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Rimsza RR, Frolova AI, Kelly JC, Carter EB, Cahill AG, Raghuraman N. Intrapartum electronic fetal monitoring features associated with a clinical diagnosis of nonreassuring fetal status. Am J Obstet Gynecol MFM 2023; 5:101068. [PMID: 37380056 DOI: 10.1016/j.ajogmf.2023.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Nonreassuring fetal status detected by continuous electronic fetal monitoring accounts for almost 1 in 4 primary cesarean deliveries. However, given the subjective nature of the diagnosis, there is a need to identify the electronic fetal monitoring patterns that are clinically considered nonreassuring. OBJECTIVE This study aimed to describe which electronic fetal monitoring features are most commonly associated with first-stage cesarean delivery for nonreassuring fetal status, and to evaluate the risk of neonatal acidemia following cesarean delivery for nonreassuring fetal status. STUDY DESIGN This was a nested case-control study in a prospectively collected cohort of patients with singleton pregnancies at ≥37 weeks' gestation, admitted in spontaneous labor or for induction of labor from 2010 to 2014 at a single tertiary care center. Patients with preterm pregnancies, multiple gestations, planned cesarean delivery, or nonreassuring fetal status in the second stage of labor were excluded. Cases were identified as having nonreassuring fetal status on the basis of what was documented in the operative note by the delivering physician. Controls were patients without nonreassuring fetal status within 1 hour of delivery. Cases were matched to controls in a 1:2 ratio by parity, obesity, and history of cesarean delivery. Electronic fetal monitoring data were abstracted by credentialed obstetrical research nurses for the 60 minutes before delivery. The primary exposure of interest was the incidence of high-risk category II electronic fetal monitoring features in the 60 minutes before delivery; in particular, the incidence of minimal variability, recurrent late decelerations, recurrent variable decelerations, tachycardia, and >1 prolonged deceleration were compared between groups. We also compared neonatal outcomes between cases and controls, including fetal acidemia (umbilical artery pH <7.1), other umbilical artery gas analytes, and neonatal and maternal outcomes. RESULTS Of the 8580 patients in the parent study, 714 (8.3%) underwent cesarean delivery for nonreassuring fetal status in the first stage of labor. Patients diagnosed with nonreassuring fetal status requiring cesarean delivery were more likely to have recurrent late decelerations, >1 prolonged deceleration, and recurrent variable decelerations compared with controls. More than 1 prolonged deceleration was associated with 6 times increased rate of nonreassuring fetal status diagnosis resulting in cesarean delivery (adjusted odds ratio, 6.73 [95% confidence interval, 2.47-8.33]). Rates of fetal tachycardia were similar between groups. Minimal variability was less common in the nonreassuring fetal status group compared with controls (adjusted odds ratio, 0.36 [95% confidence interval, 0.25-0.54]). Compared with control deliveries, cesarean delivery for nonreassuring fetal status was associated with nearly 7 times higher risk of neonatal acidemia (7.2% vs 1.1%; adjusted odds ratio, 6.93 [95% confidence interval, 3.83-12.54]). Composite neonatal morbidity and composite maternal morbidity were more likely among patients delivered for nonreassuring fetal status in the first stage (3.9% vs 1.1%; adjusted odds ratio, 5.70 [2.60-12.49]; and 13.3% vs 8.0%; adjusted odds ratio, 1.99 [1.41-2.80]). CONCLUSION Although multiple category II electronic fetal monitoring features have been traditionally linked to acidemia, the presence of recurrent late decelerations, recurrent variable decelerations, and prolonged decelerations seemed to concern obstetricians enough to surgically intervene for nonreassuring fetal status. A clinical intrapartum diagnosis of nonreassuring fetal status in the setting of these electronic fetal monitoring features is also associated with increased risk of acidemia, suggesting clinical validity to the diagnosis of nonreassuring fetal status.
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Affiliation(s)
- Rebecca R Rimsza
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Rimsza, Frolova, Kelly, Carter, and Raghuraman).
| | - Antonina I Frolova
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Rimsza, Frolova, Kelly, Carter, and Raghuraman)
| | - Jeannie C Kelly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Rimsza, Frolova, Kelly, Carter, and Raghuraman)
| | - Ebony B Carter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Rimsza, Frolova, Kelly, Carter, and Raghuraman)
| | - Alison G Cahill
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dell Medical School, The University of Texas at Austin, Austin, TX (Dr Cahill)
| | - Nandini Raghuraman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Rimsza, Frolova, Kelly, Carter, and Raghuraman)
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Chen X, Gao J, Liu J, Hu J, Li S, Tang Y, Zhong M, He J, Liao S, Yang J, Liu X, Wang X, Liu X, Liu X, Cao Y, Wang T, Liu C, Sun J. Previous mode of delivery affects subsequent pregnancy outcomes: a Chinese birth register study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1135. [PMID: 34430576 PMCID: PMC8350719 DOI: 10.21037/atm-20-8127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/07/2021] [Indexed: 11/06/2022]
Abstract
Background With the comprehensive implementation of the second child policy in China, the proportion of multiparous women has increased dramatically in the past few years. As nearly half of them have a history of previous cesarean delivery, there is widespread concern regarding complications of their pregnancy. Methods The aim of this study was to evaluate the effect of the previous delivery mode on subsequent pregnancy outcomes in the real world based on data from a Chinese birth registry. Birth registry data from July 1, 2016 to June 30, 2017 among a Chinese population were collected and analyzed retrospectively. This study included 14 representative hospitals from 10 provinces of China. All delivery data were collected by an internet-based system using a birth registration platform. The study enrolled 36,355 multiparas. Information extracted for analysis included basic demographic characteristics, previous delivery mode, current delivery mode, major maternal complications, and neonatal outcomes. Pregnancy outcomes of women with previous cesarean delivery (PCS group, n=14,774) were compared with the outcomes of women with previous vaginal delivery (PVD group, n=21,581). Results There were statistically significant differences in the major pregnancy outcomes between the PCS group and the PVD group. The PCS group had a higher incidence of cesarean section (CS), placenta previa, postpartum hemorrhage, uterus rupture, hysterectomy, gestational diabetes, gestational hypertension, delivery before 37 weeks of gestation, low birth weight, and Apgar Score at 5 min ≤3. Conclusions Women with previous cesarean delivery had poorer pregnancy outcomes than women with previous vaginal delivery. Avoiding unnecessary CS, especially in primiparas is essential to improving maternal and neonatal outcomes in later pregnancies.
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Affiliation(s)
- Xiaoxu Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Jinsong Gao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Juntao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Jing Hu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Sijian Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Yabin Tang
- Department of Obstetrics and Gynecology, Hunan Maternal and Child Health Care Hospital, Changsha, China
| | - Mei Zhong
- Department of Obstetrics and Gynecology, Nanfang Hospital Southern Medical University, Guangzhou, China
| | - Jing He
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Sibiu Liao
- Department of Obstetrics and Gynecology, Provincial People's Hospital, Zhengzhou, China
| | - Jimmying Yang
- Department of Obstetrics and Gynecology, Harbin Nangang District Maternity Hospital, Harbin, China
| | - Xiaowei Liu
- Department of Obstetrics and Gynecology, Beijing Obstetrics and Gynecology Hospital Capital Medical University, Beijing, China
| | - Xietong Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaohong Liu
- Department of Obstetrics and Gynecology, Beijing Haidian Maternal and Child Health Hospital, Beijing, China
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, Sichuan University West China Second Hospital, Chengdu, China
| | - Yinli Cao
- Department of Obstetrics and Gynecology, Northwest Women and Children's Hospital, Xi'an, China
| | - Tianyun Wang
- Department of Obstetrics and Gynecology, Ruijin Maternal and Child Health Hospital, Shanghai, China
| | - Caixia Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, China
| | - Jingxia Sun
- Department of Obstetrics and Gynecology, The First Clinical Hospital Affiliated to Harbin Medical University, Harbin, China
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Stephens AJ, Chen HY, Chauhan SP, Sibai B. Association of Cerclage with Composite Adverse Outcomes among Women Delivered at 36 Weeks or Later. Am J Perinatol 2020; 37:1400-1410. [PMID: 32521562 DOI: 10.1055/s-0040-1712962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aimed to compare the maternal and neonatal adverse outcomes among singletons delivered at 36 weeks or later with cerclage during index pregnancy versus those without cerclage. STUDY DESIGN This retrospective cohort study utilized the U.S. vital statistics datasets from 2011 to 2013. Inclusion criteria were women with nonanomalous singletons, with and without cerclage placement, without diabetes or hypertensive disorders, and delivered at 36 to 41 weeks. The coprimary outcomes were composite maternal and neonatal adverse outcomes. Composite maternal adverse outcome included admission to intensive care unit, maternal transfusion, ruptured uterus, unplanned hysterectomy, or unplanned operating room procedure. Composite neonatal adverse outcome included Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, neonatal seizure, birth injury, or neonatal death. Secondary outcomes were chorioamnionitis and cesarean delivery. Multivariable Poisson's regression models with error variance were used while adjusting for confounders. Adjusted relative risk (aRR) with 95% confidence intervals (CIs) were calculated. RESULTS Of the 8,508,228 women who met inclusion criteria, 0.2% had a cerclage and reached 36 weeks. Composite maternal (aRR: 2.04; 95% CI: 1.76-2.36) and neonatal (aRR: 1.28; 95% CI: 1.11-1.47) adverse outcomes were significantly higher among those with cerclage than those without cerclage. Chorioamnionitis (aRR: 1.47; 95% CI: 1.30-1.67) and cesarean delivery (aRR: 1.10; 95% CI: 1.08-1.12) were also significantly higher in women with cerclage than those without cerclage. CONCLUSION There is an association between increased composite maternal and neonatal adverse outcomes among women with cerclage who delivered at 36 to 41 weeks as compared with those without cerclage. KEY POINTS · Cerclage is associated with increased composite maternal adverse outcome in women at 36-41 weeks.. · Cerclage is associated with increased composite neonatal adverse outcome in women at 36-41 weeks.. · Increased chorioamnionitis and cesarean delivery rates are associated with cerclage in women at 36-41 weeks..
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Affiliation(s)
- Angela J Stephens
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Han-Yang Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Baha Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Mariani GL, Vain NE. The rising incidence and impact of non-medically indicated pre-labour cesarean section in Latin America. Semin Fetal Neonatal Med 2019; 24:11-17. [PMID: 30291045 DOI: 10.1016/j.siny.2018.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the poorest populations of the world the difficulties of performing a surgical procedure lead to extremely low cesarean section rates associated with very high perinatal mortality. Meanwhile the proportion of births by cesarean section has been increasing for several decades in many areas of the world, reaching alarmingly high rates especially in Latin America. This review aims to describe this secular trend. The causes of the increase in cesarean deliveries are analyzed with a multidimensional approach, trying to recognize the reasons behind the choice of the route of delivery. We are facing a shift in the guiding paradigm, leaving the classical biomedical one. Advantages and disadvantages of non-medically indicated cesarean section are being sought, comparing it with the results of vaginal delivery, with special emphasis on the short- and long-term morbidity of the newborn. Several variables involved in this controversial topic are considered, with the objective of stimulating critical thoughts about the medical, bioethical and social aspects of the increasing trend in the cesarean section rate.
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Affiliation(s)
- Gonzalo L Mariani
- Division of Neonatology, Italian Hospital, Buenos Aires, Argentina; Neonatology Training Program, University Institute Italian Hospital, Buenos Aires, Argentina.
| | - Nestor E Vain
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Departments of Pediatrics and Newborn Medicine, Hospital Sanatorio Trinidad, Buenos Aires, Argentina; Fundasamin, Foundation for Maternal Infant Health, Buenos Aires, Argentina
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Asoglu MR, Bears B, Turan S, Harman C, Turan OM. The factors associated with mode of delivery in fetuses with congenital heart defects. J Matern Fetal Neonatal Med 2018; 33:816-824. [PMID: 30153755 DOI: 10.1080/14767058.2018.1505855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: It is not evident whether the mode of delivery (MOD) should be modified in pregnancies complicated by fetal congenital heart defects (CHDs). The question as to whether MOD of CHD infants has a significant impact on neonatal outcome remains elusive. The aim of this study was to evaluate factors associated with MOD and its impact on immediate neonatal outcomes in a cohort of late preterm or term fetuses with CHDs born in a tertiary center.Methods: This retrospective study comprised of singleton pregnancies with known fetal CHDs who delivered after 34 0/7 weeks of gestation over a 7-year period. Fetuses with chromosomal abnormality or stillbirths were excluded. Obstetric risk factors were classified as maternal medical, maternal surgical or fetal comorbidities. MOD was classified as elective cesarean delivery (CD) or attempted vaginal delivery (VD). The latter was further categorized as successful VD or intrapartum CD. The study population was stratified into four categories based on the severity of cardiac abnormalities diagnosed by fetal echocardiography. Immediate neonatal outcomes included Apgar scores and umbilical cord artery pH.Results: Of a total of 222 patients, 79.8% underwent attempted VD and 20.2% had elective CD. Of the attempted VD group, 80.2% had successful VD and 19.8% had intrapartum CD. The frequencies of maternal medical, maternal surgical and fetal comorbidities were higher in the elective CD group than in the attempted VD group and also were higher in the intrapartum CD group than in the successful VD group (p < .05 for all). Multivariate logistic regression models revealed that maternal surgical or fetal comorbidities increased the chance of elective CD and maternal medical or fetal comorbidities decreased the chance of successful VD. The severity of CHDs was not an independent factor that affected MOD. Elective or intrapartum CD did not improve immediate neonatal outcomes.Conclusion: Our results demonstrated that preexisting obstetric comorbidities were significant variables that affected the MOD in fetuses with CHD. Vaginal delivery should be attempted unless obstetric and medical contraindications accompany index pregnancy.
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Affiliation(s)
- Mehmet Resit Asoglu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Breanne Bears
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sifa Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher Harman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ozhan M Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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Hu HT, Xu JJ, Lin J, Li C, Wu YT, Sheng JZ, Liu XM, Huang HF. Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth 2018; 18:273. [PMID: 29954355 PMCID: PMC6027796 DOI: 10.1186/s12884-018-1895-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/12/2018] [Indexed: 01/07/2023] Open
Abstract
Background Few studies have explored the association between a previous caesarean section (CS) and adverse perinatal outcomes in a subsequent pregnancy, especially in women who underwent a non-indicated CS in their first delivery. We designed this study to compare the perinatal outcomes of a subsequent pregnancy in women who underwent spontaneous vaginal delivery (SVD) or CS in their first delivery. Methods This retrospective cohort study included women who underwent singleton deliveries at the International Peace Maternity and Child Health Hospital from January 2013 to December 2016. Data on the perinatal outcomes of all the women were extracted from the medical records. Multivariate logistic regression was conducted to assessed the association between CS in the first delivery and adverse perinatal outcomes in the subsequent pregnancy. Results CS delivery in the subsequent pregnancy was more likely for women who underwent CS in their first birth than for women with previous SVD (97.3% versus 13.2%). CS in the first birth was also associated with a significantly increased risk of adverse outcomes in the subsequent pregnancy, especially in women who underwent a non-indicated CS. Adverse perinatal outcomes included pregnancy-induced hypertension [adjusted odds ratio (OR), 95% confidence interval (CI): 2.20, 1.59–3.05], gestational diabetes mellitus (1.82, 1.57–2.11), gestational anaemia (1.27, 1.05–1.55), placenta previa (3.18, 2.15–4.71), placenta accreta (2.75, 1.75–4.31), and polyhydramnios (2.60, 1.57–4.31) in the mother and preterm delivery (1.37, 1.06–1.78), low birth weight (3.78, 2.07–6.90), macrosomia (5.04, 3.95–6.44), and neonatal jaundice (1.72, 1.39–2.14) in the baby. Conclusions CS in the first delivery markedly increases the risk of repeated CS and maternal-fetal complications in the subsequent pregnancy, especially in women with a non-indicated CS.
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Affiliation(s)
- Hong-Tao Hu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing-Jing Xu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Lin
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Li
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan-Ting Wu
- Department of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Zhong Sheng
- Department of Pathology and Pathophysiology, School of Medicine, Zhejiang University, Zhejiang, China
| | - Xin-Mei Liu
- Institute of Embryo-Fetal Original Adult Disease, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.
| | - He-Feng Huang
- Department of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,Institute of Embryo-Fetal Original Adult Disease, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.
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Allen VM, Baskett TF, Allen AC, Burrows J, Vincer M, O'Connell CM. Type of Labour in the First Pregnancy and Cumulative Perinatal Morbidity. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:804-810. [PMID: 27670705 DOI: 10.1016/j.jogc.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To estimate cumulative perinatal morbidity among infants delivered at term, according to the type of labour in the first pregnancy, when the first pregnancy was low risk. METHODS In a 26-year population-based cohort study (1988-2013) using the Nova Scotia Atlee Perinatal Database, we identified the type of labour in successive pregnancies in low-risk, nulliparous women at term in their first pregnancy (who had at least one subsequent pregnancy), and also identified perinatal outcomes in subsequent deliveries according to the type of labour in the first pregnancy. RESULTS A total of 37 756 pregnancies satisfied inclusion and exclusion criteria; of these, 1382 (3.7%) had a Caesarean section without labour in the first pregnancy. Rates of most adverse perinatal outcomes were low (≤ 1%). The risks for stillbirth were low in subsequent deliveries, including those that followed CS without labour in the first pregnancy, and the risks for the overall severe perinatal morbidity outcome were less than 10% for all subsequent deliveries. CONCLUSION The absolute risks for severe perinatal morbidity outcomes in a population of low-risk women (with up to four additional pregnancies) were small, regardless of type of labour in the first pregnancy. This finding provides important information on perinatal outcomes in subsequent pregnancies when considering type of labour in the first pregnancy.
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Affiliation(s)
- Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - Thomas F Baskett
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS
| | - Alexander C Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax NS; Department of Pediatrics, Dalhousie University, Halifax NS; Perinatal Epidemiology Research Unit, Dalhousie University, Halifax NS
| | - Jason Burrows
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Michael Vincer
- Department of Pediatrics, Dalhousie University, Halifax NS
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Landis BJ, Levey A, Levasseur SM, Glickstein JS, Kleinman CS, Simpson LL, Williams IA. Prenatal diagnosis of congenital heart disease and birth outcomes. Pediatr Cardiol 2013; 34:597-605. [PMID: 23052660 PMCID: PMC3647457 DOI: 10.1007/s00246-012-0504-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/26/2012] [Indexed: 11/26/2022]
Abstract
This study was undertaken to examine the impact that prenatal diagnosis of congenital heart disease (CHD) has on birth and early neonatal outcomes. The prevalence of prenatally diagnosed CHD has risen over the past decade, but the effect that prenatal diagnosis of CHD has on peripartum decisions remains unclear. No consensus exists on the effect of prenatal diagnosis on neonatal outcomes. Between January 2004 and July 2009, a retrospective chart review of all neonates with CHD admitted to our institution's neonatal intensive care unit was conducted. Obstetric and postnatal variables were collected. Among the 993 subjects, 678 (68.3%) had a prenatal diagnosis. A prenatal diagnosis increased the odds of a scheduled delivery [odds ratio (OR) 4.1, 95% confidence interval (CI) 3.0-5.6] and induction of labor (OR 11.5, 95% CI 6.6-20.1). Prenatal diagnosis was not significantly associated with cesarean delivery when control was used for maternal age, multiple gestation, and presence of extracardiac anomaly. Mean gestational age had no impact on prenatal diagnosis, but prenatal diagnosis was associated with increased odds of delivery before a gestational age of 39 weeks (OR 1.5, 95% CI 1.1-1.9) and decreased odds of preoperative intubation (OR 0.5, 95% CI 0.3-0.6). Prenatal diagnosis did not have an impact on preoperative or predischarge mortality. Prenatal diagnosis was associated with increased odds of a scheduled delivery, birth before a gestational age of 39 weeks, and a decreased need for invasive respiratory support. Prenatal diagnosis of CHD was not associated with preoperative or predischarge mortality.
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Affiliation(s)
- Benjamin J Landis
- Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
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Bergmann RL. Acute neonatal respiratory morbidity after prior cesarean. J Perinat Med 2011; 39:615. [PMID: 21767222 DOI: 10.1515/jpm.2011.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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