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Hoshino M, Shinozaki H, Kitahara Y, Kameda T, Hayashi K, Ogawa S, Itoh M, Iwase A. Optimal timing of elective repeat cesarean deliveries of term singleton pregnancies: A multicenter cross-sectional study. Taiwan J Obstet Gynecol 2022; 61:317-322. [PMID: 35361394 DOI: 10.1016/j.tjog.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Cesarean deliveries must be optimally timed to minimize their effects on mothers and neonates. This study aimed to determine the optimal timing of elective repeat cesarean deliveries to reduce the incidence of neonatal respiratory disorders and of emergent cesarean deliveries. MATERIALS AND METHODS This multi-center, cross-sectional, retrospective analysis evaluated data on the maternal and neonatal outcomes of 856 singleton pregnancies scheduled for elective repeat cesarean deliveries at 37-39 weeks' gestation. The emergent cesarean delivery and neonatal respiratory disorder risks were analyzed according to the scheduled cesarean delivery times. RESULTS The elective cesarean delivery rates were 91.0% during the first and 92.6% during the second half of the 37th week of gestation, 88.7% during the first and 82.9% during the second half of the 38th week of gestation, and 62.5% during the first and 33.3% during the second half of the 39th week of gestation. The neonatal respiratory disorder rates were 21.8% for elective cesarean deliveries during the first half of the 37th week of gestation and approximately 8% for elective cesarean deliveries during the second half of the 37th week until the first half of the 38th week of gestation. No neonatal respiratory disorders occurred among the babies delivered by elective cesarean deliveries during the 39th week of gestation. CONCLUSION For improved maternal and neonatal outcomes in the Asian population, it may be better to perform scheduled elective repeat cesarean deliveries from the second half of the 37th week of gestation until the 38th week of gestation following confirmation of gestational age by early first trimester ultrasonography.
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Affiliation(s)
- Masamichi Hoshino
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan; Iwajuku Clinic, 1506-3 Azami, Kasakakemachi, Midori, Gunma, 379-2311, Japan
| | - Hiromitsu Shinozaki
- Graduate School of Health Sciences, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8514, Japan.
| | - Yoshikazu Kitahara
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Takashi Kameda
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Kunihiko Hayashi
- Graduate School of Health Sciences, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8514, Japan
| | - Shota Ogawa
- Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Itoh
- Japan Community Health Care Organization, Gunma Chuo Hospital, 1 Chome-7-13 Kouncho, Maebashi, Gunma, 371-0025, Japan
| | - Akira Iwase
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
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The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome: A Prospective Cohort Study. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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] [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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McLaren R, London V, Stein JL, Minkoff H. Adverse outcomes in early term versus full-term deliveries among higher-order cesarean births. J Matern Fetal Neonatal Med 2021; 35:5464-5469. [PMID: 33550869 DOI: 10.1080/14767058.2021.1882985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In an attempt to avoid emergency deliveries of women with multiple prior scars, providers may choose to schedule those repeat cesarean births prior to 39 weeks. Our primary goal was to compare rates of assisted ventilation use between neonates with early term (37°-386 weeks) and full-term (39°-396 weeks) deliveries among women with three or more prior cesarean births. METHODS A retrospective cohort study of women with three or more previous cesarean births. The study group consisted of women who delivered at early term (37°-386 weeks). The control group consisted of women who delivered at full term (39°-396 weeks gestation). Women with a history of pre-gestational diabetes, gestational hypertension and chronic hypertension were excluded. Data were extracted from the 2017 United States Natality database. Characteristics were compared between groups for potential confounders. Primary outcome, neonatal assisted ventilation use greater than 6 h, and other secondary outcomes (including immediate assisted ventilation in the neonate and uterine rupture) were compared between groups. Multivariable logistic regression analyses were performed to adjust for potential confounding factors between groups. RESULTS A total of 28,584 women with three or more prior cesarean births were included. There were 12,391 women who delivered at early term, and 16,193 who delivered at full term. Neonates born from women who delivered at early term had an increased risk of assisted ventilation use greater than 6 h compared with neonates who delivered at full term (assisted ventilation greater than 6 h, adjusted odds ratio (aOR) 2.08, 95% confidence interval (CI) [1.59-2.73]). Neonates delivered at early term were also more likely to need immediate ventilation use than were neonates delivered at full term (aOR 1.52, 95% CI [1.33-1.73]). Women who delivered at early term had a higher rate of uterine rupture compared with women who delivered at full term (OR 5.67, 95% CI [2.33-13.79]). CONCLUSION Higher order cesarean births performed early term had an increased risk of neonatal assisted ventilation use greater than 6 h compared with full-term births. These results argue against delivering women with multiple prior uterine scars before term in an attempt to avoid emergency sections.
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Affiliation(s)
- Rodney McLaren
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Viktoriya London
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Janet L Stein
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Howard Minkoff
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA.,Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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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] [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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Breslin N, Vander Haar E, Friedman AM, Duffy C, Gyamfi-Bannerman C. Impact of timing of delivery on maternal and neonatal outcomes for women after three previous caesarean deliveries; a secondary analysis of the caesarean section registry. BJOG 2019; 126:1008-1013. [PMID: 30739400 DOI: 10.1111/1471-0528.15652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND As more women are presenting with three previous caesarean deliveries (CD), providers may suggest early term delivery as a means to avoid the risk of spontaneous labour and associated maternal morbidity. OBJECTIVE To determine whether early term delivery is associated with lower maternal and neonatal morbidity for women with three previous CD. STUDY DESIGN Secondary analysis of a prospective registry of CD at 19 US academic centres from 1999 to 2002. POPULATION Women with three previous CD undergoing scheduled or emergent delivery with live, singleton gestations 37-41+ weeks of gestation were included. Women with non-low transverse incisions, antepartum stillbirth, previous myomectomy, fetal anomalies, more or fewer than three previous CD or attempting trial of labour after caesarean section were excluded. METHODS Gestational age was categorised by week. We fitted logistic regression models to adjust for clinically relevant or statistically significant confounders. MAIN OUTCOME MEASURES The primary and secondary outcomes were composites, respectively, of maternal and neonatal morbidity. RESULTS In all, 821 women met the inclusion criteria; maternal morbidity composite occurred in 9.86% and neonatal morbidity occurred in 10.5%. After adjusting for confounding variables, maternal and neonatal morbidity occurred least frequently at 39 weeks. CONCLUSIONS In women with three previous CDs, adverse maternal outcomes do not increase with increasing gestational age beyond 37 weeks but early term elective repeat CDs are associated with higher neonatal morbidity. Elective delivery of women with three previous CD at 39 weeks of gestation is safe in the absence of maternal or fetal indications for early term delivery. TWEETABLE ABSTRACT Delivery of women with three previous caesarean deliveries at 39 weeks, in the absence of maternal or fetal indications for early term delivery, is associated with decreased maternal morbidity.
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Affiliation(s)
- N Breslin
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - E Vander Haar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - A M Friedman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - C Duffy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - C Gyamfi-Bannerman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
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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] [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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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] [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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Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis. Obstet Gynecol 2016; 129:111-119. [PMID: 27926650 DOI: 10.1097/aog.0000000000001800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of universal group B streptococci (GBS) screening in women with a singleton pregnancy planning a repeat cesarean delivery. METHODS We conducted a decision analysis from a health care perspective to compare the cost-effectiveness of GBS screening for women planning a repeat cesarean delivery. With universal screening, all GBS-positive women who labored before a scheduled cesarean delivery received antibiotic prophylaxis. With no screening, women who presented in labor received antibiotics based on risk-based criteria. Neonates born to women colonized with GBS were at risk for early-onset GBS disease, disability, and death. We assumed a GBS prevalence of 25%, that 26.6% of women labored between 35 weeks of gestation and their scheduled time for cesarean delivery, and that 3.3% who planned a repeat cesarean delivery instead delivered vaginally. The primary outcome was cost per neonatal quality-adjusted life-year gained, with a cost-effectiveness threshold of $100,000 per quality-adjusted life-year. Neonatal quality of life was assessed using five health states (healthy, mild, moderate, or severe disability, and death) with a life expectancy of 79 years for healthy neonates. One-way sensitivity and Monte Carlo analyses were used to evaluate the results. RESULTS In the base case, universal GBS screening in women planning a repeat cesarean delivery was not cost-effective compared with no screening, costing $114,445 per neonatal quality-adjusted life-year gained. The cost to prevent an adverse outcome from GBS exceeded $400,000. If greater than 28% of women were GBS-positive, greater than 29% labored before their scheduled delivery, or greater than 10% delivered vaginally, universal screening became cost effective. CONCLUSION Universal GBS screening in women with a singleton pregnancy planning a repeat cesarean delivery may not be cost-effective in all populations. However, in populations with a high GBS prevalence, women at high risk of laboring before their scheduled cesarean delivery, or women who may ultimately opt for a vaginal delivery, GBS screening may be cost effective.
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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] [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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Ganchimeg T, Nagata C, Vogel JP, Morisaki N, Pileggi-Castro C, Ortiz-Panozo E, Jayaratne K, Mittal S, Ota E, Souza JP, Mori R. Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health. PLoS One 2016; 11:e0149091. [PMID: 26866368 PMCID: PMC4750937 DOI: 10.1371/journal.pone.0149091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/27/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate optimal timing of elective repeat caesarean section among low-risk pregnant women with prior caesarean section in a multicountry sample from largely low- and middle-income countries. DESIGN Secondary analysis of a cross-sectional study. SETTING Twenty-nine countries from the World Health Organization Multicountry Survey on Maternal and Newborn Health. POPULATION 29,647 women with prior caesarean section and no pregnancy complications in their current pregnancy who delivered a term singleton (live birth and stillbirth) at gestational age 37-41 weeks by pre-labour caesarean section, intra-partum caesarean section, or vaginal birth following spontaneous onset of labour. METHODS We compared the rate of short-term adverse maternal and newborn outcomes following pre-labour caesarean section at a given gestational age, to those following ongoing pregnancies beyond that gestational age. MAIN OUTCOME MEASURES Severe maternal outcomes, neonatal morbidity, and intra-hospital early neonatal mortality. RESULTS Odds of neonatal morbidity and intra-hospital early neonatal mortality were 0.48 (95% confidence interval [CI] 0.39-0.60) and 0.31 (95% CI 0.16-0.58) times lower for ongoing pregnancies compared to pre-labour caesarean section at 37 weeks. We did not find any significant change in the risk of severe maternal outcomes between pre-labour caesarean section at a given gestational age and ongoing pregnancies beyond that gestational age. CONCLUSIONS Elective repeat caesarean section at 37 weeks had higher risk of neonatal morbidity and mortality compared to ongoing pregnancy, however risks at later gestational ages did not differ between groups.
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Affiliation(s)
- Togoobaatar Ganchimeg
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Chie Nagata
- Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
- * E-mail:
| | - Joshua P. Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Cynthia Pileggi-Castro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Suneeta Mittal
- Department of Obstetrics & Gynecology, Fortis Memorial Research Institute, Gurgaon, India
| | - Erika Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Schemann K, Patterson JA, Nippita TA, Ford JB, Roberts CL. Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study. BMC Pregnancy Childbirth 2015; 15:179. [PMID: 26285692 PMCID: PMC4545707 DOI: 10.1186/s12884-015-0609-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internationally, repeat caesarean sections make the largest contribution to overall caesarean section rates and inter-hospital variation has been reported. The aim of this study was to determine if casemix and hospital factors explain variation in hospital rates of repeat caesarean sections and whether these rates are associated with maternal and neonatal morbidity. METHODS This population-based record linkage study utilised data from New South Wales, Australia between 2007 and 2011. The study population included maternities with any previous caesarean section(s) and were singleton, cephalic and ≥ 37 weeks' gestation (Robson Group 5). Multilevel regression models were used to examine variation in hospital rates of 'planned repeat caesarean section' and, among women who planned a vaginal birth, 'intrapartum caesarean section'. We assessed associations between risk-adjusted hospital rates of planned and intrapartum caesarean sections and rates of casemix adjusted maternal and neonatal morbidity, postpartum haemorrhage and Apgar score <7 at five minutes. RESULTS Of 61894 maternities with a previous caesarean section in 81 hospitals, 82.1% resulted in a caesarean section (72.7% planned and 9.4% unplanned intrapartum caesareans) and 17.9% in vaginal birth. Observed hospital rates of planned caesarean sections ranged from 50.7% to 98.4%. Overall 49.0% of between-hospital variation in planned repeat caesarean section rates was explained by patient (17.3%) and hospital factors (31.7%). Increased odds of planned caesarean section were associated with private hospital status and lower hospital propensity for vaginal birth after caesarean. There were no associations between hospital rates of planned repeat caesarean section and adjusted morbidity rates. Among women who intended a vaginal birth, the observed rates of intrapartum caesarean section ranged from 12.9% to 71.9%. In total, 27.5% of between-hospital variation in rates of intrapartum caesarean section was explained by patient (19.5%) and hospital factors (8.0%). The adjusted morbidity rates differed among hospital intrapartum caesarean section rates, but were influenced by a few hospitals with outlying morbidity rates. CONCLUSIONS Among women with at least one previous caesarean section, less than half of the variation in hospital caesarean section rates was explained by differences in hospital's patient characteristics and practices. Strategies aimed at modifying caesarean section rates for these women should not affect morbidity rates.
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Affiliation(s)
- Kathrin Schemann
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. .,NSW Biostatistics Training Program, NSW Ministry of Health, North Sydney, NSW, 2060, Australia.
| | - Jillian A Patterson
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Tanya A Nippita
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. .,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.
| | - Jane B Ford
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Christine L Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
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