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Smith GCS. Mode of delivery of twins at term. Best Pract Res Clin Obstet Gynaecol 2022; 84:194-204. [PMID: 35466063 DOI: 10.1016/j.bpobgyn.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/13/2022] [Indexed: 11/02/2022]
Abstract
Observational epidemiological analyses demonstrated a decreased risk of death and severe morbidity associated with caesarean delivery at term but an increased risk at preterm gestational age. A multicentre international randomized controlled compared planned caesarean section with vaginal birth and observed no difference in outcome; however, the trial included preterm and term births in approximately similar proportions. A subsequent re-analysis of the trial demonstrated that planned caesarean section was associated with an increased risk of adverse neonatal outcome at preterm gestational ages, but reduced the risk of perinatal complications at term, consistent with the epidemiological studies. Hence, decision-making around mode of delivery for twins should recommend against routine caesarean delivery preterm. At term, the balance of risks and benefits will vary according to the mother's prioritization of avoiding intervention, her attitude to managing the risks of uncommon but potentially severe adverse events, and her plans and potential for future pregnancies.
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Affiliation(s)
- Gordon C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0SW, UK.
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2
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Hinkson L, Schauer M, Latartara E, Alonso-Espias M, Rossetti E, Gebert P, Hinkson S, Henrich W. The Charité external cephalic version for leading twin breech without regional anesthesia and tocolysis. A prospective study on feasibility, sonographic assessment and outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 268:62-67. [PMID: 34871953 DOI: 10.1016/j.ejogrb.2021.11.426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the feasibility of external cephalic version (ECV) for the leading twin (twin A) in breech presentation in dichorionic and diamniotic twin pregnancies without the use of regional anesthetics and tocolysis and to characterize the sonographic parameters, maternal and neonatal outcomes. STUDY DESIGN Prospective study performed in the Charité University Hospital outpatient obstetric department in Berlin, Germany. A total of 23 women from the 35th completed week of pregnancy with confirmed dichorionic-diamniotic twin pregnancy were recruited. ECVs were performed by the lead consultant for the breech and ECV clinic. Ethical approval provided by the Charité Ethics Commission (EA2/241/18). Demographic data were recorded. Fetal sonographic parameters were assessed. The success rate of ECV, duration of the ECV, gestational age at delivery, mode of delivery for both fetuses, maternal and neonatal outcomes were analyzed. RESULTS Our main finding showed that ECV for twin A breech in dichorionic-diamniotic twins is successful in 56% (10/18) of cases without the need for regional anesthesia and without tocolysis. There is a significant increase in the spontaneous vaginal delivery rate for both twins of 95% (19/20) vs 12.5% (2/16) (p < 0.001). There is also a significant reduction in blood loss at delivery of 300 ml vs 500 ml (p = 0.034) in successful cases. CONCLUSIONS We show that ECV for twin A in breech is feasible and in 56% (10/18) successful without regional anesthesia and tocolysis. The option of ECV for twin A breech should be offered to women.
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Affiliation(s)
- Larry Hinkson
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany.
| | - Madeleine Schauer
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
| | - Elisabetta Latartara
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany; Università Cattolica del Sacro Cuore Largo Francesco Vito, Roma, Italy
| | - Maria Alonso-Espias
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany; La Paz University Hospital, Madrid, Spain
| | - Emma Rossetti
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany; University of Udine, Udine, Italy
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Susan Hinkson
- Department of Anesthesia, Helios Klinikum Emil von Behring, Zehlendorf, Berlin, Germany
| | - Wolfgang Henrich
- Dept. of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
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Zafarmand MH, Goossens SMTA, Tajik P, Bossuyt PMM, Asztalos EV, Gardener GJ, Willan AR, Roumen FJME, Mol BW, Barrett Y(J. Planned Cesarean or planned vaginal delivery for twins: secondary analysis of randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:582-591. [PMID: 31674091 PMCID: PMC8048696 DOI: 10.1002/uog.21907] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate whether there is a differential benefit of planned Cesarean delivery (CD) over planned vaginal delivery (VD) in women with a twin pregnancy and the first twin in cephalic presentation, depending on prespecified baseline maternal and pregnancy characteristics, and/or gestational age (GA) at delivery. METHODS This was a secondary analysis of the Twin Birth Study, which included 2804 women with a twin pregnancy and the first twin (Twin A) in cephalic presentation between 32 + 0 and 38 + 6 weeks' gestation at 106 centers in 25 countries. Women were assigned randomly to either planned CD or planned VD. The main outcome measure was composite adverse perinatal outcome, defined as the occurrence of perinatal mortality or serious neonatal morbidity in at least one twin. The baseline maternal and pregnancy characteristics (markers) considered were maternal age, parity, history of CD, use of antenatal corticosteroids, estimated fetal weight (EFW) of Twin A, EFW of Twin B, > 25% difference in EFW between the twins, presentation of Twin B, chorionicity on ultrasound, method of conception, complications of pregnancy, ruptured membranes at randomization and GA at randomization. Separate logistic regression models were developed for each marker in order to model composite adverse perinatal outcome as a function of the specific marker, planned delivery mode and the interaction between these two terms. In addition, multivariable logistic regression analysis with backward variable elimination was performed separately in each arm of the trial. The association between planned mode of delivery and composite adverse perinatal outcome, according to GA at delivery, was assessed using logistic regression analysis. RESULTS Of the 2804 women initially randomized, 1391 were included in each study arm. None of the studied baseline markers was associated with a differential benefit of planned CD over planned VD in the rate of composite adverse perinatal outcome. GA at delivery was associated differentially with composite adverse perinatal outcome in the treatment arms (P for interaction < 0.001). Among pregnancies delivered at 32 + 0 to 36 + 6 weeks, there was a trend towards a lower rate of composite adverse perinatal outcome in those in the planned-VD group compared with those in planned-CD group (29 (2.2%) vs 48 (3.6%) cases; odds ratio (OR) 0.62 (95% CI, 0.37-1.03)). In pregnancies delivered at or after 37 + 0 weeks, planned VD was associated with a significantly higher rate of composite adverse perinatal outcome, as compared with planned CD (23 (1.5%) vs 10 (0.7%) cases; OR, 2.25 (95% CI, 1.06-4.77)). CONCLUSION The perinatal outcome of twin pregnancies with the first twin in cephalic presentation may differ depending on GA at delivery and planned mode of delivery. At 32-37 weeks, planned VD seems to be favorable, while, from around 37 weeks onwards, planned CD might be safer. The absolute risks of adverse perinatal outcomes at term are low and must be weighed against the increased maternal risks associated with planned CD. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. H. Zafarmand
- Department of Clinical Epidemiology and Data Science, Department of Obstetrics & Gynecology, Amsterdam Public Health Research Institute, Amsterdam UMC, Location Academic Medical CenterUniversity of Amsterdam, AmsterdamThe Netherlands
| | - S. M. T. A. Goossens
- GROW – School for Oncology and Developmental BiologyMaastricht and Department of Obstetrics and Gynecology Máxima Medical Centre VeldhovenThe Netherlands
| | - P. Tajik
- Department of Pathology, Amsterdam UMC, Location Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - P. M. M. Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location Academic Medical CenterUniversity of Amsterdam, AmsterdamThe Netherlands
| | - E. V. Asztalos
- Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Sunnybrook Research InstituteUniversity of TorontoTorontoOntarioCanada
| | - G. J. Gardener
- Mater Research InstituteUniversity of QueenslandSouth BrisbaneQueenslandAustralia
| | - A. R. Willan
- Department of Ontario Child Health Support Unit, SickKids Research Institute, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - F. J. M. E. Roumen
- Department of Obstetrics and GynecologyZuyderland Medical Centre Heerlen‐Sittard (previously: Atrium Medical Centre)HeerlenThe Netherlands
| | - B. W. Mol
- Monash Medical Centre, Department of Obstetrics and GynaecologyMonash UniversityClaytonVictoriaAustralia
| | - Y. (Jon) Barrett
- University of TorontoSunnybrook Health Science CentreTorontoOntarioCanada
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Laopaiboon M, Lumbiganon P, Rattanakanokchai S, Chaiwong W, Souza JP, Vogel JP, Mori R, Gülmezoglu AM. An outcome-based definition of low birthweight for births in low- and middle-income countries: a secondary analysis of the WHO global survey on maternal and perinatal health. BMC Pediatr 2019; 19:166. [PMID: 31132994 PMCID: PMC6535858 DOI: 10.1186/s12887-019-1546-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/20/2019] [Indexed: 11/28/2022] Open
Abstract
Background 2500 g has been used worldwide as the definition of low birthweight (LBW) for almost a century. While previous studies have used statistical approaches to define LBW cutoffs, a LBW definition using an outcome-based approach has not been evaluated. We aimed to identify an outcome-based definition of LBW for live births in low- and middle-income countries (LMICs), using data from a WHO cross-sectional survey on maternal and perinatal health outcomes in 23 countries. Methods We performed a secondary analysis of all singleton live births in the WHO Global Survey (WHOGS) on Maternal and Perinatal Health, conducted in African and Latin American countries (2004–2005) and Asian countries (2007–2008). We used a two-level logistic regression model to assess the risk of early neonatal mortality (ENM) associated with subgroups of birthweight (< 1500 g, 1500–2499 g with 100 g intervals; 2500–3499 g as the reference group). The model adjusted for potential confounders, including maternal complications, gestational age at birth, mode of birth, fetal presentation and facility capacity index (FCI) score. We presented adjusted odds ratios (aORs) with 95% confidence intervals (CIs). A lower CI limit of at least two was used to define a clinically important definition of LBW. Results We included 205,648 singleton live births at 344 facilities in 23 LMICs. An aOR of at least 2.0 for the ENM outcome was observed at birthweights below 2200 g (aOR 3.8 (95% CI; 2.7, 5.5) of 2100–2199 g) for the total population. For Africa, Asia and Latin America, the 95% CI lower limit aORs of at least 2.0 were observed when birthweight was lower than 2200 g (aOR 3.6 (95% CI; 2.0, 6.5) of 2100–2199 g), 2100 g (aOR 7.4 (95% CI; 5.1, 10.7) of 2000–2099 g) and 2200 g (aOR 6.1 (95% CI; 3.4, 10.9) of 2100–2199 g) respectively. Conclusion A birthweight of less than 2200 g may be an outcome-based threshold for LBW in LMICs. Regional-specific thresholds of low birthweight (< 2200 g in Africa, < 2100 g in Asia and < 2200 g in Latin America) may also be warranted. Electronic supplementary material The online version of this article (10.1186/s12887-019-1546-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malinee Laopaiboon
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, 123 Mittraphap Road, Nai-Muang, Muang District, Khon Kaen, 40002, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Siwanon Rattanakanokchai
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, 123 Mittraphap Road, Nai-Muang, Muang District, Khon Kaen, 40002, Thailand
| | - Warut Chaiwong
- Bangkok Health Research Center 2 Soi Soonvijai 7, New Petchburi Rd., Huaykwang, Bangkok, 10310, Thailand
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Joshua P Vogel
- UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Maternal and Child Health Program, Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Ahmet Metin Gülmezoglu
- Department of Reproductive Health and Research World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland
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5
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Mol BW, Bergenhenegouwen L, Ensing S, Ravelli AC, Kok M. The impact of mode of delivery on the outcome in very preterm twins. J Matern Fetal Neonatal Med 2019; 33:2089-2095. [PMID: 30608005 DOI: 10.1080/14767058.2018.1540579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Studies on the optimal mode of delivery in women with a twin pregnancy <32 weeks are scarce. We studied the effects of the mode of delivery on perinatal and maternal outcomes in very preterm twin pregnancy.Study Design: Population-based cohort study including all women with twin pregnancy who delivered very preterm (26-32 weeks of gestation) in the Netherlands between January 2000 and December 2010. We compared perinatal mortality and neonatal and maternal morbidity according to the intended mode of delivery as well as to the actual mode of delivery. Perinatal outcomes were paired taking into account the dependency between the children of the same twin pregnancy and were also analysed for each child separately. We used logistic regression to correct for possible confounding factors.Results: We studied 1,655 women with a very preterm delivery of a twin pregnancy. A planned caesarean section (n = 212) was associated with a significantly higher perinatal mortality compared to a planned vaginal delivery (n = 1.443) (10% compared to 6.5%; adjusted odds ratio (OR) 2.5, 95% confidence interval (CI) 1.5-4.2). The same applied for perinatal morbidity (66% compared to 63%; adjusted OR 1.5, 95% CI 1.1-2.0), maternal morbidity (17% compared to 4.9%; adjusted OR 4.0, 95% CI 2.6-6.3) and for perinatal mortality for the second twin (7.1% compared to 3.5% adjusted OR 2.9, 95% CI 1.7-5.2).Conclusion: In very preterm delivery of twins a vaginal delivery is the preferred mode of delivery.
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Affiliation(s)
- Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | - Sabine Ensing
- Department of Medical Informatics, Amsterdam Medical Centre, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Anita C Ravelli
- Department of Medical Informatics, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Amsterdam, The Netherlands
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Mol BW, Bergenhenegouwen L, Velzel J, Ensing S, van de Mheen L, Ravelli AC, Kok M. Perinatal outcomes according to the mode of delivery in women with a triplet pregnancy in The Netherlands. J Matern Fetal Neonatal Med 2018; 32:3771-3777. [PMID: 29807452 DOI: 10.1080/14767058.2018.1471680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: In women with a triplet pregnancy, there is debate on the preferred mode of delivery. We performed a nationwide cohort study to assess the impact of mode of delivery on perinatal outcome in women with a triplet pregnancy. Methods: Nationwide cohort study on women with a triplet pregnancy who delivered between 26 + 0 and 40 + 0 weeks of gestation in the years 1999-2008. We compared perinatal outcomes according to the intended mode of delivery and the actual mode of delivery. Outcome measures were perinatal mortality and neonatal morbidity. Perinatal outcomes were analyzed taking into account the dependency between the children of the same triplet pregnancy ("any mortality" and "any morbidity") and were also analyzed separately per child. Results: We identified 386 women with a triplet pregnancy in the study period. Mean gestational age at delivery was 33.1 weeks (SD 2.5 weeks; range 26.0-40.0 weeks). Perinatal mortality was 2.3% for women with a planned caesarean section and 2.4% in women with a planned vaginal delivery (aOR 0.37; 95% confidence interval (CI) 0.09-1.5) and neonatal morbidity was 26.0% versus 36.0%, (aOR 0.88; 95% CI 0.51-1.4) respectively. In the subgroup analyses according to gestational age and in the analysis of perinatal outcomes per child separately, there were also no large differences in perinatal outcomes. The same applied for perinatal outcomes according to the actual mode of delivery. Conclusion: In this large cohort study among women with a triplet pregnancy, caesarean delivery is not associated with reduced perinatal mortality and morbidity.
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Affiliation(s)
- Ben W Mol
- a Department of Obstetrics and Gynaecology , Monash University , Clayton , Australia
| | - Lester Bergenhenegouwen
- b Department of Obstetrics and Gynaecology , Ziekenhuis Groep Twente , Almelo , The Netherlands
| | - Joost Velzel
- c Department of Obstetrics and Gynaecology , Amsterdam Medical Centre , Amsterdam , The Netherlands
| | - Sabine Ensing
- c Department of Obstetrics and Gynaecology , Amsterdam Medical Centre , Amsterdam , The Netherlands.,d Department of Medical Informatics , Amsterdam Medical Centre , Amsterdam , The Netherlands
| | - Lidewij van de Mheen
- d Department of Medical Informatics , Amsterdam Medical Centre , Amsterdam , The Netherlands
| | - Anita C Ravelli
- c Department of Obstetrics and Gynaecology , Amsterdam Medical Centre , Amsterdam , The Netherlands
| | - Marjolein Kok
- d Department of Medical Informatics , Amsterdam Medical Centre , Amsterdam , The Netherlands
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Reitter A, Daviss BA, Krimphove MJ, Johnson KC, Schlößer R, Louwen F, Bisits A. Mode of birth in twins: data and reflections. J OBSTET GYNAECOL 2018; 38:502-510. [PMID: 29433366 DOI: 10.1080/01443615.2017.1393402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Our primary objective was to compare neonatal and maternal outcomes in women with twin pregnancies, beyond 32 weeks, having a planned vaginal birth or a planned caesarean section (CS). This was a retrospective cohort study from a single tertiary centre over nine years. 534 sets of twins ≥32 + 0 weeks of gestation were included. 401 sets were planned vaginally and 133 sets were planned by CS. We compared a composite adverse perinatal outcome (perinatal mortality or serious neonatal morbidity; five minute APGAR score ≤4, neurological abnormality and need for intubation) and a composite maternal adverse outcome (major haemorrhage, trauma or infection) between the groups. There were no significant differences. Given the similarity of these results with several other larger studies of twin birth, we sought to look at reasons why there is still a rising rate of CS for twin births. We further make suggestions for keeping this rate to a sensible minimum. Impact statement What is already known on this subject? The largest randomised controlled study comparing planned vaginal birth with planned CSs for lower risk twins between 32 and 39 weeks of gestation, showed no added safety from planned CS. However, in most of the Western countries this conclusion has failed to increase the number of planned vaginal births for lower risk twins. What do the results of this study add? This observational study from a single tertiary centre provides external validation of the twin trial results in a practical day-to-day setting. It also provides insights as to how planned vaginal birth can be developed and maintained, with a key focus on safety and maternal participation in decision making. It does focus on consent and providing accurate data. What are the implications of these findings for clinical practice and/or further research? There are good grounds to encourage vaginal birth for low-risk twin pregnancies. The trend of rising caesarean rates in low-risk twin pregnancies worldwide will erode important skills for the conduct of vaginal births without any clear benefit for mothers or babies. The current situation demands careful thought about implementing innovative training opportunities for younger obstetricians. Finally, we need intelligent responses to many non-evidence-based factors which can drive clinical practice.
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Affiliation(s)
- A Reitter
- a Department of Obstetrics and Gynaecology , University Hospital Frankfurt, Goethe-University , Frankfurt , Germany
| | - B A Daviss
- b Department of Obstetrics and Gynaecology, Midwifery Division , Montfort Hospital , Ottawa , Canada
| | - M J Krimphove
- a Department of Obstetrics and Gynaecology , University Hospital Frankfurt, Goethe-University , Frankfurt , Germany
| | - K C Johnson
- c Department of Epidemiology and Community Medicine , University of Ottawa , Ottawa , Canada
| | - R Schlößer
- d Department of Pediatrics, Division Neonatology , University Hospital Frankfurt, Goethe-University , Frankfurt , Germany
| | - F Louwen
- a Department of Obstetrics and Gynaecology , University Hospital Frankfurt, Goethe-University , Frankfurt , Germany
| | - A Bisits
- e Department of Obstetrics and Gynecology, Royal Hospital for Women , University of New South Wales , Randwick , Australia
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Ye J, Torloni MR, Ota E, Jayaratne K, Pileggi-Castro C, Ortiz-Panozo E, Lumbiganon P, Morisaki N, Laopaiboon M, Mori R, Tunçalp Ö, Fang F, Yu H, Souza JP, Vogel JP, Zhang J. Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America. BMC Pregnancy Childbirth 2015; 15:324. [PMID: 26634821 PMCID: PMC4669645 DOI: 10.1186/s12884-015-0765-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background No consensus definition of macrosomia currently exists among researchers and obstetricians. We aimed to identify a definition of macrosomia that is more predictive of maternal and perinatal mortality and morbidity in low- and middle-income countries. Methods We conducted a secondary data analysis using WHO Global Survey on Maternal and Perinatal Health data on Africa and Latin America from 2004 to 2005 and Asia from 2007 to 2008. We compared adverse outcomes, which were assessed by the composite maternal mortality and morbidity index (MMMI) and perinatal mortality and morbidity index (PMMI) in subgroups with birthweight (3000–3499 g [reference group], 3500–3999 g, 4000–4099 g, 4100–4199 g, 4200–4299 g, 4300–4399 g, 4400–4499 g, 4500–4999 g) or country-specific birthweight percentile for gestational age (50th–74th percentile [reference group], 75th–89th, 90th–94th, 95th–96th, and ≥97th percentile). Two-level logistic regression models were used to estimate odds ratios of MMMI and PMMI. Results A total of 246,659 singleton term births from 363 facilities in 23 low- and middle-income countries were included. Adjusted odds ratios (aORs) for intrapartum caesarean sections exceeded 2.0 when birthweight was greater than 4000 g (2 · 00 [95 % CI: 1 · 68, 2 · 39], 2 · 42 [95 % CI: 2 · 02, 2 · 89], 2 · 01 [95 % CI: 1 · 74, 2 · 33] in Africa, Asia and Latin America, respectively). aORs of MMMI reached 2.0 when birthweight was greater than 4000 g, 4500 g in Asia and Africa, respectively. aORs of PMMI approached to 2.0 (1 · 78 [95 % CI: 1 · 16, 2 · 74]) when birthweight was greater than 4500 g in Latin America. When birthweight was at the 90th percentile or higher, aORs of MMMI and PMMI increased, but none exceeded 2.0. Conclusions The population-specific definition of macrosomia using birthweight cut-off points irrespective of gestational age (4500 g in Africa and Latin America, 4000 g in Asia) is more predictive of maternal and perinatal adverse outcomes, and simpler to apply compared to the definition based on birthweight percentile for a given gestational age. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0765-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jiangfeng Ye
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Maria Regina Torloni
- Department of Internal Medicine, Post Graduate program of Evidence Based Healthcare, São Paulo Federal University, São Paulo, SP, Brazil.
| | - Erika Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
| | - Kapila Jayaratne
- Family Health Bureau, Ministry of Health, 231, De Saram Place, Colombo 10, Sri Lanka.
| | - Cynthia Pileggi-Castro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico.
| | - Pisake Lumbiganon
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Naho Morisaki
- Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Malinee Laopaiboon
- Department of Biostatistics & Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
| | - Özge Tunçalp
- UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Fang Fang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hongping Yu
- School of Public Health, Guilin Medical College, Guangxi, China.
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Joshua Peter Vogel
- UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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