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Leybovitz-Haleluya N, Saban A, Yariv A, Hershkovitz R. Timing of planned cesarean delivery among patients with two previous cesarean sections. Arch Gynecol Obstet 2024:10.1007/s00404-024-07456-8. [PMID: 38507091 DOI: 10.1007/s00404-024-07456-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES The timing of planned repeat cesarean delivery (CD) is debateful in clinical practice. Planned repeat CD is typically scheduled before the spontaneous onset of labor to minimize the risk of uterine rupture during labor and the associated risk for fetal compromise. This timing should be balanced with the potential risk of delivering an infant who could benefit from additional maturation in utero. We aim to study the influence of gestational age at the time of repeat CD on maternal and fetal complications. STUDY DESIGN A population-based retrospective cohort study including all term singleton third CDs (≥ 37 weeks of gestation), between February-2020 and January-2022 at a tertiary medical center was conducted. Maternal and neonatal adverse outcomes were compared by gestational age at the time of the CD. A logistic regression models were constructed to adjust for confounders. RESULTS The study population included624 third CDs. Among them, two study groups were defined: 199 were at 37 + 0 to 37 + 6 weeks of gestation, and 44 were at ≥ 39 weeks of gestation at the time of delivery. 381 were at 38 + 0 to 38 + 6 weeks. Since our routine practice is to schedule elective CD at 38 + 0 to 38 + 6 weeks of gestation, we defined this group as the comparison group. In a multivariate analysis, both study groups were associated with significantly higher rates of emergent CDs after adjusting for maternal age, parity, ethnicity, premature rapture of membranes, spontaneous onset of labor and birthweight. After adjusting also for emergent CDs, CDs at 37 + 0 to 37 + 6 weeks of gestation were significantly associated with maternal and neonatal length of stay exceeding 4 days. Additionally, CDs at 37 + 0 to 37 + 6 weeks of gestation were also associated with composite of adverse neonatal and maternal outcomes. CONCLUSIONS Our study demonstrated that scheduling third CD at 38 + 0 to 38 + 6 weeks is associated with reduced risk of emergent CD, as well as beneficial maternal and neonatal outcomes.
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Affiliation(s)
- Noa Leybovitz-Haleluya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Alla Saban
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Yariv
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Takahashi D, Fujino Y, Sato T, Kuramoto A, Kawakami S, Ito M, Goto K. Timing of Elective Cesarean Section and Neonatal Outcomes in Term Singleton Deliveries: A Single-Center Experience. Am J Perinatol 2023. [PMID: 37607591 DOI: 10.1055/a-2158-5619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE This study aimed to evaluate the timing of elective cesarean sections at 37 to 41 weeks from a tertiary hospital in Japan. The primary outcome was the rate of adverse neonatal outcomes, especially focusing on neonates delivered at 38 weeks of gestation. STUDY DESIGN The study population was drawn from singleton pregnancies delivered following planned cesarean birth at the Fukuda Hospital from 2012 to 2019. Information on deliveries was obtained from the hospital database, which contains clinical, administrative, laboratory, and operating room databases. RESULTS After excluding women with chronic conditions, maternal complications, indications for multiple births, or a neonate with an anomaly, 2,208 neonates remained in the analysis. Among adverse neonatal outcomes, the rate was significantly higher in neonates delivered at 37 weeks of gestation (unadjusted odds ratio [OR] = 13.22 [95% confidence interval [CI]: 6.28, 27.86], p < 0.001) or 38 weeks of gestation (unadjusted OR = 1.82 [95% CI: 1.04, 3.19], p = 0.036) compared with neonates delivered at 39 to 41 weeks. The adjusted risk of any adverse outcome was significantly higher at 380-1/7 weeks (adjusted OR = 2.40 [95% CI: 1.35, 4.30], p = 0.003) and 382-3/7 weeks (adjusted OR = 1.89 [95% CI: 1.04, 3.44], p = 0.038) compared with neonates delivered at 39 to 41 weeks, respectively. CONCLUSION Our findings suggest that elective cesarean sections might be best scheduled at 39 weeks or later. When considering a cesarean at 38 weeks, it appears that 384/7 weeks of gestation or later could be a preferable timing in the context of reducing neonatal risks. However, as the composite outcome includes mostly minor conditions, the clinical significance of this finding needs to be carefully interpreted. KEY POINTS · Timing of elective cesarean sections from 37 to 41 weeks was evaluated in a Japanese tertiary hospital.. · Neonates delivered at 37 and 38 weeks had higher adverse outcome rates compared with 39 to 41 weeks.. · Scheduling elective cesarean sections at least 384/7 weeks or later may reduce neonatal risk..
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Affiliation(s)
- Daijiro Takahashi
- Division of Neonatology, Fukuda Hospital, Kumamoto, Japan
- Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tomoki Sato
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Akitaka Kuramoto
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Shoichi Kawakami
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Masaharu Ito
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Kei Goto
- Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan
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Danieli-Gruber S, Shalev-Rosenthal Y, Matot R, Brzezinski-Sinai N, Zeevi G, Pardo A, Orbach S, Hadar E. Risks of urgent cesarean delivery preceding the planned schedule: A retrospective cohort study. PLoS One 2023; 18:e0289655. [PMID: 37549150 PMCID: PMC10406283 DOI: 10.1371/journal.pone.0289655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE The aim of the study was to ascertain risk factors and outcomes of elective cesarean deliveries performed urgently prior to their scheduled date. METHODS Women carrying a viable singleton fetus who were scheduled for elective cesarean delivery at a tertiary medical center between 2012-2020 were identified by retrospective database. Differences in maternal and neonatal parameters between those who ultimately required urgent cesarean delivery and those who underwent the procedure as scheduled were analyzed. RESULTS Of 4403 women who met the inclusion criteria, 559 underwent urgent cesarean delivery before the scheduled date. On multivariate analysis, factors significantly associated with a risk of transformation to an urgent cesarean delivery were chronic hypertension (aOR 1.92, 95% CI 1.30-2.83 P = 0.001), antenatal corticosteroids administration (aOR 3.26, 95% CI 2.38-4.47, P <0.001), and contraindication for vaginal delivery as the reason for elective cesarean delivery (aOR 1.67, 95% CI 1.32-2.12, P <0.001). Neonates born via urgent cesareans had an increased risk of 1-minute Apgar <7 (6% vs. 1.7%, P <0.001), intensive care unit admission (6.6% vs. 2.5%, P <0.001); their mothers were at risk of postpartum hemorrhage (5.9% vs. 3%, P = 0.001). CONCLUSIONS The present study sheds light on the risk factors and maternal and fetal morbidities associated with elective cesarean deliveries that become urgent before the originally scheduled date. Physicians should take this information into account when planning an optimal date for elective cesarean delivery.
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Affiliation(s)
- Shir Danieli-Gruber
- Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shalev-Rosenthal
- Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Matot
- Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Brzezinski-Sinai
- Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Zeevi
- Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Orbach
- Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Usman F, Tsiga-Ahmed FI, Farouk ZL, Gambo MJ, Mohammed AD, Mohammed AM, Salihu HM, Aliyu MH. Perinatal factors associated with admission to neonatal intensive care unit following cesarean delivery in Kano, northern Nigeria. J Perinat Med 2022; 50:493-502. [PMID: 35038815 DOI: 10.1515/jpm-2021-0409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cesarean section is the most common obstetric surgical procedure, with associated risks for adverse neonatal outcomes. The interplay of perinatal factors associated with neonatal admissions following cesarean delivery remains poorly understood in developing countries. We examined how perinatal and facility-based factors affect Neonatal Intensive Care Unit (NICU) admission after cesarean delivery in northern Nigeria. METHODS A prospective cohort study involving 200 women undergoing cesarean section were consecutively enrolled with subsequent follow-up of their infants in the post-natal period. Data were abstracted from the medical record using an interviewer-administered questionnaire. The primary outcomes were NICU admission and intrauterine or early neonatal deaths. Binary logistic regression modelling was used to identify variables independently associated with the outcomes. RESULTS Over the study period (six months), there were 200 cesarean sections. A total of 30 (15.0%) neonates were admitted into the NICU following the procedure. No stillbirths or early neonatal deaths were recorded. NICU admission was associated with gestational age (preterm vs. term [adjusted odds ratio, aOR: 18.9, 95% confidence interval (CI): 4.0-90.4]), birth weight (small vs. appropriate [aOR: 6.7, 95% CI 1.9-22.7] and large vs. appropriate birth weight [aOR: 20.3, 95% CI 2.9-143.7]) and the number of indications for cesarean section (≥2 vs. one [aOR: 0.2, 95% 0.1-0.8]). CONCLUSIONS Prematurity, small and large for gestational age neonates; and indications for cesarean section were associated with increased likelihood of neonatal admission following cesarean delivery. These findings could inform ongoing quality enhancement initiatives to improve NICU admission outcomes at the study site, and other similar settings.
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Affiliation(s)
- Fatima Usman
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
| | - Fatimah I Tsiga-Ahmed
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
| | - Zubaida L Farouk
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
| | - Mahmoud J Gambo
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University, Kano, Nigeria
| | - Alhassan D Mohammed
- Department of Anesthesiology & Intensive Care, Kano & Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Abdullahi M Mohammed
- Department of Anesthesiology & Intensive Care, Kano & Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, TX, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Shinar S, Walsh L, Roberts N, Melamed N, Barrett J, Riddell C, Berger H. Timing of cesarean delivery in women with ≥2 previous cesarean deliveries. Am J Obstet Gynecol 2022; 226:110.e1-110.e10. [PMID: 34363783 DOI: 10.1016/j.ajog.2021.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The rate of cesarean delivery is continuously increasing with the leading indication being a previous cesarean delivery. For women with 1 previous cesarean delivery, it is generally agreed that the optimal timing of delivery by elective cesarean delivery is during the 39th week of gestation, whereas for women with ≥2 previous cesarean deliveries, the optimal delivery time remains debatable. OBJECTIVE To assess the maternal and neonatal risks associated with elective delivery at different gestational ages ranging from 37 0/7 to 39 6/7 weeks' gestation and to compare it with expectant management among women with at least 2 previous cesarean deliveries. STUDY DESIGN This was a retrospective, population-based cohort study of all women with at least 2 previous cesarean deliveries who delivered after 36 6/7 weeks of gestation in Ontario, Canada, between April 2012 and March 2019. Women with multifetal pregnancies or major fetal anomalies were excluded. For each completed gestational week, outcomes of women who had an elective repeat cesarean delivery at that week solely because of 2 previous cesarean deliveries were compared with the outcomes of those who were managed expectantly and delivered at a later gestational age. The primary outcome was a composite of maternal outcomes including mortality and severe maternal morbidity. Secondary outcomes were adverse neonatal outcomes. RESULTS A total of 26,522 women met the inclusion criteria. The maternal risk was similar for elective delivery at 37 0/7 to 38 6/7 weeks of gestation compared with expectant management. However, elective delivery at 39 0/7 to 39 6/7 weeks' gestation was associated with a decreased risk for adverse outcomes when compared with expectant management (adjusted risk ratio, 0.51; 95% confidence interval, 0.29-0.91). For the neonate, elective delivery during the 37th week of gestation significantly increased the incidence of the composite adverse outcome than in an ongoing pregnancy (adjusted risk ratio, 1.68; 95% confidence interval, 1.39-2.01), but was comparable for elective delivery at 38 0/7 to 39 6/7 weeks' gestation and expectant management. The risk for an unplanned cesarean delivery increased from 6.5% before 38 weeks' gestation to 21.7% before 39 weeks' gestation and to 32.6% before 40 weeks' gestation. CONCLUSION For women with ≥2 cesarean deliveries, elective delivery at 38 0/7 to 38 6/7 weeks' gestation likely represents the optimal balance between neonatal and maternal risk while decreasing the likelihood of an unplanned cesarean delivery.
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Affiliation(s)
- Shiri Shinar
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Laura Walsh
- Better Outcomes Registry & Network (BORN), Ottawa, Ontario, Canada
| | - Nicole Roberts
- Better Outcomes Registry & Network (BORN), Ottawa, Ontario, Canada
| | - Nir Melamed
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Howard Berger
- Department of Obstetrics and Gynecology, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Çintesun E, Ezveci H, Celik C. Can ultrasound predict the delivery time of patients with previous cesarean section in the 37th gestational week? A prospective cross-sectional study. J Matern Fetal Neonatal Med 2021; 35:8717-8722. [PMID: 34747318 DOI: 10.1080/14767058.2021.1999923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim was to investigate factors that predict when patients with previous cesarean section will undergo cesarean section (CS) using ultrasonography in the 37th gestational week. MATERIAL AND METHODS In this prospective cross-sectional study, a total of 166 patients with previous CS who presented to the hospital for routine checks at the 370/7th gestational week were included in the study. Uterine-related, fetus-related, and patient-related factors that affect labor time were analyzed by the same physician at admission, and the patients were then divided into two groups as those having CS at early term (370/7 to 386/7 weeks of gestation) and full-term (390/7 to 406/7 weeks of gestation). Ninety-four patients underwent CS at full-term and 72 patients underwent CS at the early term in the study. RESULTS There was no significant difference for age (years), parity, weight gain, previous cesarean number, cervical length, myometrial thickness, estimated fetal weight, and full lower uterine segment thickness between the groups (p>.05). In the full-term group, 58% had a history of vaginal birth, whereas, in the early-term group, 42% had a history of vaginal birth (p < .05). Vaginal birth history was found to be independently associated with reaching full-term (respectively, OR: 2.876, 95% CI: [1.227-6.738]; p = .015) in all patients. Two different regression models were created to predict different CS times after the 37th week of pregnancy. Weight gain was found to be independently associated with CS time within the first seven days after admission (OR: 1.267, 95% CI: [1.003-1.599]; p = .047). Vaginal birth history and estimated fetal weight were found to be independently associated with CS time in the 8th day and further after admission (OR: 0.244, 95% CI: [0.089-0.675]; p = .007 and OR: 1.002, 95% CI: [1.000-1.003]; p = .047). CONCLUSION Vaginal birth history can be useful to predict reaching full-term in patients with previous CS. Determination of such risk factors is important in terms of reducing the frequency of emergency cesarean delivery.
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Affiliation(s)
- Ersin Çintesun
- Obstetrics and Gynecology, Selcuk Universitesi, Konya, Turkey
| | - Huriye Ezveci
- Obstetrics and Gynecology, Selcuk Universitesi, Konya, Turkey
| | - Cetin Celik
- Selcuk University Faculty of Medicine, Konya, Turkey
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Ramadan MK, Jarjour I, Hubeish M, Itani SE, Mneimneh S, Badr DA. The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome: A Prospective Cohort Study. Maternal-Fetal Medicine 2021; 3:255-62. [DOI: 10.1097/fm9.0000000000000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Adams N, Tudehope D. Australia's persistently high rate of early-term prelabour Caesarean delivery. AUST HEALTH REV 2021; 45:463-471. [PMID: 33567249 DOI: 10.1071/ah20176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/04/2020] [Indexed: 11/23/2022]
Abstract
Objective To compare the incidence of prelabour Caesarean delivery (PCD) at early term (37 weeks and 0 days (370) to 38 weeks and 6 days (386) of gestation) between Australian states and hospital sectors over time and to compare these rates with those of England and the United States of America (USA). Method A population-based descriptive study of 556040 singleton PCDs at term (370-406 weeks) in all public and private hospitals in Australian states, 2005-16, was performed. The primary outcome was the early-term PCD rate, defined as early-term PCDs as a percentage of all term PCDs. Results Across Australian states, the early-term PCD rate fell from 56.4% in 2005 to 52.0% in 2016. Over a similar period, England's rate fell from 48.2% in 2006-07 to 35.2% in 2016-17, while the USA's rate fell from 47.4% in 2006 to 34.2% in 2016. Australian public hospitals reduced their rate from 54.2% in 2005 to 44.7% in 2016, but the rate increased in private hospitals from 59.1% in 2005 to 62.5% in 2016. There was considerable variation between states and hospital sectors. Conclusions The early-term PCD rate increased in Australian private hospitals from 2005 to 2016. The public hospital rate fell by nearly 10% over the period but remained ~10% above the English and USA national rates. What is known about the topic? Babies born at early term (370-386 weeks) are at greater risk of morbidity than babies born at full term (390-406 weeks). Australia has a persistently high rate of early-term prelabour Caesarean delivery (PCD). What does this paper add? This paper reveals concerning differences in the early-term PCD rate between Australian states and hospital sectors. Further, the paper highlights that both Australian hospital sectors (public and private) have not reduced their rates to levels achieved in England and the USA. What are the implications for practitioners? These results should inform efforts to reduce Australia's early-term PCD rate to prevent harm to babies.
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Affiliation(s)
- Nicole Adams
- Mater Research - University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, Qld 4101, Australia; and Corresponding author.
| | - David Tudehope
- Mater Research - University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, Qld 4101, Australia
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Sananès N, Haller L, Jochum F, Koch A, Lecointre L, Rozenberg P. Morbidity associated with planned cesarean deliveries performed before the scheduled date: A cohort study. Eur J Obstet Gynecol Reprod Biol 2021; 264:83-87. [PMID: 34284272 DOI: 10.1016/j.ejogrb.2021.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Women with planned cesareans can require delivery before the scheduled date. However, data describing the morbidity associated with planned cesarean deliveries performed before the originally scheduled date is lacking. The objective of this study was to compare the morbidity associated with planned cesarean delivery performed before compared with on the scheduled date. STUDY DESIGN This retrospective single-center cohort study included all 3595 women with singleton pregnancies and cesarean deliveries after 36+6 weeks. All cases were reviewed individually to identify the initial intended mode of delivery, determined before 37 weeks. We excluded the 2145 (59.7%) unplanned cesareans initially planned as vaginal deliveries. Finally, the analysis included 1450 women with planned cesareans: 1232 (85.0%) performed as scheduled, and 218 (15.0%) before that date. The composite outcomes of maternal morbidity was one or more of the morbidity measures, including surgical complications, postpartum hemorrhage, infection and thrombo-embolism. Neonatal morbidity measures included 5 min Apgar score < 7, arterial cord blood pH < 7.00, and admission to the neonatal intensive care unit (NICU). RESULTS Reasons for performing planned cesarean delivery before the scheduled date were as follows: onset of labor (n = 109; 50.0%), rupture of membranes (n = 85; 39.0%), preeclampsia (n = 9; 4.1%), scar pain in women with a previous cesarean (n = 6; 2.8%), unexplained vaginal bleeding (n = 5; 2.3%), and nonreassuring fetal heart rate (n = 4; 1.8%). Mean gestational age for planned cesarean deliveries before the scheduled date was 38.7 weeks ± 0.8 versus 39.2 weeks ± 0.7 for those performed when scheduled (P < 0.0001). The maternal morbidity composite outcome rate was significantly higher among planned cesareans performed early compared with those on the scheduled date: 18.3% vs 9.7%, respectively, P = 0.0002. It was still higher in the multivariable analysis: aOR 2.17, 95% CI 1.46-3.21, P = 0.0001. The neonatal composite outcome did not differ significantly between the two groups. CONCLUSION In planned cesarean deliveries, maternal morbidity is higher for cesareans performed before rather than on the scheduled date. Studies without accurate intent-to-treat analyses underestimate the morbidity associated with planned cesareans. Accordingly, medical records must make it possible to distinguish planned cesarean deliveries performed before the scheduled date from those performed as planned.
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Affiliation(s)
- Nicolas Sananès
- Department of Obstetrics, Strasbourg University Hospital, Strasbourg, France; INSERM UMR-S 1121 "Biomaterials and Bioengineering", Strasbourg University, France.
| | - Laure Haller
- Department of Obstetrics, Strasbourg University Hospital, Strasbourg, France
| | - Floriane Jochum
- Department of Obstetrics, Strasbourg University Hospital, Strasbourg, France; Department of Public Health, Strasbourg University Hospital, Strasbourg, France
| | - Antoine Koch
- Department of Obstetrics, Strasbourg University Hospital, Strasbourg, France
| | - Lise Lecointre
- Department of Obstetrics, Strasbourg University Hospital, Strasbourg, France; I-Cube UMR 7357, Strasbourg University, France
| | - Patrick Rozenberg
- Department of Obstetrics, Poissy-Saint-Germain-en-Laye Hospital Poissy, France; Research Unit EA 7285, Versailles St-Quentin University, Montigny-le-Bretonneux, France
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Nielsen TM, Glavind J, Milidou I, Henriksen TB. Early-term elective Caesarean sections did not increase the risk of behavioural problems at six to eight years of age. Acta Paediatr 2021; 110:857-868. [PMID: 32649011 DOI: 10.1111/apa.15468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
AIM Our aim was to explore the under-researched associations between an elective Caesarean section (C-section) at early-term or full-term gestation and behaviour at 6-8 years of age. METHODS We identified 1220 eligible children born by elective C-sections at Danish hospital from 2009 to 2011. Their mothers were randomised to elective C-sections at either 38+3 (early-term) or 39+3 (full-term) weeks of gestation. From December 2017 to August 2018, the parents completed the Strengths and Difficulties Questionnaire. The results were adjusted for maternal education, parity and the child's sex. RESULTS Of the 574 (45%) children followed up, 288 were delivered early-term and 286 were delivered full-term. The groups had similar baseline characteristics. There were no differences in the total difficulties score, subscale scores or the risk of being classified as having a possible or probable psychiatric disorder. Early-term boys had a lower risk of being classified as having a possible or probable psychiatric disorder and early-term girls had higher risk, but the results were not statistically significant. CONCLUSION We found no difference in behaviour at 6-8 years of age between children born by elective C-section at early- versus full-term gestation.
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Affiliation(s)
| | - Julie Glavind
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Obstetrics and Gynaecology Aarhus University Hospital Aarhus Denmark
| | - Ioanna Milidou
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Paediatrics and Adolescent Medicine Herning Regional Hospital Herning Denmark
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Paediatrics and Adolescent Medicine Aarhus University Hospital Aarhus Denmark
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Chawanpaiboon S, Titapant V, Pooliam J. A Randomized Controlled Trial of the Effect of Music During Cesarean Sections and the Early Postpartum Period on Breastfeeding Rates. Breastfeed Med 2021; 16:200-214. [PMID: 33434087 DOI: 10.1089/bfm.2020.0299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The objective of this research was to study the role of music listening by mothers during a cesarean section and the postpartum period to achieve exclusive breastfeeding in the first 6 months. Methods and Study Design: This was a prospective, observational, randomized controlled trial study. A total of 185 singleton pregnant women, in at least 37 weeks of gestation, who were appointed for elective cesarean sections, were recruited. They were randomized into three groups, including pregnant women who did not listen to music (Group 1), listened to music during cesarean section (Group 2), and listened to music during cesarean section and the postpartum room for the first 2 days (Group 3). The breastfeeding results of all three groups were followed up at 7 days, 14 days, and then at months 1, 2, 3, and 6. Results: Success in exclusive breastfeeding among Groups 1, 2, and 3 and Groups 1 and 2 + 3 was not different in every lactating period (7 days-6 months). From subgroup analysis, mothers who listened to music in a private ward had more success in exclusive breastfeeding than those in a common ward. Mothers who listened to music and had an income of <20,000 baht, an educational level lower than university, planned the pregnancy, had their first pregnancy, and stayed in a private ward had more successful exclusive breastfeeding in a 6-month period than those mothers who did not listen to music, and the difference was statistically significant. Conclusions: Music listening by mothers during a cesarean section and in the postpartum ward did not enhance exclusive breastfeeding during the first 6 months of the postpartum period. However, from subgroup analysis, mothers who listened to music in a private ward had more success in exclusive breastfeeding than those in a common ward. Thai Clinical Trials Registry number was TCTR20180712001.
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Affiliation(s)
- Saifon Chawanpaiboon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vitaya Titapant
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Julaporn Pooliam
- Clinical Epidemiological Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Kruse AR, Arendt LH, Jakobsen DH, Kehlet H, Lauszus FF, Forman A, Uldbjerg N, Sundtoft IB, Kesmodel US. Length of hospital stay after cesarean section in Denmark from 2004 to 2016: A national register-based study. Acta Obstet Gynecol Scand 2020; 100:244-251. [PMID: 32979215 DOI: 10.1111/aogs.14000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Length of hospital stay after birth has decreased during the last decades, but nationwide data on length of hospital stay after cesarean section are lacking. Elements of Enhanced Recovery Programs were reported to reduce the length of hospital stay. The aim of this nationwide study was to describe the length of hospital stay after cesarean section in Denmark from 2004 to 2016 taking into account birth- and health-related factors as well as demographic changes and, further, to assess potential differences between the five Danish regions. MATERIAL AND METHODS Length of hospital stay was assessed in 164 209 deliveries by cesarean section in Denmark from 2004 to 2016. Data were obtained from the Danish National Patient Register. All deliveries by cesarean section at gestational age <22 weeks were excluded. Median length of hospital stay was reported based on crude and adjusted analyses. RESULTS The median length of hospital stay was significantly reduced by 39 hours (95% confidence interval [CI] 37.9-40.1), from 97 hours (4.0 days) in 2004 to 58 hours (2.4 days) in 2016. Reductions were observed among both planned and emergency cesarean sections. When birth- and health-related factors as well as demographic changes were accounted for, median length of hospital stay was reduced by 30 hours (95% CI 29.3-30.8) in the period. The decrease in length of hospital stay from 2004 to 2016 varied between the five Danish regions, with adjusted reductions between 19 and 46 hours. CONCLUSIONS A nationwide decrease in length of hospital stay after cesarean section was observed from 2004 to 2016 across all five regions but with significant regional variations. Further studies on the optimal length of hospital stay are needed, especially with regard to implementation of enhanced recovery programs.
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Affiliation(s)
- Anne R Kruse
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Linn H Arendt
- Department of Obstetrics and Gynecology, Regional Hospital Horsens, Horsens, Denmark
| | | | - Henrik Kehlet
- Surgical Pathophysiology Unit, Rigshospitalet, Copenhagen, Denmark
| | - Finn F Lauszus
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Iben B Sundtoft
- Department of Obstetrics and Gynecology, Regional Hospital West Jutland, Herning, Denmark
| | - Ulrik S Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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13
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Nitahara K, Fujita Y, Magarifuchi N, Taniguchi S, Shimamoto T. Maternal characteristics and neonatal outcomes of emergency repeat caesarean deliveries due to early-term spontaneous labour onset. Aust N Z J Obstet Gynaecol 2020; 61:48-54. [PMID: 32783334 DOI: 10.1111/ajo.13225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The optimal timing of elective repeat caesarean delivery has yet to be determined. One of the reasons to schedule an elective repeat caesarean delivery before 39 weeks gestation is to avoid emergency caesarean delivery due to spontaneous onset of labour. AIMS By ascertaining maternal characteristics and neonatal outcomes associated with early-term onset of spontaneous labour, we aim to determine the optimal timing for each individual repeat caesarean delivery. MATERIALS AND METHODS We performed a retrospective analysis of women with repeat caesarean deliveries planned at 38 weeks gestation between 2005 and 2019 at a tertiary referral hospital in Japan. A multivariate logistic regression analysis was adopted to identify independent contributing factors for early-term spontaneous labour onset. We also compared the rate of neonatal adverse events between women who underwent emergency repeat caesarean deliveries due to the onset of early-term labour and the ones who underwent elective repeat caesarean deliveries at 38 weeks. RESULTS We included 1152 women. History of vaginal deliveries (adjusted odds ratio (AOR), 2.12; 95% confidence interval (95% CI), 1.21-3.74), history of preterm deliveries (AOR, 2.28; 95% CI, 1.38-3.77), and inadequate maternal weight gain during pregnancy (AOR, 1.78; 95% CI, 1.15-2.75) significantly increased the risk of early-term spontaneous labour onset. In terms of occurrence rate of neonatal complications, we found no significant difference between the groups. CONCLUSION These maternal factors are significant predictors for early-term labour onset of repeat caesarean deliveries. The onset of early-term labour did not increase the likelihood of neonatal complications.
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Affiliation(s)
- Kenta Nitahara
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Yasuyuki Fujita
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Naomi Magarifuchi
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Shuichi Taniguchi
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Tomihiro Shimamoto
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
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Abstract
INTRODUCTION To minimize the risk of neonatal respiratory morbidity it is recommended that elective cesarean sections should not be done before 39-week gestation unless medically indicated. However, elective cesarean sections are still being performed at early term (at 370-386 weeks gestation) without sound medical indications. In this study, we evaluated the indications for elective cesarean sections performed at early term to assess the proportion of procedures that could possibly have been postponed until ≥39 weeks to avoid neonatal respiratory morbidity. MATERIAL AND METHODS Maternal and neonatal information was collected from medical records on all elective cesarean sections performed in singleton pregnancies at ≥370 weeks gestation over a 20-year period in a population with secure ultrasound gestational age assignment. Indications were grouped and uterine scar, breech, or transverse presentation and maternal request classified as nonurgent. RESULTS There were 3411 elective cesarean sections performed at ≥37-week gestation, of which 790 (23.2%) were at 370-386 weeks. Medical indications were present for 34% (272/790), but 65.6% (518/790) could possibly have been postponed until ≥390 weeks. Of the neonates 5.7% developed respiratory morbidity if delivery was at 370-386 weeks gestation compared to 2.4% at 390-421 weeks gestation (p < .001). CONCLUSION Of elective cesarean sections before 39-week gestation two-thirds were done without a clear medical indication, thereby exposing the newborn to an increased risk of respiratory morbidity. Scheduling elective cesarean sections at ≥39-week gestation is important to minimize the risk of neonatal respiratory morbidity, unless a clear medical indication dictates earlier delivery.
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Affiliation(s)
| | - Hildur Hardardottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavík, Iceland
| | - Thordur Thorkelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Neonatology, Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
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15
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Rotem R, Bitensky S, Pariente G, Sergienko R, Rottenstreich M, Weintraub AY. Placental complications in subsequent pregnancies after prior cesarean section performed in the first versus second stage of labor. J Matern Fetal Neonatal Med 2019; 34:2089-2095. [PMID: 31416380 DOI: 10.1080/14767058.2019.1657086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine whether prior cesarean delivery (CD) in the first stage of labor (non-progressive labor in the first stage - NPL1), when compared with CD in the second stage of labor (non-progressive labor in the second stage - NPL2), is associated with different rates of third stage placental complications in the subsequent delivery. METHODS A retrospective cohort study, of all deliveries following a CD due to NLP1 or NLP2 that occurred between the years 1988 and 2013, was undertaken. Multiple gestation pregnancies, known uterine malformations or uterine fibroids were excluded. Rates of third stage complications (retained placenta, adherent/increta/percreta placenta, manual removal of the placenta) were compared between the groups. Univariate analysis was followed by multivariate analysis. RESULTS During the study period, there were 3828 subsequent deliveries of parturients who were operated due to NPL1 and NPL2 (72.91 and 27.09%, respectively). Rates of manual removal of the placenta as well as adherent placenta were significantly higher among parturients following CD due to NPL2 (28.4 versus 24.0%, p = .04, 1.2 versus 0.4% p < .01, respectively). In a multivariate analysis controlling for possible confounders, adherent placenta was found to be independently associated with vaginal delivery following CD due to NPL2 (odds ratio 2.98, 95% confidence interval 1.30-6.77). CONCLUSIONS Prior CD due to NPL2 as opposed to NPL1 is independently associated with adherent placenta in the subsequent delivery. A higher index of suspicion may be needed when evaluating these women during pregnancy as well as during management of the delivery.
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Affiliation(s)
- Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Shira Bitensky
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel
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Wilmink FA, Pham CT, Edge N, Hukkelhoven CW, Steegers EA, Mol BW. Timing of elective pre-labour caesarean section: A decision analysis. Aust N Z J Obstet Gynaecol 2019; 59:221-227. [PMID: 29700811 PMCID: PMC6492094 DOI: 10.1111/ajo.12821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since caesarean sections (CSs) before 39+0 weeks gestation are associated with higher rates of neonatal respiratory morbidity, it is recommended to delay elective CSs until 39+0 weeks. However, this bears the risk of earlier spontaneous labour resulting in unplanned CSs, which has workforce and resource implications, specifically in smaller obstetric units. AIM To assess, in a policy of elective CSs from 39+0 weeks onward, the number of unplanned CSs to prevent one neonate with respiratory complications, as compared to early elective CS. MATERIALS AND METHODS We performed a decision analysis comparing early term elective CS at 37+0-6 or 38+0-6 weeks to elective prelabour CS, without strict medical indication, at 39+0-6 weeks, with earlier unplanned CS, in women with uncomplicated singleton pregnancies. We used literature data to calculate the number of unplanned CSs necessary to prevent one neonate with respiratory morbidity. RESULTS Planning all elective CSs at 39+0-6 weeks required 10.9 unplanned CSs to prevent one neonate with respiratory morbidity, compared to planning all elective CSs at 38+0-6 weeks. Compared to planning all elective CSs at 37+0-6 weeks we needed to perform 3.3 unplanned CSs to prevent one neonate with respiratory morbidity. CONCLUSION In a policy of planning all elective pre-labour CSs from 39+0 weeks of gestation onward, between three and 11 unplanned CSs have to be performed to prevent one neonate with respiratory morbidity. Therefore, in our opinion, fear of early term labour and workforce disutility is no argument for scheduling elective CSs <39+0 weeks.
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Affiliation(s)
- Freke A. Wilmink
- Department of Obstetrics and GynaecologyRadboudumcNijmegenThe Netherlands
| | - Clarabelle T. Pham
- School of Public HealthUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Nicole Edge
- Department of Obstetrics and GynaecologyMildura Base HospitalMilduraVictoriaAustralia
| | | | - Eric A.P. Steegers
- Department of Obstetrics and GynaecologyErasmus MC – Sophia Children's HospitalRotterdamThe Netherlands
| | - Ben W. Mol
- Department of Obstetrics and GynaecologyThe Robinson Research InstituteUniversity of AdelaideNorth AdelaideSouth AustraliaAustralia
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17
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Ko HS, Wie JH, Choi SK, Park IY, Park YG, Shin JC. Optimal time of delivery to reduce the risk of infant mortality in small and normally grown fetuses: A national cohort study in Korea. PLoS One 2018; 13:e0209308. [PMID: 30550584 DOI: 10.1371/journal.pone.0209308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 12/04/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose To examine the competing risks of stillbirth versus infant death and to evaluate the optimal time of delivery in the population of small for gestational age (SGA) and non-SGA late preterm and term fetuses. Methods This was a retrospective national cohort study of all singleton births between 34 0/7 and 42 6/7 weeks of gestation using the Korean vital statistics (n = 2,106,159). We compared the risk of infant mortality with a composite of fetal–infant mortality risk that would occur after expectant management for one additional week and evaluated the optimal time of delivery, in SGA and non-SGA pregnancies. Results In the total population, the risk of expectant management became significantly higher than the risk of delivery, at 39 weeks and beyond, similar with non-SGA group. In the SGA group, the risk of stillbirth was significantly greater at all GAs than for non-SGA pregnancies, and the risk of infant death was significantly increased until 38 weeks (25.8 per 10,000 live births, 95% CI 20.11–32.47), and the risk of stillbirth was significantly increased at 41 weeks (11.65 per 10,000 ongoing pregnancies, 95% CI 6.95–18.09), compared to 39 weeks (12 per 10,000 live births, 95% CI 8.98–15.64 and 5.12 per 10,000 ongoing pregnancies, 95% CI 3.84–6.66, respectively). Conclusion In Korean women, delivery between 39 and 41 weeks minimizes fetal/infant mortality, in non-SGA pregnancies. In uncomplicated SGA pregnancies, delivery between 39 and 40 weeks can be considered to decrease risk of infant death and stillbirths.
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18
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Pirjani R, Afrakhteh M, Sepidarkish M, Nariman S, Shirazi M, Moini A, Hosseini L. 'Elective caesarean section at 38-39 weeks gestation compared to > 39 weeks on neonatal outcomes: a prospective cohort study. BMC Pregnancy Childbirth 2018; 18:140. [PMID: 29739452 PMCID: PMC5941590 DOI: 10.1186/s12884-018-1785-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background This study was conducted to compare neonatal complications in scheduled cesarean sections (CS) between 38 and 39 gestational weeks with CS performed after 39 gestational weeks in Iranian low -risk pregnant women. Methods In this cohort study, 2086 patients were enrolled based on the inclusion and exclusion criteria. The neonates were evaluated in terms of the following items: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), sepsis, need for NICU hospitalization, birth weight, birth height, head circumference, and the first minute and fifth minute Apgar score. Several multiple logistic regression models were performed for each response variable (adverse outcome) separately. Results The incidence of NICU admission was significantly higher in neonates born at 38–39 gestational weeks than those who were born after 39 gestational weeks. No significant differences were found in the incidence of neonatal sepsis, TTN, and RDS between the two groups. Conclusion According to our study results, elective CS at 38–9 weeks’ gestation is associated with a higher rate of TTN and NICU admission in comparison with elective CS performed after 39 completed gestational weeks.
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Affiliation(s)
- Reihaneh Pirjani
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Research development center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Shahin Nariman
- Department of Pediatrics, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Moini
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR., Tehran, Iran
| | - Ladan Hosseini
- Research development center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Katwa N, Vasudeva A, Lewis LES, Kumar P. There is Only a Modest Increase in Neonatal Respiratory Morbidity Following Early Term Elective Cesarean in a South Indian Population. J Obstet Gynaecol India 2018; 68:104-110. [DOI: 10.1007/s13224-017-0995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/08/2017] [Indexed: 10/19/2022] Open
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20
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Weiniger CF, Krichevsky A, Mankuta D, Eventov Friedman S. Retrospective cohort study to investigate the impact of timing for term cesarean delivery on maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2018; 32:2716-2720. [PMID: 29495901 DOI: 10.1080/14767058.2018.1447560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Early-term cesarean delivery (CD) increases neonatal respiratory morbidity; however, planned late-term cesarean delivery (CD) may generate urgent CD related to spontaneous onset of labor. AIMS We investigated maternal and neonatal morbidity for planned early (37/38 week) versus late-term (39/40 weeks) CD. Our primary study aim was to investigate severe maternal morbidity and general anesthesia rates according to early versus late-term CD. Our secondary study aims were to investigate the rate of urgent surgery and other measures of maternal morbidity, and neonatal morbidity, according to early versus late-term CD and according to urgent versus elective planned CD. METHODS In our retrospective, ethically approved study of planned CD we compared maternal morbidity and neonatal respiratory morbidity, for early versus late-term CD. RESULTS Among 370 early versus 300 late-term CD, women who delivered at late-term CD had significantly higher rates of urgent surgery 101 (33.7%) versus 85 (23.0%) at early-term, p = .002; spontaneous onset of labor 85 (28.3%) versus 67 (18.1%), p = .0002 and out-of-hours surgery 101 (33.7%) versus 64 (17.3%), p < .0001. The frequency of neonatal respiratory morbidity composite was 10 (2.7%) for early versus 1 (0.3%) for late-term CD, p = .03. CONCLUSIONS Late-term CD was not associated with increased maternal morbidity or use of general anesthesia in our tertiary institution. Prior reports of increased neonatal respiratory morbidity at early term CD were confirmed. Of concern, late-term CD was associated with urgent and out-of-hours CD.
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Affiliation(s)
- Carolyn F Weiniger
- a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel.,b Division of Anesthesia and Critical Care and Pain , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Anya Krichevsky
- c School of Medicine , Hadassah Hebrew University Hospital , Jerusalem , Israel
| | - David Mankuta
- d Obstetrics and Gynecology , Hadassah Hebrew University Hospital , Jerusalem , Israel
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21
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Ko HS, Jang YR, Yun H, Wie J, Choi SK, Park IY, Shin JC. Late-preterm infants, early-term infants, and timing of elective deliveries; current status in a Korean medical center. J Matern Fetal Neonatal Med 2017; 32:1267-1274. [PMID: 29130825 DOI: 10.1080/14767058.2017.1404564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to examine the current perinatal outcomes among infants born late-preterm and early-term compared to those born full-term and evaluate the optimal gestational age for delivery. METHODS We performed a retrospective cohort study for births occurred at Seoul St. Mary's Hospital over the past 7 years. Statistical comparison was performed using χ2 test and multivariable logistic regression models. RESULTS A total of 7580 women met the study criteria. Compared to 39 weeks, delivery at late-preterm and early-term had higher risk of composite morbidity, including respiratory morbidities, intracranial hemorrhage (ICH), and admission to neonatal intensive care unit (NICU) (34 weeks adjusted odds ratio [aOR]: 132.54; 95% confidence interval (CI): 74.00-240.10; 37 weeks aOR: 2.14; 95%CI: 1.65-2.77). The risks of sepsis and necrotizing enterocolitis in deliveries before 36 weeks and the risk of feeding difficulty in deliveries before 37 weeks were significantly higher than those of 39 weeks. Neonatal morbidity at deliveries was not significantly different between 38 and 39 weeks. CONCLUSIONS Neonatal morbidities at late-preterm births are significant and surveillance for them seems increasing. Obstetricians should recognize the risk of respiratory morbidity, ICH, and NICU admission for deliveries before 38 weeks' gestation.
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Affiliation(s)
- Hyun Sun Ko
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Yu-Ri Jang
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Hanggoo Yun
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - JeongHa Wie
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Sae Kyung Choi
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - In Yang Park
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jong Chul Shin
- a Department of Obstetrics and Gynecology, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea
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Muoto I, Darney BG, Lau B, Cheng YW, Tomlinson MW, Neilson DR, Friedman SA, Rogovoy J, Caughey AB, Snowden JM. Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy. Health Serv Res 2017; 53 Suppl 1:2839-2857. [PMID: 29131330 DOI: 10.1111/1475-6773.12797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To assess the use and timing of scheduled cesareans and other categories of cesarean delivery and the prevalence of neonatal morbidity among cesareans in Oregon before and after the implementation of Oregon's statewide policy limiting elective early deliveries. DATA SOURCES Oregon vital statistics records, 2008-2013. STUDY DESIGN Retrospective cohort study, with multivariable logistic regression, regression controlling for time trends, and interrupted time series analyses, to compare the odds of different categories of cesarean delivery and the odds of neonatal morbidity pre- and postpolicy. DATA COLLECTION/EXTRACTION METHODS We analyzed vital statistics data on all term births in Oregon (2008-2013), excluding births in 2011. PRINCIPAL FINDINGS The odds of early-term scheduled cesareans decreased postpolicy (adjusted odds ratio [aOR], 0.70; 95 percent confidence interval [CI], 0.66-0.74). In the postpolicy period, there were mixed findings regarding assisted neonatal ventilation and neonatal intensive care unit admission, with regression models indicating higher postpolicy odds in some categories, but lower postpolicy odds after controlling for time trends. CONCLUSIONS Oregon's hard stop policy limiting elective early-term cesarean delivery was associated with lower odds of cesarean delivery in the category of women who were targeted by the policy; more research is needed on impact of such policies on neonatal outcomes.
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Affiliation(s)
- Ifeoma Muoto
- Kaiser Permanente Northwest-Regional Administration, Portland, OR
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR.,Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Bernard Lau
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Yvonne W Cheng
- Sutter Health, California Pacific Medical Center, Department of Obstetrics and Gynecology, San Francisco, CA.,Department of Surgery, University of California, Davis, CA
| | - Mark W Tomlinson
- Providence Health and Services Women and Children's Program, Portland, OR
| | | | - Steven A Friedman
- Department of Perinatology, Kaiser Permanente, Kaiser Sunnyside Medical Center, Clackamas, OR
| | | | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Jonathan M Snowden
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR.,School of Public Health, Oregon Health & Science University/Portland State University, Portland, OR
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Abstract
PURPOSE We sought to examine if the method of pregnancy dating at five increasing term gestational ages is associated with increasing neonatal morbidity. MATERIALS AND METHODS A cohort of women who underwent elective repeat cesarean delivery at ≥37 weeks' gestation were identified from the NICHD MFMU Network registry. We excluded women who were in labor, those carrying a fetus with a congenital anomaly, those with a non-reassuring fetal heart tracing, and those with preeclampsia, preexisting chronic hypertension or diabetes. Composite neonatal morbidity was defined for our study as any of the following: NICU admission, hypotonia, meconium aspiration, seizures, need for ventilator support, NEC, RDS, TTN, hypoglycemia, or neonatal death. We compared composite neonatal morbidity rates among infants born at five different gestational age cutoffs according to their method of pregnancy dating. RESULTS At 39 and 40 weeks' gestation, the lowest rate of neonatal complications was seen in pregnancies dated by first trimester ultrasound (5.8% and 5.5%, respectively), while those with the highest neonatal morbidity rates were seen when dated by a second or third trimester ultrasound (8.1% and 6.0%, respectively); p < .001. Additionally within each pregnancy dating category, the neonatal morbidity rates declined from 37 to 40 weeks' gestation and then significantly increased at 41 + 0 weeks' gestation. CONCLUSION Even with suboptimal dating methods, amongst women undergoing elective repeat cesarean delivery, neonatal morbidity was lowest when delivery occurred between 40 and 40 + 6 weeks gestation.
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Affiliation(s)
- Kathleen F Brookfield
- a Department of Obstetrics and Gynecology , Oregon Health and Science University , Portland , OR , USA
| | - Sarah S Osmundson
- b Department of Obstetrics and Gynecology , Vanderbilt University School of Medicine, B-1100 Medical Center North , Nashville , TN , USA
| | - Aaron B Caughey
- a Department of Obstetrics and Gynecology , Oregon Health and Science University , Portland , OR , USA
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Abstract
OBJECTIVE To assess the relationship between the timing of antepartum elective caesarean delivery (CD) at term and perinatal outcomes in a Chinese population. METHODS We conducted a retrospective cohort study of mode of delivery at a large obstetric centre in Shanghai, China between 2007 and 2014. Eligibility criteria included: term nulliparous women with a singleton gestation undergoing antepartum elective CD. RESULTS There were 19 939 women delivered by antepartum CD without indications, with 5.9% performed at 37-37 6/7 weeks, 36.2% at 38-38 6/7 weeks, 38.4% at 39-39 6/7 weeks, 15.4% at 40-40 6/7 weeks, 4.0% at ≥41 weeks. As compared with births at 39-39 6/7 weeks, births at 37 weeks were associated with an increased odds of neonatal respiratory disease (adjusted odds ratian(aOR): 4.82; 95% CI 3.35 to 6.94), neonatal infection (aOR: 3.68; 95% CI 1.80 to 7.52), hypoglycaemia (aOR: 3.85; 95%CI 2.29 to 6.48), hyperbilirubinaemia (aOR: 3.50; 95%CI 2.12 to 5.68), neonatal intensive care admission (aOR: 3.73; 95% CI 2.84 to 4.89) and prolonged hospitalisation (aOR: 7.51; 95% CI 5.10 to 11.07). Births at 38 weeks, 40 weeks or ≥41 weeks were also associated with an increased odds of neonatal respiratory disease with corresponding aORs (95% CI) of 2.26 (1.71 to 3.00), 1.97 (1.33 to 2.94) and 2.91 (1.80 to 4.70), respectively. CONCLUSION For women undergoing elective CD, neonatal outcome data suggest that delivery at 39-39 6/7 complete weeks is optimal timing in a Chinese population.
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Affiliation(s)
- Yong HU
- Department of Neonatology, Shanghai Children’s hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hong Shen
- Obstetrics Department, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Mark B Landon
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Weiwei Cheng
- Obstetrics Department, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xiaohua Liu
- Obstetrics Department, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
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Sananès N, Koch A, Escande B, Aissi G, Fritz G, Roth E, Weil M, Bakri A, Bolender C, Meyer N, Vayssiere C, Gaudineau A, Nisand I, Favre R, Kuhn P, Langer B. Pilot randomised controlled trial comparing the risk of neonatal respiratory distress in elective caesarean section at 38 weeks’ gestation following a course of corticosteroids versus caesarean at 39 weeks. Eur J Obstet Gynecol Reprod Biol 2017; 212:54-9. [DOI: 10.1016/j.ejogrb.2017.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/23/2017] [Accepted: 03/08/2017] [Indexed: 11/20/2022]
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Glavind J, Milidou I, Uldbjerg N, Maimburg R, Henriksen TB. Neonatal morbidity after spontaneous labor onset prior to intended cesarean delivery at term: a cohort study. Acta Obstet Gynecol Scand 2017; 96:479-486. [DOI: 10.1111/aogs.13097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Julie Glavind
- Perinatal Epidemiology Research Unit; Department of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ioanna Milidou
- Perinatal Epidemiology Research Unit; Department of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
- Department of Pediatrics; Aarhus University Hospital; Aarhus Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Rikke Maimburg
- Perinatal Epidemiology Research Unit; Department of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
- Center of Research in Rehabilitation (CORIR); Aarhus University Hospital; Aarhus Denmark
| | - Tine B. Henriksen
- Perinatal Epidemiology Research Unit; Department of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
- Department of Pediatrics; Aarhus University Hospital; Aarhus Denmark
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O’Neill SM, Agerbo E, Khashan AS, Kearney PM, Henriksen TB, Greene RA, Kenny LC. Trial of labour after caesarean section and the risk of neonatal and infant death: a nationwide cohort study. BMC Pregnancy Childbirth 2017; 17:74. [PMID: 28241870 PMCID: PMC5327578 DOI: 10.1186/s12884-017-1255-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caesarean section (CS) rates are increasing worldwide and as a result repeat CS is common. The optimal mode of delivery in women with one previous CS is widely debated and the risks to the infant are understudied. The aim of the current study was to evaluate if women with a trial of labour after caesarean (TOLAC) had an increased odds of neonatal and infant death compared to women with an elective repeat CS (ERCS). METHODS A population register-based cohort study was conducted in Denmark between 1982 and 2010. All women with two deliveries [in which the first was a CS, and the second was an uncomplicated, term delivery (n = 61,626)] were included in the study. Logistic regression models were used to report adjusted odds ratios (AOR) and 95% confidence intervals (CI) of the odds of death according to mode of delivery. The main outcome measures were neonatal death (early and late) and infant death. RESULTS Women with a TOLAC had an increased odds of neonatal death (AOR 1 · 87, 95% CI 1 · 12 to 3 · 12) due to an increased risk of early neonatal death (AOR 2 · 06, 95% CI 1 · 19 to 3 · 56) and no effect on late neonatal death (AOR 0 · 97, 95% CI 0 · 22 to 4 · 32), or infant death (AOR 1 · 12, 95% CI 0 · 79 to 1 · 59) when compared to the reference group of women with an ERCS. There was evidence of a cohort effect as the increased odds of neonatal death (AOR 3 · 89, 95% CI 1 · 33 to 11 · 39) was most significant in the earlier years (1982-1991) and gradually disappeared (AOR 1 · 01, 95% CI 0 · 44 to 2 · 31) in the later years (2002-2010). CONCLUSIONS Although an increased risk of neonatal death was found in women with a TOLAC, there was evidence of a cohort effect, which showed this increased odds disappearing over time. Advances in modern healthcare including improved monitoring and earlier detection of underlying pregnancy complications may explain the findings.
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Affiliation(s)
- Sinéad M. O’Neill
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- National Perinatal Epidemiology Centre (NPEC), Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, 5th Floor Wilton, Cork, Ireland
| | - Esben Agerbo
- Centre for Integrated Register-based Research (CIRRAU), National Centre for Register-based Research (NCRR), Aarhus University, Aarhus, Denmark
| | - Ali S. Khashan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Patricia M. Kearney
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Department of Paediatrics, Aarhus University Hospital, Skejby, Aarhus N, DK-8200 Denmark
| | - Richard A. Greene
- National Perinatal Epidemiology Centre (NPEC), Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, 5th Floor Wilton, Cork, Ireland
| | - Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
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Hamadneh J, Alchalabi H, Hamadneh S, Amarin Z, Khader YS, Kassab M, Bani-Hani M. Association between timing of elective cesarean delivery and adverse outcomes among women with at least two previous cesareans. Int J Gynaecol Obstet 2017; 137:51-56. [DOI: 10.1002/ijgo.12089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/02/2016] [Accepted: 12/20/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Jehan Hamadneh
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - Haifaa Alchalabi
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | | | - Zouhair Amarin
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - Yousef S. Khader
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - Manal Kassab
- Faculty of Nursing; Jordan University of Science and Technology; Irbid Jordan
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Moreira ME, Pereira APE, Gomes Junior SC, Guinsburg R, de Almeida MFB, Gama SG, Leal MDC. Factors associated with the use of supplemental oxygen or positive pressure ventilation in the delivery room, in infants born with a gestational age ≥ 34 weeks. Reprod Health 2016; 13:116. [PMID: 27766977 PMCID: PMC5073976 DOI: 10.1186/s12978-016-0235-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 5–10 % of newborns require some form of resuscitationupon delivery; several factors, such as maternal abnormal conditions, gestational age and type of delivery could be responsible for this trend. This study aimed to describe the factors associated with the need for positive pressure ventilation (PPV) via a mask or endotracheal tube and the use of supplemental O2 in newborns with a gestational age greater than 34 weeks in Brazil. Methods We performed a cross-sectional study and obtained data from the Birth in Brazil Survey. The inclusion criterion was a gestational age ≥34 weeks. Exclusion criteria were newborns with congenital malformations, and cases with undetermined gestational age or type of delivery (vaginal, pre labor cesarean section and cesarean section during labor). The primary outcomes were need of PPV via a mask or endotracheal tube and the use of supplemental oxygen without PPV. Confounding variables, including maternal age, source of birth payment, years of maternal schooling, previous birth, newborn presentation, multiple pregnancy, and maternal obstetric risk, were analyzed. Results We included 22,720 newborns. Of these, 2974 (13.1 %) required supplementary oxygen. PPV with a bag and mask was used for 727 (3.2 %) newborns and tracheal intubation for 192 (0.8 %) newborns. Chest compression was necessary for 136 (0.6 %) newborns and drugs administered in 114 (0.5 %). 51.3 % of newborns were delivered by cesarean section, with the majority of cesarean sections (88.7 %) being performed prior to labor. Gestational age (late preterm infants: (Relative Risk-(RR) 2.46; 95 % (Confidence interval-CI 1.79–3.39), maternal obstetric risk (RR 1.59; 95 % CI1.30–1.94), and maternal age of 12–19 years old (RR 1.36; 95 % CI1.06–1.74) contributed to rates of PPV in the logistic regression analysis. Newborns aged between 37–38 weeks of gestaional age weren´t less likely to require PPV compared with those aged 39–41 weeks of gestational age. Conclusions Late preterm infants, previous maternal obstetric risks and maternal age contributed to the higher needs of PPV and use of O2 in the delivery room. These variables need to be considered in planning care in the delivery room.
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Affiliation(s)
- Maria Elisabeth Moreira
- Fundação Oswaldo Cruz/Instituto Fernandes Figueira, Avenida Rui Barbosa 716, Rio de Janeiro, RJ, 22520-020, Brazil.
| | - Ana Paula Esteves Pereira
- Fundação Oswaldo Cruz/Escola Nacional de Saúde Publica, R. Leopoldo Bulhões, 1480 - Benfica, Rio de Janeiro, RJ, 20911-300, Brazil
| | - Saint Clair Gomes Junior
- Fundação Oswaldo Cruz/Instituto Fernandes Figueira, Avenida Rui Barbosa 716, Rio de Janeiro, RJ, 22520-020, Brazil
| | - Ruth Guinsburg
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Silvana Granado Gama
- Fundação Oswaldo Cruz/Escola Nacional de Saúde Publica, R. Leopoldo Bulhões, 1480 - Benfica, Rio de Janeiro, RJ, 20911-300, Brazil
| | - Maria do Carmo Leal
- Fundação Oswaldo Cruz/Escola Nacional de Saúde Publica, R. Leopoldo Bulhões, 1480 - Benfica, Rio de Janeiro, RJ, 20911-300, Brazil
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Abstract
The optimal timing of delivery in the setting of various clinical conditions and scenarios remains one of the most common questions for obstetric providers. Over the past 5-10 years, the optimal timing of delivery at term, particularly for elective repeat cesareans, has been the subject of considerable investigation and discussion. There is an increasing consensus that when women opt for an elective repeat cesarean delivery, it should be performed at term rather than preterm. The recent redefinition of the "term" period into early term (37-38 weeks), full-term (39-40 weeks), late term (41 weeks), and post term designations (≥42 weeks) underscores observed heterogeneity in outcomes following delivery at term. The American College of Obstetricians and Gynecologists currently recommends that elective repeat cesarean delivery be performed at full-term. Herein, the available data to support this recommendation regarding timing of elective repeat cesarean delivery are reviewed, including contributions from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network.
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Phaloprakarn C, Tangjitgamol S, Manusirivithaya S. Timing of elective cesarean delivery at term and its impact on maternal and neonatal outcomes among Thai and other Southeast Asian pregnant women. J Obstet Gynaecol Res 2016; 42:936-43. [PMID: 27079277 DOI: 10.1111/jog.13016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 02/01/2016] [Accepted: 02/26/2016] [Indexed: 12/01/2022]
Abstract
AIM The impact of timing of elective cesarean delivery (CD) at term on maternal and neonatal outcomes among Thai and other Southeast Asian pregnancies was investigated. The rate of spontaneous labor before the scheduled CD, as well as maternal characteristics predicting spontaneous labor, was also evaluated. METHODS Data on maternal and neonatal outcomes of 1221 singleton pregnancies scheduled for either an elective repeat CD or an elective primary CD at 37-40 weeks of gestation were studied. The association between maternal characteristics and the risk of spontaneous labor was evaluated by univariate and multivariate analyses. RESULTS There were no significant differences in severe maternal complications between performing an elective CD at 39 weeks and at the other gestational ages. Severe neonatal complications were significantly decreased when a CD was performed electively from 38 weeks onwards. A total of 503 women (41.2 %) went into spontaneous labor before the scheduled CD. Using 39 weeks as the reference group, scheduling a CD at 37 or 38 weeks decreased the risk of spontaneous labor (6.67-fold and 4.55-fold, respectively) while scheduling a CD at 40 weeks had a 2.54-fold increased risk. A history of previous CD and teenage pregnancy were also predictors of spontaneous labor; adjusted odds ratios were 14.27 and 3.93, respectively. CONCLUSION The timing of elective CD at term had impacts on pregnancy outcomes among Thai and other Southeast Asian women. Gestational age at scheduled CD, a previous CD and teenage pregnancy were predictors of spontaneous labor.
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Affiliation(s)
- Chadakarn Phaloprakarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Siriwan Tangjitgamol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sumonmal Manusirivithaya
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Vidic Z, Blickstein I, Štucin Gantar I, Verdenik I, Tul N. Timing of elective cesarean section and neonatal morbidity: a population-based study. J Matern Fetal Neonatal Med 2015; 29:2461-3. [PMID: 26444222 DOI: 10.3109/14767058.2015.1087500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the incidence of neonatal complications related to gestational age at elective cesarean section near term. METHODS We used a population-based dataset to compare neonatal outcomes by gestational age in uncomplicated singleton pregnancies delivered by elective cesarean section ≥37 weeks. RESULTS A total of 7364 mothers had an elective cesarean during 2002-2012; 343 (4.7%) at 37, 21 753 (3.8%) at 38, 3140 (2.6%) at 39, 1718 (23.3%) at 40 and 410 (5.6%) at ≥41 weeks. Infants born at a lower gestational age had a higher rate of Apgar scores <7 (2%, 0.4%, 0.6%, 0,3%, 0.2% at 37, 38, 39, 40 and ≥41 week, p = 0.013), hypoglycemia (1.5%, 1.0%, 0.8%, 0.4%, 0.5% at 37, 38, 39, 40 and ≥ 41 week, p = 0.012), hyperbilirubinemia (12.2%, 9.5%, 6.4%, 4.8%, 4.1% at 37, 38, 39, 40 and ≥ 41 week, p < 0.001), respiratory distress syndrome (5.5%, 2.2%, 1.6%, 0.5%, 0.7% at 37, 38, 39, 40 and ≥ 41 week, p < 0.001), and neonatal intensive care admissions (8.7%, 2.3%, 1.9%, 1.0%, 1.7% at 37, 38, 39, 40 and ≥ 41 week, p < 0.001). CONCLUSIONS Elective cesarean section at ≥ 39 weeks gestation would significantly reduce neonatal complications.
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Affiliation(s)
- Zala Vidic
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
| | - Isaac Blickstein
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
| | - Irena Štucin Gantar
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
| | - Ivan Verdenik
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
| | - Nataša Tul
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
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Burgos J, Rodríguez L, Cobos P, Osuna C, Del Mar Centeno M, Larrieta R, Martínez-Astorquiza T, Fernández-Llebrez L. Management of breech presentation at term: a retrospective cohort study of 10 years of experience. J Perinatol 2015; 35:803-8. [PMID: 26181721 DOI: 10.1038/jp.2015.75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the impact of management of childbirth (external cephalic version (ECV) plus planned vaginal delivery (PVD)) of breech presentation at term (⩾37 weeks of gestation). STUDY DESIGN This retrospective cohort study was based on data collected of singleton breech presentations at term in the Obstetrics and Gynaecology Service, Cruces University Hospital (Biscay, Spain), from January 2003 to December 2012. RESULT We attended 2377 singleton breech pregnancies at term. We attended 1684 singleton breech term deliveries, attempting vaginal delivery after selection in 52.9% of cases and were successful in 57.5% of attempts. A total of 1360 ECV were attempted, with a success rate of 50.3% of those attempted. The use of ECV has decreased the rate of breech presentation at delivery by 39.0%, the rate of breech presentation as a caesarean section (CS) indication by 47.1% (CS due to breech presentation/total of CS) and the rate of CS for breech presentation out of the total of deliveries by 39.1% (CS due to breech presentation/total of deliveries). Early postnatal parameters (5-min Apgar score, umbilical cord arterial pH and acid-base analysis) were significantly lower following PVD compared with planned CS for breech presentation. However, we did not find any differences in the rates of admissions to the neonatal unit or neonatal mortality. CONCLUSION Management of breech presentation with a protocol that includes ECV, careful selection criteria and active management of vaginal delivery achieve a great decrease in the rate of CS for breech presentation.
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Metcalfe A, Lisonkova S, Joseph KS. The association between temporal changes in the use of obstetrical intervention and small-for-gestational age live births. BMC Pregnancy Childbirth 2015; 15:233. [PMID: 26420607 PMCID: PMC4588231 DOI: 10.1186/s12884-015-0670-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The literature attributes secular declines in small-for-gestational age (SGA) live births to changes in maternal smoking and other maternal characteristics. However, there are reasons to believe that the observed reductions in SGA may be a consequence of early delivery following obstetric intervention. METHODS We examined temporal trends in obstetrical intervention and SGA among singleton live births in the United States from 1990 to 2010. The modified Kitagawa decomposition, based on the fetuses-at-risk approach, was used to assess the relative contribution of changes in the gestational age distribution and gestational age-specific SGA to overall changes in SGA. Reductions in SGA rates due to a left shift in the gestational age distribution were assumed to primarily reflect increased obstetrical intervention, whereas decreases in overall SGA due to decreases in gestational-age-specific SGA rates were assumed to reflect declines in risk factors. RESULTS Temporal trends in SGA followed a non-linear pattern, with substantial declines from 10.1% in 1990-92 to 8.9% in 2002-04, followed by a small increase to 9.1% in 2008-10. Rates of maternal smoking steadily decreased throughout the same time period and changes in SGA rates were more consistent with changes in the gestational age distribution. The modified Kitagawa decomposition analysis also attributed the initial decline in SGA rates to changes in the gestational age distribution. CONCLUSIONS Complex temporal pattern in SGA rates cannot be explained by the linear pattern of changes in factors like maternal smoking. Changes in the gestational age distribution are more consistent with the observed secular trends in SGA rates.
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Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada.
| | - Sarka Lisonkova
- Department of Obstetrics and Gynecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada.
| | - K S Joseph
- Department of Obstetrics and Gynecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Finn D, O'Neill SM, Collins A, Khashan AS, O'Donoghue K, Dempsey E. Neonatal outcomes following elective caesarean delivery at term: a hospital-based cohort study. J Matern Fetal Neonatal Med 2015; 29:904-10. [PMID: 25758621 DOI: 10.3109/14767058.2015.1023187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess neonatal outcomes following elective caesarean delivery (CD) at term (≥37 + 0 weeks gestation). METHODS A retrospective cohort study was conducted in a single Irish maternity hospital. Elective CDs at term between August 2008 and July 2012 were reviewed. Outcome measures were admission to the neonatal intensive care unit (NICU), length of stay, respiratory complications, hypoglycaemia, jaundice, newborn sepsis and medical interventions. RESULTS A total of 4242 women had an elective CD at term, accounting for approximately 15% of all term deliveries. Admission rate to the NICU at 37 weeks gestation was 21.8% versus 10% at 39 weeks (p for trend <0.0001). Similar trends of decreasing risk with later gestational age were noted for the other outcomes. An increased odds of admission to the NICU at 37 weeks [adjusted odds ratio (OR) 2.48 (95% CI 1.28, 4.79)] and at 38 weeks [OR 1.34, 95% CI 1.02, 1.77] compared to the reference of 39 weeks gestation was found. CONCLUSIONS This study supports evidence that, with regard to neonatal outcome, 39 weeks gestational age is the optimal delivery time. Heightened awareness of the increased risk of neonatal morbidity, when delivery is performed electively before 39 weeks, is warranted among healthcare workers.
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Affiliation(s)
- Daragh Finn
- a Department of Paediatrics and Child Health, Neonatal Intensive Care Unit , University College Cork , Cork , Ireland
| | - Sinéad M O'Neill
- b Department of Obstetrics and Gynecology , National Perinatal Epidemiology Centre, Anu Research Centre, Cork University Maternity Hospital , Wilton , Cork , Ireland .,c The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork , Cork , Ireland , and
| | - Aedin Collins
- a Department of Paediatrics and Child Health, Neonatal Intensive Care Unit , University College Cork , Cork , Ireland
| | - Ali S Khashan
- c The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork , Cork , Ireland , and.,d Department of Obstetrics and Gynaecology , University College Cork , Cork , Ireland
| | - Keelin O'Donoghue
- d Department of Obstetrics and Gynaecology , University College Cork , Cork , Ireland
| | - Eugene Dempsey
- a Department of Paediatrics and Child Health, Neonatal Intensive Care Unit , University College Cork , Cork , Ireland
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Hutcheon JA, Strumpf EC, Harper S, Giesbrecht E. Maternal and neonatal outcomes after implementation of a hospital policy to limit low-risk planned caesarean deliveries before 39 weeks of gestation: an interrupted time-series analysis. BJOG 2015; 122:1200-6. [PMID: 25851865 DOI: 10.1111/1471-0528.13396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the extent to which implementing a hospital policy to limit planned caesarean deliveries before 39 weeks of gestation improved neonatal health, maternal health, and healthcare costs. DESIGN Retrospective cohort study. SETTING British Columbia Women's Hospital, Vancouver, Canada, in the period 2005-2012. POPULATION Women with a low-risk planned repeat caesarean delivery. METHODS An interrupted time series design was used to evaluate the policy to limit planned caesarean deliveries before 39 weeks of gestation, introduced on 1 April 2008. MAIN OUTCOME MEASURES Composite adverse neonatal health outcome (respiratory morbidity, 5-minute Apgar score of <7, neonatal intensive care unit admission, mortality), postpartum haemorrhage, obstetrical wound infection, out-of-hour deliveries, length of stay, and healthcare costs. RESULTS Between 2005 and 2008, 60% (1204/2021) of low-risk planned caesarean deliveries were performed before 39 weeks of gestation. After the introduction of the policy, the proportion of planned caesareans dropped by 20 percentage points (adjusted risk difference of 20 fewer cases per 100 deliveries; 95% CI -25.8, -14.3) to 41% (1033/2518). The policy had no detectable impact on adverse neonatal outcomes (2.2 excess cases per 100; 95% CI -0.4, 4.8), maternal complications, or healthcare costs, but increased the risk of out-of-hours delivery from 16.2 to 21.1% (adjusted risk difference 6.3 per 100; 95% CI 1.6, 10.9). CONCLUSIONS We found little evidence that a hospital policy to limit planned caesareans before 39 weeks of gestation reduced adverse neonatal outcomes. Hospital administrators intending to introduce such policies should anticipate, and plan for, modest increases in out-of-hours and emergency-timing.
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Affiliation(s)
- J A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - E C Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, Montréal, QC, Canada.,Department Economics, McGill University, Montréal, QC, Canada
| | - S Harper
- Department of Epidemiology, Biostatistics and Occupational Health, Montréal, QC, Canada
| | - E Giesbrecht
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Cho Y, Carvalho B, Butwick A, Blumenfeld Y, Riley E. Elective ceasarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial. BJOG 2014; 121:1748. [PMID: 25413764 DOI: 10.1111/1471-0528.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Y Cho
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
After several decades of research, we now have evidence that at least six interventions are suitable for immediate use in contemporary clinical practice within high-resource settings and can be expected to safely reduce the rate of preterm birth. These interventions involve strategies to prevent non-medically indicated late preterm birth; use of maternal progesterone supplementation; surgical closure of the cervix with cerclage; prevention of exposure of pregnant women to cigarette smoke; judicious use of fertility treatments; and dedicated preterm birth prevention clinics. Quantification of the extent of success is difficult to predict and will be dependent on other clinical, cultural, societal, and economic factors operating in each environment. Further success can be anticipated in the coming years as other research discoveries are translated into clinical practice, including new approaches to treating intra-uterine infection, improvements in maternal nutrition, and lifestyle modifications to ameliorate maternal stress. The widespread use of human papillomavirus vaccination in girls and young women will decrease the need for surgical interventions on the cervix and can be expected to further reduce the risk of early birth. Together, this array of clinical interventions, each based on a substantial body of evidence, is likely to reduce rates of preterm birth and prevent death and disability in large numbers of children. The process begins with an acceptance that early birth is not an inevitable and natural feature of human reproduction. Preventative strategies are now available and need to be applied. The best outcomes may come from developing integrated strategies designed specifically for each health-care environment.
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Affiliation(s)
- John P Newnham
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Roger J Hart
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Craig E Pennell
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Catherine A Arrese
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Jeffrey A Keelan
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
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Vlemmix F, Bergenhenegouwen L, Schaaf JM, Ensing S, Rosman AN, Ravelli ACJ, Van Der Post JAM, Verhoeven A, Visser GH, Mol BWJ, Kok M. Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. Acta Obstet Gynecol Scand 2014; 93:888-96. [PMID: 25113411 DOI: 10.1111/aogs.12449] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 06/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. DESIGN Retrospective cohort. SETTING The Netherlands. POPULATION Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. METHOD We used data from the Dutch national perinatal registry from 1999 up to 2007. MAIN OUTCOME MEASURES Perinatal mortality and morbidity. RESULTS We studied 58,320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3 0/00 vs. 0.7 0/00;odds ratio 0.51 (95% confidence interval 0.28–0.93)], whereas it remained stable in the planned vaginal birth group [1.7 0/00 vs. 1.6 0/00; odds ratio 0.96(95% confidence interval 0.52–1.76)]. The number of cesareans done to prevent one perinatal death was 338. CONCLUSIONS Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.
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Doan E, Gibbons K, Tudehope D. The timing of elective caesarean deliveries and early neonatal outcomes in singleton infants born 37-41 weeks' gestation. Aust N Z J Obstet Gynaecol 2014; 54:340-7. [PMID: 24836174 DOI: 10.1111/ajo.12220] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/18/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Births by elective caesarean section (CS) are rising, particularly before 39 weeks' gestation, which may be associated with unacceptably high risk of adverse neonatal outcomes. The optimal timing of these deliveries needs to be determined with recent recommendations to delay births by elective CS until 39 weeks. AIMS To evaluate the association between gestational age (GA) at delivery and neonatal outcomes after elective CS between 37 and 41 weeks. MATERIALS AND METHODS Retrospective cohort study of viable singleton neonates delivered by elective CS at Mater Mothers' Hospitals (1998-2009). Neonates were stratified into two GA groups with early term (ET, 37-38 weeks) compared with the reference group of full and late term (FLT, 39-41 weeks). The primary outcome examined was serious respiratory morbidity; secondary outcomes included depression at birth, nursery admission and assisted ventilation. RESULTS Fourteen thousand and four hundred and forty-seven mother-baby pairs were included (59.9% delivered before 39 weeks). There was a significantly decreasing risk of adverse neonatal outcomes with increasing GA. Compared to FLT, delivery at ET almost tripled the risk of the primary outcome (AOR 2.74; 95% CI 1.79-4.21). Rates of most secondary outcomes were at least doubled. CONCLUSION Elective CS performed at 37-38 weeks is associated with poorer neonatal outcomes compared to those delivered at 39-41 weeks. This study supports recent recommendations to delay delivery by elective CS until week 39 if possible.
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Affiliation(s)
- Emily Doan
- School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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Amorim MM, Nakamura-Pereira M, Takemoto MLS, Knobel R, Katz L, Andreucci CB. Elective caesarean section at 38 versus 39 weeks of gestation: neonatal and maternal outcomes in a randomised controlled trial Are we trivialising neonatal intensive care unit admissions? BJOG 2014; 120:1702. [PMID: 24589005 DOI: 10.1111/1471-0528.12470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2013] [Indexed: 11/26/2022]
Affiliation(s)
- M M Amorim
- Instituto Paraibano de Pesquisa Prof. Joaquim Amorim Neto, Campina Grande, Paraíba, Brazil; Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
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Sanu O. Elective caesarean section at 38 versus 39 weeks of gestation: neonatal and maternal outcomes in a randomised controlled trial. BJOG 2014; 120:1703. [PMID: 24589008 DOI: 10.1111/1471-0528.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/29/2022]
Affiliation(s)
- O Sanu
- Department of Obstetrics and Gynaecology, West Hertfordshire Hospitals NHS Trust, Watford, UK
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Glavind J. Author's reply: elective caesarean section at 38 versus 39 weeks of gestation: neonatal and maternal outcomes in a randomised controlled trial. BJOG 2014; 120:1703-4. [PMID: 24589007 DOI: 10.1111/1471-0528.12471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Do pregnant women prefer timing of elective cesarean section prior to versus after 39 weeks of gestation? Secondary analyses from a randomized controlled trial. J Matern Fetal Neonatal Med 2014; 27:1782-6. [DOI: 10.3109/14767058.2013.879707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Randomised trial of planned caesarean section prior to versus after 39 weeks: unscheduled deliveries and facility logistics--a secondary analysis. PLoS One 2013; 8:e84744. [PMID: 24376842 PMCID: PMC3869904 DOI: 10.1371/journal.pone.0084744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 11/26/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives To compare the impact of scheduling caesarean section prior to versus after 39 completed weeks of gestation on the occurrence of unscheduled caesarean section and rescheduling of the procedure. Methods Secondary analysis from a multicentre randomised open-label trial including singleton pregnant women with a healthy foetus and a reliable due date. Women were allocated by computerized telephone randomisation to planned caesarean section at 38 weeks and three days or 39 weeks and three days. The outcomes were unscheduled deliveries with provided reasons, such as spontaneous labour onset or supervening complications, and any changes in the scheduled delivery date. Statistical analyses were according to intention-to-treat using Fisher’s exact test. Results From March 2009 to June 2011 1,274 women were included. Median difference in gestational age at delivery was six days. Compared to the 38 weeks group, the women in the 39 weeks group were more likely to have an unscheduled caesarean section (15.2% vs. 9.3%; RR 1.64, 95% CI 1.21; 2.22), to deliver between 6 pm and 8 am (10 % vs. 6%; RR 1.68, 95% CI 1.14; 2.47), or to have the procedure rescheduled (36.7% vs. 23%; RR 1.6, 95% CI 1.34;1.90). Conclusions Scheduling caesarean section after 39 weeks leads to a 60% increase in unscheduled caesarean sections and a 70% increase in delivery outside regular work hours as compared to scheduling of the procedure prior to 39 weeks. Trial Registration www.clinicaltrials.gov NCT00835003 http://www.clinicaltrials.gov/ct2/show/NCT00835003?term=NCT00835003&rank=1
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Affiliation(s)
- Julie Glavind
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Perinatal Epidemiology Research Unit, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Pediatrics, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sara Fevre Kindberg
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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