to an early preterm birth (22 + 0 – 24 + 6 weeks of pregnancy) due to an allegedly lower perinatal risk of cerebral haemorrhage. In contrast to this, the Austrian Society for Gynaecology and Obstetrics (OEGGG) considers there to be no clinical and scientific basis for this recommendation and the mode of delivery in the case of early preterm birth must be adapted to the individual maternal and foetal clinical situation. The international data available from the generally retrospective investigations show heterogeneous results regarding the mode of delivery. The prospective and randomised data in this regard are insufficient. A Cochrane analysis does not show any advantage in favour of a Caesarean delivery. The German-language guidelines (AWMF and Switzerland) make analogous recommendations for adapting the mode of delivery with regard to an early preterm birth individually to the respective clinical situation. In the case of an early preterm birth and a singleton in cephalic presentation, the OEGGG therefore recommends individual management of the delivery which takes the maternal and foetal clinical situation into account and also includes vaginal delivery as a mode of delivery in the clinical decision process.
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Affiliation(s)
- Thorsten Fischer
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Paracelsus Medizinischen Universität Salzburg, Salzburg, Austria
| | - Manfred Mörtl
- Frauenklinik des Klinikums Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Philipp Reif
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - Herbert Kiss
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Vienna, Austria
| | - Uwe Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
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Stern JE, Liu CL, Cabral HJ, Richards EG, Coddington CC, Hwang S, Dukhovny D, Diop H, Missmer SA. Birth outcomes of singleton vaginal deliveries to ART-treated, subfertile, and fertile primiparous women. J Assist Reprod Genet 2018; 35:1585-1593. [PMID: 29926374 PMCID: PMC6133822 DOI: 10.1007/s10815-018-1238-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 06/08/2018] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To determine whether differences in birth outcomes among assisted reproductive technology (ART)-treated, subfertile, and fertile women exist in primiparous women with, singleton, vaginal deliveries. METHODS Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) data were linked to Massachusetts vital records and hospital discharges for deliveries between July 2004 and December 2010. Primiparous women with in-state vaginal deliveries, adequate prenatal care, and singleton birth at ≥ 20 weeks (n = 117,779) were classified as ART-treated (linked to ART data from SART CORS, n = 3138); subfertile (not ART-treated but with indicators of subfertility, n = 1507); or fertile (neither ART-treated nor subfertile, n = 113,134). Outcomes of prematurity (< 37 weeks), low birthweight (< 2500 g), perinatal death (death at ≥ 20 weeks to ≤ 7 days), and maternal prolonged length of hospital stay (LOS > 3 days) were compared using multivariable logistic regression. RESULTS Compared to fertile, higher odds were found for prematurity among ART-treated (adjusted odds ratio [AOR] 1.40, 95% confidence interval [CI] 1.25-1.50) and subfertile (AOR 1.25, 95% CI 1.03-1.50) women, low birthweight among ART-treated (AOR 1.41, 95% CI 1.23-1.62) and subfertile (AOR 1.40, 95% CI 1.15-1.71) women, perinatal death among subfertile (AOR 2.64, 95% CI 1.72-4.05), and prolonged LOS among ART-treated (AOR 1.33, 95% CI 1.19-1.48) women. Differences remained despite stratification by young age and absence of pregnancy/delivery complications. CONCLUSIONS Greater odds of prematurity and low birthweight in ART-treated and subfertile, and perinatal death in subfertile deliveries are evident among singleton vaginal deliveries. The data suggest that even low-risk pregnancies to ART-treated and subfertile women be managed for adverse outcomes.
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Affiliation(s)
- Judy E Stern
- Department of Obstetrics & Gynecology and Pathology, Dartmouth-Hitchcock, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | | | - Howard J Cabral
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Elliott G Richards
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sunah Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health & Science University, Portland, USA
| | | | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
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Zhang JW, Branch W, Hoffman M, De Jonge A, Li SH, Troendle J, Zhang J. In which groups of pregnant women can the caesarean delivery rate likely be reduced safely in the USA? A multicentre cross-sectional study. BMJ Open 2018; 8:e021670. [PMID: 30082355 PMCID: PMC6078266 DOI: 10.1136/bmjopen-2018-021670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/19/2018] [Accepted: 06/18/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To identify obstetrical subgroups in which (1) the caesarean delivery (CD) rate may be reduced without compromising safety and (2) CD may be associated with better perinatal outcomes. DESIGN A multicentre cross-sectional study. SETTING 19 hospitals in the USA that participated in the Consortium on Safe Labor. PARTICIPANTS 228 562 pregnant women in 2002-2008. MAIN OUTCOME MEASURES Maternal and neonatal safety was measured using the individual Weighted Adverse Outcome Score. METHODS Women were divided into 10 subgroups according to a modified Robson classification system. Generalised estimated equation model was used to examine the relationships between mode of delivery and Weighted Adverse Outcome Score in each subgroup. RESULTS The overall caesarean rate was 31.2%. Repeat CD contributed 29.5% of all CD, followed by nulliparas with labour induction (15.3%) and non-cephalic presentation (14.3%). The caesarean rates in induced nulliparas with a term singleton cephalic pregnancy and women with previous CD were 31.6% and 82.0%, respectively. CD had no clinically meaningful association with perinatal outcomes in most subgroups. However, in singleton preterm breech presentation and preterm twin gestation with the first twin in non-cephalic presentation, CD was associated with substantially improved maternal and perinatal outcomes. CONCLUSIONS Women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births may be the potential targets for safely reducing prelabour CD rate, while nulliparas or multiparas with spontaneous or induced labour, women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births are potential targets for reducing intrapartum CD rate without compromising maternal and neonatal safety in the USA. On the other hand, CD may still be associated with better perinatal outcomes in women with singleton preterm breech presentation or preterm twins with the first twin in non-cephalic presentation.
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Affiliation(s)
- Jin-Wen Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ware Branch
- Intermountain Healthcare and University of Utah, Utah, USA
| | | | - Ank De Jonge
- AVAG and the Amsterdam University Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Sheng-Hui Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - James Troendle
- National Institute of Heart, Lung and Blood Institute, National Institutes of Health, Maryland, USA
| | - Jun Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Cerovac A, Gordana G, Ljuca D. Mode of Delivery in Preterm Births - Bosnian and Herzegovinian Experience. Mater Sociomed 2018; 30:290-293. [PMID: 30936795 PMCID: PMC6377931 DOI: 10.5455/msm.2018.30.290-293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: The method of carrying out PTB is one of the most controversial topics of modern perinatology, because there are no clear and undeniable works and studies that would in any case support vaginal delivery (VD) or delivery to the cesarean section (CS). Aim: To determine more frequent mode of delivery in different groups of birth weights and degrees of prematurity from single and twin pregnancies. To determine the degree of vitality of premature born vaginal delivery (VD) in relation to the cesarean section (CS) in different degrees of prematurity from single and twin pregnancies. Patients and methods: Research has retrospective cohort character. Data were collected from the databases of University Clinic of Gynecology and Obstetrics Tuzla for the period of five years (January 1st, 2012–December 31st, 2016). The study included newborns of both genders, gestational age from 24 to 37 weeks of gestation (WG) in singleton and twin pregnancies. Results: Out of 19506 births, 1350 (6.92%) were preterm birth (PTB). Singleton PTB was 1180 (87.40%), and the twins were 170 (12.59%). Vaginal delivery (VD) was born 788 (58.37%). Cesarean section (CS) was born 562 (41.63%). There was statistically significant association between the mode of delivery (MD) in singleton and twins pregnancy in all three subgroups of birth weight (BW) 1000-1499, 2000-2499 and >2500 grams in 33-37 WG. In this group was more frequent VD than CS mode of singleton delivery, and CS than VD mode of twins delivery. In contrast to newborn with BW 1500-1999 grams (chi-square = 23.16, P <0.0001) in same gestational period where was more frequent CS than VD (OR: 2.56, 95% CI: 1.71-3,85). Apgar score (AS) at first and five minute 5-7 and 8-10 in the period 28-32 and 33-37 was a statistically significant frequent in VD and singletons in contrast to CS and twins. Conclusion: VD was more frequent in the higher WG, as well as the higher AS in singletons in contrast to twins delivery.
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Affiliation(s)
- Anis Cerovac
- Department of Gynecology and Obstetrics, General hospital Tesanj, Tesanj, Bosnia and Herzegovina
| | - Grgic Gordana
- Clinic for Gynecology and Obstetrics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Dzenita Ljuca
- Clinic for Gynecology and Obstetrics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
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Kearney L, Kynn M, Craswell A, Reed R. The relationship between midwife-led group-based versus conventional antenatal care and mode of birth: a matched cohort study. BMC Pregnancy Childbirth 2017; 17:39. [PMID: 28103820 PMCID: PMC5244557 DOI: 10.1186/s12884-016-1216-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwife facilitated, group models of antenatal care have emerged as an alternative to conventional care both within Australia and internationally. Group antenatal care can be offered in a number of different ways, however usually constitutes a series of sessions co-ordinated by a midwife combining physical assessment, antenatal education and peer support in a group setting. Midwife-led group antenatal care is viewed positively by expectant mothers, with no associated adverse outcomes identified in the published literature for women or their babies when compared with conventional care. Evidence of an improvement in outcomes is limited. The aim of this study was to compare mode of birth (any vaginal birth with caesarean birth) between pregnant women accessing midwife-led group antenatal care and conventional individual antenatal care, in Queensland, Australia. METHODS This was a retrospective matched cohort study, set within a collaborative antenatal clinic between the local university and regional public health service in Queensland, Australia. Midwife-led group antenatal care (n = 110) participants were compared with controls enrolled in conventional antenatal care (n = 330). Groups were matched by parity, maternal age and gestation to form comparable groups, selecting a homogeneous sample with respect to confounding variables likely to affect outcomes. RESULTS There was no evidence that group care resulted in a greater number of caesarean births. The largest increase in the odds of caesarean birth was associated with a previous caesarean birth (p < 0.001), no previous birth (compared with previous vaginal birth) (p < 0.003), and conventional antenatal care (p < 0.073). The secondary outcomes (breastfeeding and infant birth weight) which were examined between the matched cohorts were comparable between groups. CONCLUSIONS There is no evidence arising from this study that there was a significant difference in mode of birth (caesarean or vaginal) between group and conventional care. Group care was associated with a lower risk of caesarean birth after controlling for previous births, with the highest chance for a vaginal birth being a woman who has had a previous vaginal birth and was in group care. Conversely, the highest risk of caesarean birth was for women who have had a previous caesarean birth and conventional care.
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Affiliation(s)
- Lauren Kearney
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
- Women and Families Service Group, Sunshine Coast Hospital and Health Service, Maroochydore DC, Queensland Australia
| | - Mary Kynn
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
| | - Alison Craswell
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
| | - Rachel Reed
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
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A Simionescu A, Marin E. Caesarean Birth in Romania: Safe Motherhood Between Ethical, Medical and Statistical Arguments. MAEDICA 2017; 12:5-12. [PMID: 28878830 PMCID: PMC5574073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The number of caesarean sections increased significantly in Romania. In 2012, caesarean sections accounted for 41.2% of total births, according to a study of the Romanian National School for Public Health. This estimation is in agreement with the statistical data on caesarean sections recorded in one of the most important hospitals in Bucharest, Romania, Filantropia Hospital. Many factors have influenced the large number and sharply increasing trend of caesarean sections, from the historical ones, with roots in the communist regime, when abortions were outlawed, to current day doctors' medical practices and mothers' beliefs and fears related to the process of labor and the newborn's health. This paper aims to examine the pros and cons for caesarean birth. The analysis is presented from three perspectives: expressed by the doctor/medical caregiver, the patient/mother and some of the third parties indirectly involved in the medical decision: the foetus/newborn, the hospital/medical unit and the society as a whole, knowing that ethics is beyond the legal, economic or administrative frames.
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Affiliation(s)
- Anca A Simionescu
- "Carol Davila" University of Medicine, Filantropia Hospital, Bucharest, Romania
| | - Erika Marin
- Department of Statistics and Econometrics, University of Economic Studies Bucharest, Romania
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Effect of delivery mode on neonatal outcome among preterm infants: an observational study. Wien Klin Wochenschr 2016; 129:612-617. [PMID: 28004267 PMCID: PMC5599430 DOI: 10.1007/s00508-016-1150-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/30/2016] [Indexed: 11/25/2022]
Abstract
Background The optimal mode of delivery as a predictor for outcomes in preterm infants is under debate. The purpose of this study was to evaluate the effect of the delivery mode on neonatal outcome among preterm infants in different birthweight categories. Methods A retrospective analysis of singleton preterm deliveries from 23 + 0 to 33 + 6 gestational weeks was performed. Infants were categorized based on birthweight as large for gestational age (LGA), appropriate for gestational age (AGA) and small for gestational age (SGA). The Apgar score at 5 min served as the main outcome parameter. A sensitivity analysis was performed to adjust for maternal age, parity and fetal malformations as potential confounders. Results Out of 1320 singleton preterm infants, 970 (73.5%) were delivered by cesarean section and 350 (26.5%) were delivered vaginally. The AGA infants between 23 + 0 and 27 + 6 weeks showed better outcomes after cesarean section (p < 0.01 from 23 + 0–24 + 6; p = 0.03 from 25 + 0–27 + 6), whereas AGA infants between 31 + 0 and 33 + 6 gestational weeks showed better outcomes after vaginal delivery (p = 0.02). Cesarean section was beneficial in extremely and very preterm SGA infants (p = 0.01 from 25 + 0–27 + 6; p = 0.02 from 28 + 0–30 + 6). The sensitivity analysis showed no confounding effect of other variables. Conclusion There is a benefit from cesarean section in AGA preterm infants until 28 weeks of gestation and in SGA preterm infants until 31 weeks of gestation. Vaginal delivery should be chosen for moderately preterm AGA infants.
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Morgan AS, Marlow N, Draper ES, Alfirević Z, Hennessy EM, Costeloe K. Impact of obstetric interventions on condition at birth in extremely preterm babies: evidence from a national cohort study. BMC Pregnancy Childbirth 2016; 16:390. [PMID: 27964717 PMCID: PMC5154160 DOI: 10.1186/s12884-016-1154-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background To investigate perinatal decision-making and the use of obstetric interventions, we examined the effects of antenatal steroids, tocolysis, and delivery mode on birth in a good condition (defined as presence of an infant heart rate >100 at five minutes of age) and delivery-room (DR) death in extremely preterm deliveries. Methods Prospective cohort of all singleton births in England in 2006 at 22–26 weeks of gestation where the fetus was alive at the start of labour monitoring or decision to perform caesarean section. Odds ratios adjusted for potential confounders (aOR) were calculated using logistic regression. Results One thousand seven hundred twenty two singleton pregnancies were included. 1231 women received antenatal steroids, 437 tocolysis and 356 delivered by Caesarean section. In babies born vaginally, aOR between a partial course of steroids and improved condition at birth was 1.84, 95% CI: 1.20 to 2.82 and, for a complete course, 1.63, 95% CI: 1.08 to 2.47; for DR death, aORs were 0.34 (0.21 to 0.55) and 0.41 (0.26 to 0.64) for partial and complete courses of steroids. No association was seen for steroid use in babies delivered by Caesarean section. Tocolysis was associated with improved condition at birth (aOR 1.45, 95% CI: 1.05 to 2.0) and lower odds of death (aOR 0.48, 95% CI: 0.32 to 0.73). In women without spontaneous labour, Caesarean delivery at ≤24 and 25 weeks was associated with improved condition at birth ((aORs 12.67 (2.79 to 57.60) and 4.94 (1.44 to 16.90), respectively) and lower odds of DR death (aORs 0.03 (0.01 to 0.21) and 0.13 (0.03 to 0.55)). There were no differences at 26 weeks gestation or in women with spontaneous labour. Conclusions Antenatal steroids are strongly associated with improved outcomes in babies born vaginally. Tocolysis was associated with improvements in all analyses. Effects persisted after adjustment for perinatal decision-making. However, associations between delivery mode and birth outcomes may be attributable to case selection. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1154-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrei S Morgan
- Institute for Womens' Health, UCL, 74 Huntley Street, London, WC1E 6AU, UK.
| | - Neil Marlow
- Institute for Womens' Health, UCL, 74 Huntley Street, London, WC1E 6AU, UK
| | | | - Zarko Alfirević
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Enid M Hennessy
- The Wolfson Institute, Queen Mary University of London, London, UK
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Mode of delivery and antenatal steroids and their association with survival and severe intraventricular hemorrhage in very low birth weight infants. J Perinatol 2016; 36:832-6. [PMID: 27253893 DOI: 10.1038/jp.2016.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/15/2016] [Accepted: 04/01/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether CS delivery and receipt of antenatal steroids (ANS) in vertex-presenting singletons with a gestational age (GA) between 24 and 30 weeks is associated with improved survival and improved severe intraventricular hemorrhage (sIVH)-free survival. STUDY DESIGN Multicenter cohort, retrospective analysis of prospectively collected data. Vertex-presenting singletons newborns with GA 24 to 30 weeks, birth weight between 500 and 1500 g, without major congenital malformations, born between 2001 and 2011 at Neocosur centers were included. RESULTS Four thousand three hundred and eighty-six infants fulfilled inclusion criteria: 45.8% were delivered vaginally and 54.2% by cesarean section (CS). Newborns delivered vaginally received less ANS, had lower GA, Apgar scores and a lower incidence of survival and sIVH-free survival (P<0.001). Newborns with better survival were those with ANS, independent of mode of delivery. At 24 to 25 weeks GA, increased survival and sIVH-free survival were associated with ANS and CS delivery, compared with those who received ANS and delivered vaginally. CONCLUSIONS Among vertex-presenting singletons with GA 24 to 30 weeks, better survival and IVH-free survival were associated with ANS, independent of mode of delivery. In infants at 24 to 25 weeks gestation the combination of ANS/CS was associated with improvement in both outcomes.
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Abebe Eyowas F, Negasi AK, Aynalem GE, Worku AG. Adverse birth outcome: a comparative analysis between cesarean section and vaginal delivery at Felegehiwot Referral Hospital, Northwest Ethiopia: a retrospective record review. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2016; 7:65-70. [PMID: 29388592 PMCID: PMC5683284 DOI: 10.2147/phmt.s102619] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Some studies favor elective cesarean delivery, and other surveys benefit vaginal delivery, while others emphasize that the quality of care during labor, birth, and immediate postpartum period plays a great role than the route of delivery. However, little information is locally available regarding the incidences of adverse birth outcome with respect to the route of delivery. Methods This study was a retrospective analysis of eligible patient records that included 3,003 pregnant women who had undergone either cesarean or vaginal delivery from July 1, 2012, to June 31, 2013. Pretested questionnaire was used to collect the data. The completeness and consistency of the data were checked, cleaned, and double entered to EPI-INFO 3.5.2 and analyzed with SPSS V20. Independent sample t-test and chi-square test were conducted to compare the outcome of vaginal delivery and cesarean section (CS) using index variables. Significance was taken at P<0.05. Results Among the enrolled women, 760 mothers had CS delivery and the remaining 2,243 mothers delivered vaginally. Children born through CS (mean =6.83, standard deviation =1.31) had a significantly lower first-minute Apgar score than those in the vaginal delivery group (mean =7.19, standard deviation =1.18, P=0.001). Similarly, the observed respiratory distress syndrome (c2=0.09, P=0.793) and neonatal transfer rate to neonatal intensive care unit (c2=0.086, P=0.766) were more in neonates delivered by CS than those in the vaginally delivered group. Besides, the observed neonatal death (c2=0.675, P=0.411) and maternal death (c2= 8.878, P=0.003) were higher among CS deliveries compared with vaginal deliveries. Conclusion Neonatal and maternal morbidity and mortality appear to be more in CS than in vaginal delivery. Therefore, decision to perform CS should be based on clear, compelling, and well-supported justifications.
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Abstract
OBJECTIVE Despite the current prevalence of preterm births, no clear guidelines exist on the optimal mode of delivery. Our objective was to investigate the effects of mode of delivery on neonatal outcomes among premature infants in a large cohort. STUDY DESIGN We applied a retrospective cohort study design to a database of 6,408 births. Neonates were stratified by birth weight and a composite score was calculated to assess neonatal outcomes. The results were then further stratified by fetal exposure to antenatal steroids, birth weight, and mode of delivery. RESULTS No improvement in neonatal outcome with cesarean delivery (CD) was noted when subjects were stratified by mode of delivery, both in the presence or absence of antenatal corticosteroid administration. In the 1,500 to 1,999 g subgroup, there appears to be an increased risk of respiratory distress syndromes in neonates born by CD. CONCLUSION In our all-comers cohort, replicative of everyday obstetric practice, CD did not improve neonatal outcomes in preterm infants.
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Affiliation(s)
- Diana A Racusin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Kathleen M Antony
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Jennifer Haase
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Melissa Bondy
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Kjersti M Aagaard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Resch B, Mühlanger A, Maurer-Fellbaum U, Pichler-Stachl E, Resch E, Urlesberger B. Quality of Life of Children with Cystic Periventricular Leukomalacia - A Prospective Analysis with the Child Health Questionnaire-Parent Form 50. Front Pediatr 2016; 4:50. [PMID: 27242979 PMCID: PMC4869559 DOI: 10.3389/fped.2016.00050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/02/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Cystic periventricular leukomalacia (PVL) is associated with moderate to severe physical and mental handicaps in preterm infants. We hypothesized whether or not those handicaps were associated with a poorer quality of life (QOL) of affected children and their families compared to matched controls. PATIENTS AND METHODS All children with the diagnosis PVL collected from a local database of the Division of Neonatology of the Medical University of Graz, Austria, and born between 1997 and 2008 were included in the study group. Preterm infants matched for gestational age, birth weight, year of birth, and gender without PVL served as controls. Selected perinatal data and neurological outcome were documented. The interview of the parents was conducted using the Child Health Questionnaire-Parent Form 50 (CHQ-PF50), German version. The CHQ-PF50 consists of 50 items divided over 11 multi-item scales and 2 single-item questions. RESULTS The CHQ-PF50 was answered by 21 parents of the study (26%) and 44 of the control (39%) group. Cases were diagnosed as having developmental delay, dystonia, strabismus, central visual impairment, seizures, and cerebral palsy (81 vs. 7%, p < 0.001) more common than controls. Analysis of the CHQ-PF 50 revealed significantly poorer results for cases regarding physical health (physical functioning: p < 0.001, physical social limitations: p < 0.001, and physical summary score: p < 0.001). Several psychosocial categories (behavior, mental health, and self-esteem) and the psychosocial summary score did not differ between groups. Only two categories (parental impact concerning time p = 0.004 and family activities: p = 0.026) revealed significantly poorer results in the cases as it was for the global category for health (p = 0.009). CONCLUSION Children with PVL had an overall poorer QOL regarding physical aspects. However, PVL was not generally associated with a poorer QOL regarding psychosocial aspects.
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Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria; Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Anja Mühlanger
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz , Graz , Austria
| | - Ute Maurer-Fellbaum
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria; Outpatient Department of Developmental Follow-Up, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Elisabeth Pichler-Stachl
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria; Outpatient Department of Developmental Follow-Up, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz , Graz , Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics, Medical University of Graz , Graz , Austria
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Bruey N, Reinbold D, Creveuil C, Dreyfus M. Sièges prématurés avant 35 semaines d’aménorrhée : quelle influence de la voie d’accouchement sur l’état néonatal ? ACTA ACUST UNITED AC 2015; 43:699-704. [DOI: 10.1016/j.gyobfe.2015.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 11/27/2022]
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Bannister-Tyrrell M, Patterson JA, Ford JB, Morris JM, Nicholl MC, Roberts CL. Variation in hospital caesarean section rates for preterm births. Aust N Z J Obstet Gynaecol 2015. [PMID: 26223538 DOI: 10.1111/ajo.12351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence about optimal mode of delivery for preterm birth is lacking, and there is thought to be considerable variation in practice. OBJECTIVE To assess whether variation in hospital preterm caesarean section rates (Robson Classification Group 10) and outcomes are explained by casemix, labour or hospital characteristics. MATERIALS AND METHODS Population-based cohort study in NSW, 2007-2011. Births were categorised according to degree of prematurity and hospital service capability: 26-31, 32-33 and 34-36 weeks' gestation. Hospital preterm caesarean rates were investigated using multilevel logistic regression models, progressively adjusting for casemix, labour and hospital factors. The association between hospital caesarean rates, and severe maternal and neonatal morbidity rates was assessed. RESULTS At 26-31 weeks' gestation, the caesarean rate was 55.2% (seven hospitals, range 43.4-58.4%); 50.9% at 32-33 weeks (12 hospitals, 43.4-58.1%); and 36.4% at 34-36 weeks (51 hospitals, 17.4-48.3%). At 26-31 weeks and 32-33 weeks' gestation, 81% and 59% of the variation between hospitals was explained with no hospital significantly different from the state average after adjustment. At 34-36 weeks' gestation, although 59% of the variation was explained, substantial unexplained variation persisted. Hospital caesarean rates were not associated with severe maternal morbidity rates at any gestational age. At 26-31 weeks' gestation, medium and high caesarean rates were associated with higher severe neonatal morbidity rates, but there was no evidence of this association ≥32 weeks. CONCLUSION Both casemix and practice differences contributed to the variation in hospital caesarean rates. Low preterm caesarean rates were not associated with worse outcomes.
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Affiliation(s)
- Melanie Bannister-Tyrrell
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Jillian A Patterson
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Jane B Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Jonathan M Morris
- Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Michael C Nicholl
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Christine L Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
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Campbell-Yeo ML, Disher TC, Benoit BL, Johnston CC. Understanding kangaroo care and its benefits to preterm infants. Pediatric Health Med Ther 2015; 6:15-32. [PMID: 29388613 PMCID: PMC5683265 DOI: 10.2147/phmt.s51869] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The holding of an infant with ventral skin-to-skin contact typically in an upright position with the swaddled infant on the chest of the parent, is commonly referred to as kangaroo care (KC), due to its simulation of marsupial care. It is recommended that KC, as a feasible, natural, and cost-effective intervention, should be standard of care in the delivery of quality health care for all infants, regardless of geographic location or economic status. Numerous benefits of its use have been reported related to mortality, physiological (thermoregulation, cardiorespiratory stability), behavioral (sleep, breastfeeding duration, and degree of exclusivity) domains, as an effective therapy to relieve procedural pain, and improved neurodevelopment. Yet despite these recommendations and a lack of negative research findings, adoption of KC as a routine clinical practice remains variable and underutilized. Furthermore, uncertainty remains as to whether continuous KC should be recommended in all settings or if there is a critical period of initiation, dose, or duration that is optimal. This review synthesizes current knowledge about the benefits of KC for infants born preterm, highlighting differences and similarities across low and higher resource countries and in a non-pain and pain context. Additionally, implementation considerations and unanswered questions for future research are addressed.
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Affiliation(s)
- Marsha L Campbell-Yeo
- School of Nursing, Dalhousie University
- Department of Pediatrics, IWK Health Centre
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | | | | | - C Celeste Johnston
- Department of Pediatrics, IWK Health Centre
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
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Visser GHA. Women are designed to deliver vaginally and not by cesarean section: an obstetrician's view. Neonatology 2015; 107:8-13. [PMID: 25301178 DOI: 10.1159/000365164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Worldwide, there is a rapid increase in deliveries by cesarean section. The large differences among countries, from about 16% to more than 60%, suggest that the cesarean delivery (CD) rate has little to do with evidence-based medicine. In this review, the background for the increasing CD rate is discussed as well as the limited positive effects on neonatal outcome in both term and preterm neonates. Negative effects of CD, including direct maternal morbidity, complications of subsequent pregnancies and iatrogenic early delivery resulting in increased neonatal morbidity, are discussed in addition to long-term implications for the offspring involving altered development of the immune system. The 'battle' to lower the CD rate will be difficult, but we should not forget that women are designed to deliver vaginally and not by cesarean section.
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Affiliation(s)
- Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
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Raju TNK, Mercer BM, Burchfield DJ, Joseph GF. Periviable birth: executive summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. J Perinatol 2014; 34:333-42. [PMID: 24722647 DOI: 10.1038/jp.2014.70] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 11/09/2022]
Abstract
This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation), and the treatment options for the newborn. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (for example, antenatal steroid, tocolytic agents and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect and understanding, and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant.
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Affiliation(s)
- T N K Raju
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - B M Mercer
- The Society for Maternal-Fetal Medicine and Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| | - D J Burchfield
- The American Academy of Pediatrics and University of Florida, Gainesville, FL, USA
| | - G F Joseph
- The American College of Obstetricians and Gynecologists, Washington, DC, USA
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Comparison of fetal outcome in premature vaginal or cesarean breech delivery at 24-37 gestational weeks. Arch Gynecol Obstet 2014; 290:271-81. [PMID: 24668252 DOI: 10.1007/s00404-014-3203-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the fetal outcome of preterm breech infants delivered vaginally (VD) or by cesarean section (CS). METHODS A monocentric, retrospective consecutive case series of preterm breech deliveries between 24-37 gestational weeks over 10 years from 1/2000 to 12/2009 was performed in a perinatal care center (Level 1) at the University Clinic of Salzburg, Austria. Data from hospital database were statistically analyzed and compared regarding birth weight, head circumference, parity, transfer rate to neonatal intensive care unit (NICU), arterial and venous cord blood pH and base excess (BE), arterial cord blood pH ≤ 7.10 and BE ≤ -11. Special focus was on fetal outcome of elective CS preterm breech deliveries with a non-urgent medical indication compared to VD. RESULTS Among 22.115 deliveries, there were 346 live-born preterm singletons and twins in breech presentation (1.56 %), born between 24 + 0 and 37 + 0 gestational weeks. 180 CS and 36 vaginally delivered preterm breech infants were statistically evaluated. On comparing CS vs. VD for premature breech singletons, arterial cord blood pH and BE were lower in the VD group. VD twins had a lower arterial cord blood pH than CS twins. All other parameters were comparable. In preterm breech singletons with non-urgent CS, a statistical analysis was not possible due to small numbers. The VD twin group revealed lower values in birth weight, head circumference, arterial cord blood pH and BE, but no significant difference in venous cord blood pH and BE and transfer rate to NICU. CONCLUSIONS Although general recommendations regarding a superior mode of delivery for improved fetal outcome of preterm breech infants cannot be given, these data do not support a policy of routine CS.
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