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Vilchez G, Hoyos LR, Maldonado MC, Lagos M, Kruger M, Bahado-Singh R. Risk of neonatal mortality according to gestational age after elective repeat cesarean delivery. Arch Gynecol Obstet 2015; 294:77-81. [DOI: 10.1007/s00404-015-3955-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
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Three-Dimensional Power Doppler Ultrasonography for Diagnosing Abnormally Invasive Placenta and Quantifying the Risk. Obstet Gynecol 2015. [PMID: 26214694 DOI: 10.1097/aog.0000000000000962] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test an objective ultrasound marker for diagnosing the presence and severity of abnormally invasive placenta. METHODS Women at risk of abnormally invasive placenta underwent a three-dimensional power Doppler ultrasound scan. The volumes were examined offline by a blinded observer. The largest area of confluent three-dimensional power Doppler signal (Area of Confluence [Acon], cm) at the uteroplacental interface was measured and compared in women subsequently diagnosed with abnormally invasive placenta and women in a control group who did not have abnormally invasive placenta. Receiver operating characteristic curves were plotted for prediction of abnormally invasive placenta and abnormally invasive placenta requiring cesarean hysterectomy. RESULTS Ninety-three women were recruited. Results were available for 89. Abnormally invasive placenta was clinically diagnosed in 42 women; 36 required hysterectomy and had abnormally invasive placenta confirmed histopathologically. Median and interquartile range for Acon was greater for abnormally invasive placenta (44.2 [31.4-61.7] cm) compared with women in the control group (4.5 cm [2.9-6.6], P<.001) and even greater in the 36 requiring hysterectomy (46.6 cm [37.2-72.6], P<.001). Acon rose with histopathologic diagnosis: focal accreta (32.2 cm [17.2-57.3]), accreta (59.6 cm [40.1-89.9]), and percreta (46.6 cm [37.5-71.5]; P<.001 analysis of variance for linear trend). Receiver operating characteristic analysis for prediction of abnormally invasive placenta revealed that with an Acon of 12.4 cm or greater, 100% sensitivity (95% confidence interval [CI] 91.6-100) could be obtained with 92% specificity (95% CI 79.6-97.6); area under the curve is 0.99 (95% CI 0.94-1.0). For prediction of abnormally invasive placenta requiring hysterectomy, 100% sensitivity (95% CI 90.3-100) can be obtained with an Acon of 17.4 cm or greater with 87% specificity (95% CI 74.7-94.5; area under the curve 0.98 [0.93-1.0]). CONCLUSION The marker Acon provides a quantitative means for diagnosing abnormally invasive placenta and assessing severity. If further validated, subjectivity could be eliminated from the diagnosis of abnormally invasive placenta. LEVEL OF EVIDENCE II.
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Nakimuli A, Nakubulwa S, Kakaire O, Osinde MO, Mbalinda SN, Nabirye RC, Kakande N, Kaye DK. Incidence and determinants of neonatal morbidity after elective caesarean section at the national referral hospital in Kampala, Uganda. BMC Res Notes 2015; 8:624. [PMID: 26518174 PMCID: PMC4628293 DOI: 10.1186/s13104-015-1617-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 10/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elective caesarean sections (ECS) have been implicated in increased risk of adverse neonatal outcomes. The primary objective was to assess the incidence and determinants of neonatal morbidity after elective caesarean section deliveries. The secondary objective was to describe the maternal morbidity associated with elective caesarean section. METHODS This was a prospective cohort study of women admitted for ECS, as well as their newborns, conducted at Mulago hospital from March 1, 2013 to February 28, 2014. These were followed from the time of the operation until 6 weeks after hospitalization following the caesarean delivery. Data was collected using an interviewer-administered questionnaire and review of medical records for demographic characteristics, obstetric history, current pregnancy complications and pregnancy outcomes up to hospital discharge. Study outcomes were maternal and neonatal morbidity. The data was analyzed using Stata version 12. RESULTS There were 25,846 deliveries during the study period, of which 20,083 (77.7%) were vaginal deliveries or assisted deliveries, and 5763 (22.3%) were caesarean sections. Of the caesarean sections, 920 (15.9%) were ECS. The commonest maternal morbidity was hemorrhage (17.2%). A birth weight less than 2500 g (aRR 11.0 [95% CI 8.1-17.2]) or more than 4000 g (aRR 12.2 [95% CI 10.6-23.2]), delivery at gestation age less than or equal to 38 weeks (aRR 1.62 [95% 1.20-2.10]), multigravidity (aRR 1.70 [95% CI 1.20-2.90]) and using general anaesthesia (aRR 2.43 [95% CI 1.20-5.90]) were associated with risk of neonatal morbidity. The commonest neonatal morbidity is respiratory distress especially if delivery occurs at a gestation age of 37 weeks or lower, if the birth weight is less than 2500 g or more than 4000 g, and if general anesthesia is used. CONCLUSION Our study shows that at Mulago Hospital, ECS is associated with significant neonatal and maternal morbidity. We recommend that elective caesarean sections be performed after 39 weeks of gestation, and preferably avoid using general anaesthesia.
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Affiliation(s)
- Annettee Nakimuli
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Sarah Nakubulwa
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Othman Kakaire
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Michael O Osinde
- Department of Obstetrics and Gynecology, Jinja Regional Hospital, Jinja, Uganda.
| | - Scovia N Mbalinda
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Rose C Nabirye
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Nelson Kakande
- Joint Clinical Research Centre, Clinical, Operations and Health Services Research Program, P. O. Box 10005, Kampala, Uganda.
| | - Dan K Kaye
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
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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] [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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Senturk MB, Cakmak Y, Gündoğdu M, Polat M, Atac H. Does performing cesarean section after onset of labor has positive effect on neonatal respiratory disorders? J Matern Fetal Neonatal Med 2015; 29:2457-60. [PMID: 26381371 DOI: 10.3109/14767058.2015.1087499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate whether neonatal respiratory disorders relate to the onset of labor or labor pain in patients with history of previous cesarean section. METHODS This prospective controlled study comprised 164 patients, grouped according to the presence of labor and related labor pain. All patients in both groups were applied cesarean section at 38 weeks gestational age or beyond due to previous cesarean section. The cord blood pH, Apgar scores and the need for the neonatal intensive care unit were compared. RESULTS There was a greater need for the neonatal intensive care unit in the control group and the cord blood pH values were higher in the study group (p < 0.05). No significant difference was determined between the groups in respect of Apgar scores (p > 0.05). CONCLUSION The onset of labor and related labor pain provide a positive contribution to a reduction in neonatal respiratory disorders. Therefore, it can be considered reasonable to perform a cesarean section after the onset of labor or related pain.
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Affiliation(s)
- Mehmet B Senturk
- a Departments of Obstetrics and Gynecology , Zeynep Kamil Teaching and Research Hospital , Uskudar , İstanbul , Turkey
| | - Yusuf Cakmak
- b Department of Obstetrics and Gynecology , Batman State Hospital , Zıya Gokalp District , Batman , Turkey
| | - Mustafa Gündoğdu
- b Department of Obstetrics and Gynecology , Batman State Hospital , Zıya Gokalp District , Batman , Turkey
| | - Mesut Polat
- a Departments of Obstetrics and Gynecology , Zeynep Kamil Teaching and Research Hospital , Uskudar , İstanbul , Turkey
| | - Halit Atac
- b Department of Obstetrics and Gynecology , Batman State Hospital , Zıya Gokalp District , Batman , Turkey
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Silva LG, Portari GV, Lúcio CF, Rodrigues JA, Veiga GL, Vannucchi CI. The influence of the obstetrical condition on canine neonatal pulmonary functional competence. J Vet Emerg Crit Care (San Antonio) 2015; 25:725-30. [DOI: 10.1111/vec.12368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/07/2014] [Accepted: 07/23/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Liege Garcia Silva
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science; University of São Paulo; São Paulo Brazil
| | | | - Cristina Fátima Lúcio
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science; University of São Paulo; São Paulo Brazil
| | - Jaqueline Aguiar Rodrigues
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science; University of São Paulo; São Paulo Brazil
| | - Gisele Lima Veiga
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science; University of São Paulo; São Paulo Brazil
| | - Camila Infantosi Vannucchi
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science; University of São Paulo; São Paulo Brazil
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Abstract
PURPOSE OF REVIEW To provide an overview of the literature regarding medical and developmental risks for moderate to late preterm infants (32-36 weeks gestation), with particular attention to the pediatrician's role in care during both inpatient and outpatient periods. RECENT FINDINGS Although the risks of medical issues and developmental delays decrease with increasing gestational age, research suggests that infants born after 32 weeks' gestation often exhibit significant morbidities associated with prematurity. These infants, often referred to as 'macro preemies', have been found to be at a greater risk for medical complications secondary to immature organ systems including impairments in temperature regulation, respiratory functioning, feeding coordination, bilirubin excretion, glucose control, and infection susceptibility. Recent studies of macro preemies also suggest a higher incidence of significant deficits noted in gross and fine motor skills, speech and communication, and learning and behavior compared to their full-term counterparts. Without careful attention from birth, macro preemie infants could be susceptible to both medical issues and developmental delays. SUMMARY Physicians should be aware of the research regarding increased medical and developmental risks for all infants born before term in order to provide their patients with comprehensive medical and neurodevelopmental follow-up care.
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Grace L, Greer RM, Kumar S. Perinatal consequences of a category 1 caesarean section at term. BMJ Open 2015; 5:e007248. [PMID: 26224015 PMCID: PMC4521509 DOI: 10.1136/bmjopen-2014-007248] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To characterise maternal demographics, obstetric risk factors and neonatal outcomes associated with term category 1 caesarean sections (CS). DESIGN AND SETTING AND MAIN OUTCOME MEASURES Retrospective study of term singleton pregnancies delivering at a major tertiary unit in Brisbane, Australia. Category 1 CS were defined as one that required a decision-to-delivery time interval of <30 min when there was an immediate threat to the life of a woman or fetus. Neonatal outcomes analysed were gestation at delivery, birth weight, Apgar scores, acidosis at birth, need for resuscitation, admission to neonatal intensive care and neonatal seizures and death. RESULTS A total of 30,719 women delivering at term were included. Of these, 1179 (3.8%) women required a category 1 CS. A further 3527 women underwent non-category 1 CS. Most category 1 CS were performed for non-reassuring fetal status (65.9%, 777/1179). The indications for non-category 1 CS were for failure to progress (46.5%, 1641/3527) and non-reassuring fetal status (19%, 671/3527). Maternal age, body mass index and medical disease did not differ significantly between the two cohorts. Caucasian women were equally as likely to undergo a category 1 CS as a non-category 1 CS, while indigenous women and women of Asian ethnicity were more likely to undergo a category 1 CS. Significantly higher (p<0.001) perinatal complications were seen in the category 1 CS cohort--Apgar scores <7 at 1 min (20.4%, 241/1179 vs 10.7%, 377/3527) and 5 min (5.8%, 68/1179 vs 1.9%, 67/3527), umbilical arterial pH<7.2 (23.7%, 279/1179 vs 9.1%, 321/3527), neonatal resuscitation (59.9%, 706/1179 vs 51.8%, 1828/3527), neonatal intensive care unit admission (9.8%, 116/1179 vs 2.5%, 87/3527) and seizures (0.8%, 10/1179 vs 0.3%, 9/3527), respectively. CONCLUSIONS These results demonstrate significantly poorer outcomes associated with term category 1 CS compared with non-category 1 emergency CS.
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Affiliation(s)
- Leah Grace
- Mater Mothers’ Hospital, South Brisbane, Queensland, Australia
| | - Ristan M Greer
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Mothers’ Hospital, South Brisbane, Queensland, Australia
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
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Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:489-95. [PMID: 26249251 PMCID: PMC4555060 DOI: 10.3238/arztebl.2015.0489] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rates of cesarean section have risen around the world in recent years. Accordingly, much effort is being made worldwide to understand this trend and to counteract it effectively. A number of factors have been found to make it more likely that a cesarean section will be chosen, but the risks cannot yet be clearly defined. METHODS This review is based on pertinent publications that were retrieved by a selective search in the PubMed, Scopus, and DIMDI databases, as well as on media communications, analyses by the German Federal Statistical Office, and guidelines of the Association of Scientific Medical Societies in Germany (AWMF). RESULTS The increased rates of cesarean section are thought to be due mainly to changed risk profiles both for expectant mothers and for their yet unborn children, as well as an increase in cesarean section by maternal request. In 1991, 15.3% of all newborn babies in Germany were delivered by cesarean section; by 2012, the corresponding figure was 31.7%, despite the fact that a medical indication was present in less than 10% of all cases. This development may perhaps be explained by an increasing tendency toward risk avoidance, by risk-adapted obstetric practice, and increasing media attention. The intraoperative and postoperative risks of cesarean section must be considered, along with complications potentially affecting subsequent pregnancies. CONCLUSION Scientific advances, social and cultural changes, and medicolegal considerations seem to be the main reasons for the increased acceptibility of cesarean sections. Cesarean section is, however, associated with increased risks to both mother and child. It should only be performed when it is clearly advantageous.
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Affiliation(s)
- Ioannis Mylonas
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-Universität München
| | - Klaus Friese
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-Universität München
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Boulvain M, Senat MV, Perrotin F, Winer N, Beucher G, Subtil D, Bretelle F, Azria E, Hejaiej D, Vendittelli F, Capelle M, Langer B, Matis R, Connan L, Gillard P, Kirkpatrick C, Ceysens G, Faron G, Irion O, Rozenberg P. Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. Lancet 2015; 385:2600-5. [PMID: 25863654 DOI: 10.1016/s0140-6736(14)61904-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Macrosomic fetuses are at increased risk of shoulder dystocia. We aimed to compare induction of labour with expectant management for large-for-date fetuses for prevention of shoulder dystocia and other neonatal and maternal morbidity associated with macrosomia. METHODS We did this pragmatic, randomised controlled trial between Oct 1, 2002, and Jan 1, 2009, in 19 tertiary-care centres in France, Switzerland, and Belgium. Women with singleton fetuses whose estimated weight exceeded the 95th percentile, were randomly assigned (1:1), via computer-generated permuted-block randomisation (block size of four to eight) to receive induction of labour within 3 days between 37(+0) weeks and 38(+6) weeks of gestation, or expectant management. Randomisation was stratified by centre. Participants and caregivers were not masked to group assignment. Our primary outcome was a composite of clinically significant shoulder dystocia, fracture of the clavicle, brachial plexus injury, intracranial haemorrhage, or death. We did analyses by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00190320. FINDINGS We randomly assigned 409 women to the induction group and 413 women to the expectant management group, of whom 407 women and 411 women, respectively, were included in the final analysis. Mean birthweight was 3831 g (SD 324) in the induction group and 4118 g (392) in the expectant group. Induction of labour significantly reduced the risk of shoulder dystocia or associated morbidity (n=8) compared with expectant management (n=25; relative risk [RR] 0·32, 95% CI 0·15-0·71; p=0·004). We recorded no brachial plexus injuries, intracranial haemorrhages, or perinatal deaths. The likelihood of spontaneous vaginal delivery was higher in women in the induction group than in those in the expectant management group (RR 1·14, 95% CI 1·01-1·29). Caesarean delivery and neonatal morbidity did not differ significantly between the groups. INTERPRETATION Induction of labour for suspected large-for-date fetuses is associated with a reduced risk of shoulder dystocia and associated morbidity compared with expectant management. Induction of labour does not increase the risk of caesarean delivery and improves the likelihood of spontaneous vaginal delivery. These benefits should be balanced with the effects of early-term induction of labour. FUNDING Assistance Publique-Hôpitaux de Paris and the University of Geneva.
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Affiliation(s)
- Michel Boulvain
- Département de Gynécologie et d'Obstétrique, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Marie-Victoire Senat
- Département de Gynécologie-Obstétrique, APHP, Hôpital Bicêtre, Hôpital Antoine Béclère, Université Paris Sud, Faculté de Medecine, Orsay, Paris, France
| | - Franck Perrotin
- Pôle de Gynécologie-Obstétrique, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Norbert Winer
- Département de Gynécologie-Obstétrique, Hôpital Mère-Enfant, Nantes, France
| | - Gael Beucher
- Département de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen, France
| | - Damien Subtil
- Département de Gynécologie-Obstétrique, Hôpital Jeanne de Flandre, Lille, France
| | - Florence Bretelle
- Département de Gynécologie-Obstétrique, Hôpital Nord, Marseille, France
| | - Elie Azria
- Département de Gynécologie-Obstétrique, Hôpital Bichat, AP-HP, Paris, France
| | - Dominique Hejaiej
- Département de Gynécologie-Obstétrique, Centre Hospitalier Régional, Annecy, France
| | - Françoise Vendittelli
- Pôle de Gynécologie-Obstétrique et Reproduction Humaine, CHU de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Marianne Capelle
- Département de Gynécologie-Obstétrique, Hôpital de La Conception, Marseille, France
| | - Bruno Langer
- Département de Gynécologie-Obstétrique, Hôpital Hautepierre, Strasbourg, France
| | - Richard Matis
- Groupe Hospitalier de l'Institut Catholique de Lille, Lille, France
| | - Laure Connan
- Département de Gynécologie-Obstétrique, Hôpital Paul de Viguier, Toulouse, France
| | - Philippe Gillard
- Pôle de Gynécologie-Obstétrique, Hôpital Hôtel Dieu, Angers, France
| | | | - Gilles Ceysens
- Département de Gynécologie-Obstétrique, Hôpital Erasme, Bruxelles, Belgium; Département de Gynécologie-Obstétrique, Hôpital Ambroise Paré, Mons, Belgium
| | - Gilles Faron
- Département de Gynécologie-Obstétrique, Hôpital Brugmann, Bruxelles, Belgium
| | - Olivier Irion
- Département de Gynécologie et d'Obstétrique, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Patrick Rozenberg
- Département de Gynécologie-Obstétrique, Hôpital Poissy Saint-Germain, Université Versailles- St Quentin, France
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Early-term birth is a risk factor for wheezing in childhood: A cross-sectional population study. J Allergy Clin Immunol 2015; 136:581-587.e2. [PMID: 26115906 DOI: 10.1016/j.jaci.2015.05.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/29/2015] [Accepted: 05/07/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Early term-born (37-38 weeks' gestation) infants have increased respiratory morbidity during the neonatal period compared with full term-born (39-42 weeks' gestation) infants, but longer-term respiratory morbidity remains unclear. OBJECTIVE We assessed whether early term-born children have greater respiratory symptoms and health care use in childhood compared with full term-born children. METHODS We surveyed 1- to 10-year-old term-born children (n = 13,361). Questionnaires assessed respiratory outcomes with additional data gathered from national health databases. RESULTS Of 2,845 eligible participants, 545 were early term-born and 2,300 were full term-born. Early term-born children had higher rates of admission to the neonatal unit (odds ratio [OR], 1.7; 95% CI, 1.2-2.5) and admission to the hospital during their first year of life (OR, 1.6; 95% CI, 1.2-2.1). Forty-eight percent of early term-born children less than 5 years old reported wheeze ever compared with 39% of full term-born children (OR, 1.5; 95% CI, 1.1-1.9), and 26% versus 17% reported recent wheezing (OR, 1.7; 95% CI, 1.3-2.4). Early term-born children older than 5 years reported higher rates of wheeze ever (OR, 1.4; 95% CI, 1.05-1.8) and recent wheezing over the last 12 months than full-term control subjects (OR, 1.4; 95% CI, 1.02-2.0). Increased rates of respiratory symptoms in early term-born children persisted when family history of atopy and delivery by means of cesarean sections were included in logistic regression models. CONCLUSION Early term-born children had significantly increased respiratory morbidity and use of health care services when compared with full term-born children, even when stratified by mode of delivery and family history of atopy.
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Prefumo F, Ferrazzi E, Di Tommaso M, Severi FM, Locatelli A, Chirico G, Dani C, Lista G, Orabona R, Zambolo C, Frusca T. Neonatal morbidity after cesarean section before labor at 34(+0) to 38(+6) weeks: a cohort study. J Matern Fetal Neonatal Med 2015; 29:1334-8. [PMID: 26037729 DOI: 10.3109/14767058.2015.1047758] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To describe morbidity in neonates born by cesarean section (CS) before labor between 34(+0) and 38(+6) weeks, stratified by gestational age. METHODS Cohort study from five Italian tertiary care hospitals. Consecutive singleton pregnancies delivered by CS before labor between 34(+0) and 38(+6) weeks of gestation from January 2010 to August 2011 were included. Women in labor, with premature rupture of membranes, or with previous administration of steroids were excluded. The incidence of neonatal complication by gestational week was calculated. RESULTS A total of 1135 cases were analyzed. Composite adverse neonatal outcomes, respiratory distress syndrome, transient tachypnea and use of continuous airway positive pressure decreased from 50%, 28%, 5% and 22% at 34 weeks of gestation, to 4.7%, 1.0%, 0.9% and 0.3% at 38 weeks of gestation. Multivariate analysis showed that the only variable independently associated with composite adverse neonatal outcome was gestational age at delivery (adjusted odds ratio 0.49; 95% confidence interval 0.39-0.61). CONCLUSIONS The prevalence of neonatal complications in newborns delivered by CS before labor halves at each week of gestation from 34 to 38 weeks. Nonetheless complications, and mainly respiratory problems, are still present at early term gestation.
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Affiliation(s)
- Federico Prefumo
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
| | - Enrico Ferrazzi
- b Department of Woman Mother and Neonate, Buzzi Hospital , Biomedical and Clinical Sciences School of Medicine, University of Milan , Milan , Italy
| | - Mariarosaria Di Tommaso
- c Departments of Obstetrics, Gynecology and Neonatology , Careggi Hospital, University of Florence , Florence , Italy
| | | | - Anna Locatelli
- e Department of Obstetrics and Gynecology , San Gerardo Hospital, University of Milan-Bicocca , Monza , Italy
| | - Gaetano Chirico
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
| | - Carlo Dani
- c Departments of Obstetrics, Gynecology and Neonatology , Careggi Hospital, University of Florence , Florence , Italy
| | - Gianluca Lista
- b Department of Woman Mother and Neonate, Buzzi Hospital , Biomedical and Clinical Sciences School of Medicine, University of Milan , Milan , Italy
| | - Rossana Orabona
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
| | - Chiara Zambolo
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
| | - Tiziana Frusca
- a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy
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Becquet O, El Khabbaz F, Alberti C, Mohamed D, Blachier A, Biran V, Sibony O, Baud O. Insulin treatment of maternal diabetes mellitus and respiratory outcome in late-preterm and term singletons. BMJ Open 2015; 5:e008192. [PMID: 26038361 PMCID: PMC4458616 DOI: 10.1136/bmjopen-2015-008192] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES While the incidence of diabetes mellitus (DM) during pregnancy has been steadily increasing in recent years, the link between gestational DM and respiratory outcome in neonates has not been definitely established. We asked the question whether DM status and its treatment during pregnancy could influence the risk of neonatal respiratory distress. DESIGN We studied in a large retrospective cohort the relationship between maternal DM status (non-DM, insulin-treated DM (IT-DM) and non-insulin-treated DM (NIT-DM)), and respiratory distress in term and near-term inborn singletons. RESULTS Among 18,095 singletons delivered at 34 weeks of gestation or later, 412 (2.3%) were admitted to the neonatal intensive care unit (NICU) for respiratory distress within the first hours of life. The incidence of NICU admission due to respiratory distress groups was 2.2%, 5.7% and 2.1% in the non-DM, IT-DM and NIT-DM groups, respectively. Insulin treatment of DM, together with several other perinatal factors, was associated with a significant increased risk for respiratory distress. Several markers of the severity of respiratory illness, including durations of mechanical ventilation and supplemental oxygen, and hypertrophic cardiomyopathy were also found increased following IT-DM as compared with NIT-DM. In a multivariate model, we found that IT-DM, but not NIT-DM, was significantly associated with respiratory distress independent of gestational age and caesarean section, with an incidence rate ratio of 1.44 (1.00-2.08). CONCLUSIONS This study shows that the treatment of maternal DM with insulin during pregnancy is an independent risk factor for respiratory distress in term and near-term newborns.
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Affiliation(s)
- Odile Becquet
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France
| | - Fares El Khabbaz
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France
| | - Corinne Alberti
- PremUP Foundation, Paris, France Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123, ECEVE, Paris, France Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France INSERM, U1123 and CIC-EC 1426, Paris, France
| | - Damir Mohamed
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123, ECEVE, Paris, France Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France INSERM, U1123 and CIC-EC 1426, Paris, France
| | - Audrey Blachier
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Département d'information médicale, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France
| | - Olivier Sibony
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France
| | - Olivier Baud
- Neonatal Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France PremUP Foundation, Paris, France
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Shimokaze T, Akaba K, Banzai M, Kihara K, Saito E, Kanasugi H. Premature rupture of membranes and neonatal respiratory morbidity at 32-41 weeks' gestation: a retrospective single-center cohort study. J Obstet Gynaecol Res 2015; 41:1193-200. [PMID: 25832468 DOI: 10.1111/jog.12689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/18/2014] [Accepted: 01/04/2015] [Indexed: 11/26/2022]
Abstract
AIM To ascertain whether premature rupture of membranes (PROM) independently affects the risk of neonatal respiratory morbidity at 32-41 weeks' gestation because previous reports have given insufficient consideration to the mode of delivery and labor onset. METHODS Data on 4,629 consecutive singleton infants were retrospectively collected. Respiratory morbidity was limited to respiratory distress syndrome and transient tachypnea of the newborn, both of which are related to prematurity. Delivery modes were divided into four groups based on the existence of PROM and of labor onset, and the respiratory morbidity was examined according to the number of weeks of gestational age. Multivariate analysis including PROM and delivery mode was conducted to examine the association of respiratory morbidity. RESULTS Respiratory morbidity or a positive pressure requirement delivered after PROM and intact amniochorionic membranes accompanied by labor were similar at all weeks. Around 37 weeks, the absence of labor onset was associated with a risk of respiratory morbidity or positive pressure requirement. Significant respiratory risk was not associated with the incidence of PROM (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.52-1.83), interval from rupture to delivery (aOR, 1.00; 95% CI, 0.99-1.01), clinical chorioamnionitis, induction management, pregnancy-related complications, or neonatal sex. Delivery by Cesarean section and early gestational age presented a significant risk for respiratory morbidity. CONCLUSIONS Neither PROM nor latency after PROM at 32-41 weeks affected neonatal respiratory morbidity. Avoiding Cesarean section instead of simply increasing the time to delivery may help to reduce respiratory morbidity.
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Affiliation(s)
| | - Kazuhiro Akaba
- Departments of Pediatrics, Saiseikai Yamagata Hospital, Yamagata, Japan
| | - Michio Banzai
- Departments of Obstetrics and Gynecology, Saiseikai Yamagata Hospital, Yamagata, Japan
| | - Kaori Kihara
- Departments of Obstetrics and Gynecology, Saiseikai Yamagata Hospital, Yamagata, Japan
| | - Emi Saito
- Departments of Pediatrics, Saiseikai Yamagata Hospital, Yamagata, Japan
| | - Hiroshi Kanasugi
- Departments of Obstetrics and Gynecology, Saiseikai Yamagata Hospital, Yamagata, Japan
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Maier B. Is the narrow concept of individual autonomy compatible with or in conflict with Evidence-based Medicine in obstetric practice? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.woman.2014.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kozhimannil KB, Arcaya MC, Subramanian SV. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database. PLoS Med 2014; 11:e1001745. [PMID: 25333943 PMCID: PMC4205118 DOI: 10.1371/journal.pmed.1001745] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 09/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. METHODS AND FINDINGS Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project--a 20% sample of US hospitals--we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. CONCLUSIONS Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors-such as hospital policies, practices, and culture--in determining cesarean section use. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Katy B. Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Mariana C. Arcaya
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
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Parikh LI, Reddy UM, Männistö T, Mendola P, Sjaarda L, Hinkle S, Chen Z, Lu Z, Laughon SK. Neonatal outcomes in early term birth. Am J Obstet Gynecol 2014; 211:265.e1-265.e11. [PMID: 24631438 PMCID: PMC4149822 DOI: 10.1016/j.ajog.2014.03.021] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/20/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine neonatal morbidity rates for early term birth compared with full term birth by precursor leading to delivery. STUDY DESIGN This was a retrospective study of 188,809 deliveries from 37 0/7 to 41 6/7 weeks of gestation with electronic medical record data from 2002 to 2008. Precursors for delivery were categorized as spontaneous labor, premature rupture of membranes indicated, and no recorded indication. After excluding anomalies, rates of neonatal morbidities by precursor were compared at each week of delivery. RESULTS Early term births (37 0/7-38 6/7 weeks) accounted for 34.1% of term births. Overall, 53.6% of early term births were due to spontaneous labor, followed by 27.6% indicated, 15.5% with no recorded indication, and 3.3% with premature rupture of membranes. Neonatal intensive care unit admission and respiratory morbidity were lowest at or beyond 39 weeks compared with the early term period for most precursors, although indicated deliveries had the highest morbidity compared with other precursors. The greatest difference in morbidity was between 37 and 39 weeks for most precursors, although most differences in morbidities between 38 and 39 weeks were not significant. Respiratory morbidity was higher at 37 than 39 weeks regardless of route of delivery. CONCLUSION Given the higher neonatal morbidity at 37 compared with 39 weeks regardless of delivery precursor, our data support recent recommendations for designating early term to include 37 weeks. Prospective data is urgently needed to determine the optimal timing of delivery for common pregnancy complications.
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Affiliation(s)
- Laura I Parikh
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC; Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Uma M Reddy
- Pregnancy and Perinatalogy Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Tuija Männistö
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Lindsey Sjaarda
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Stefanie Hinkle
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Zhaohui Lu
- Glotech, Inc., Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - S Katherine Laughon
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
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Guittier MJ, Cedraschi C, Jamei N, Boulvain M, Guillemin F. Impact of mode of delivery on the birth experience in first-time mothers: a qualitative study. BMC Pregnancy Childbirth 2014; 14:254. [PMID: 25080994 PMCID: PMC4132899 DOI: 10.1186/1471-2393-14-254] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 07/09/2014] [Indexed: 12/19/2022] Open
Abstract
Background The birth of a first child is an important event in a woman’s life. Delivery psychological impacts vary depending on whether delivery has been positively or negatively experienced. Delivery experience determinants have been identified but the understanding of their expression according to the mode of delivery is poorly documented. The purpose of the study was to determine important elements associated with women’s first delivery experience according to the mode of delivery: vaginal or caesarean section. Methods Qualitative approach using thematic content analysis of in-depth interviews conducted between 4 and 6 weeks’ postpartum, in 24 primiparous women who delivered at Geneva University Hospital in 2012. Results Perceived control, emotions, and the first moments with the newborn are important elements for the experience of childbirth. Depending on the mode of delivery these are perceived differently, with a negative connotation in the case of caesarean section. Other elements influencing the delivery experience were identified among all participants, irrespective of the mode of delivery. They included representations, as well as the relationship with caregivers and the father in the delivery room, privacy, unexpected sensory experiences, and ownership of the maternal role. Women’s and health professionals’ representations sometimes led to a hierarchy based on the mode of delivery and use of analgesia. Conclusions The mode of delivery directly impacts on certain key delivery experience determinants as perceived control, emotions, and the first moments with the newborn. The ability/inability of the woman to imagine a second pregnancy is a good indicator of the birth experience. Certain health professional gestures or attitudes can promote a positive delivery experience. We recommend to better prepare women during prenatal classes for the eventuality of a caesarean section delivery and to offer all women and, possibly, their partners, the opportunity to talk about the experience of childbirth during the postpartum period. The results of this study suggest that further research is required on the social representations of women and health professionals regarding the existence of a hierarchy associated with the mode of delivery.
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Neonatal morbidity in early-term newborns. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.anpede.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Martínez-Nadal S, Demestre X, Raspall F, Álvarez J, Elizari M, Vila C, Sala P. Morbilidad neonatal en los recién nacidos a término precoz. An Pediatr (Barc) 2014; 81:39-44. [DOI: 10.1016/j.anpedi.2013.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/27/2013] [Accepted: 10/08/2013] [Indexed: 12/01/2022] Open
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Abstract
BACKGROUND There is increasing attention to labor induction and cesarean delivery occurring at 37 0/7-38 6/7 weeks' gestation (early-term) without medical indication. OBJECTIVE To measure prevalence, change over time, patient characteristics, and infant outcomes associated with early-term nonindicated births. RESEARCH DESIGN AND SUBJECTS Retrospective analysis using linked hospital discharge and birth certificate data for the 7,296,363 uncomplicated births (>37 0/7 wk' gestation) between 1995 and 2009 in 3 states. MEASURES Early-term nonindicated birth is calculated using diagnosis codes and birth certificate records. Secondary outcomes included infant prolonged length of stay and respiratory distress. RESULTS Across uncomplicated term births, the early-term nonindicated birth rate was 3.18%. After adjustment, the risk of nonindicated birth before 39 0/7 weeks was 86% higher in 2009 than in 1995 [hazard ratio (HR)=1.86; 95% confidence interval (CI), 1.81-1.90], peaking in 2006 (HR=2.03; P<0.001). Factors independently associated with higher odds included maternal age, higher education levels, private health insurance, and delivering at smaller-volume or nonteaching hospitals. Black women had higher risk of nonindicated cesarean birth (HR=1.29; 95% CI, 1.27-1.32), which was associated with greater odds of prolonged length of stay [adjusted odds ratio (AOR)=1.60; 95% CI, 1.57-1.64] and infant respiratory distress (AOR=2.44; 95% CI, 2.37-2.50) compared with births after 38 6/7 weeks. Early-term nonindicated induction was also associated with comparatively greater odds of prolonged length of stay (AOR=1.20; 95% CI, 1.17-1.23). CONCLUSIONS Nearly 4% of all uncomplicated births to term infants occurred before 39 0/7 weeks' gestation without medical indication. These births were associated with adverse infant outcomes.
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Affiliation(s)
- Katy B Kozhimannil
- *Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN †Children's Hospital of Philadelphia, Philadelphia, PA
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Thiagarajan RR. Best on time, not a little early: gestational age and outcomes for neonates with congenital heart disease. Circulation 2014; 129:2495-6. [PMID: 24795389 DOI: 10.1161/circulationaha.114.010350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ravi R Thiagarajan
- From the Department of Cardiology, Cardiac Intensive Care Unit, Boston Children's Hospital, Boston, MA; and Harvard Medical School, Boston, MA.
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Natile M, Ventura ML, Colombo M, Bernasconi D, Locatelli A, Plevani C, Valsecchi MG, Tagliabue P. Short-term respiratory outcomes in late preterm infants. Ital J Pediatr 2014; 40:52. [PMID: 24893787 PMCID: PMC4050404 DOI: 10.1186/1824-7288-40-52] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/22/2014] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate short-term respiratory outcomes in late preterm infants (LPI) compared with those of term infants (TI). Methods A retrospective study conducted in a single third level Italian centre (2005–2009) to analyse the incidence and risk factors of composite respiratory morbidity (CRM), the need for adjunctive therapies (surfactant therapy, inhaled nitric oxide, pleural drainage), the highest level of respiratory support (mechanical ventilation – MV, nasal continuous positive airway pressure – N-CPAP, nasal oxygen) and the duration of pressure support (hours in N-CPAP and/or MV). Results During the study period 14,515 infants were delivered. There were 856 (5.9%) LPI and 12,948 (89.2%) TI. CRM affected 105 LPI (12.4%), and 121 TI (0.9%), with an overall rate of 1.6%. Eighty-four LPI (9.8%) and 73 TI (0.56%) received respiratory support, of which 13 LPI (1.5%) and 16 TI (0.12%) were ventilated. The adjusted OR for developing CRM significantly increased from 3.3 (95% CI 2.0-5.5) at 37 weeks to 40.8 (95% CI 19.7-84.9%) at 34 weeks. The adjusted OR for the need of MV significantly increased from 3.4 (95% CI 1.2-10) at 37 weeks to 34.4 (95% CI 6.7-180.6%) at 34 weeks. Median duration of pressure support was significantly higher at 37 weeks (66.6 h vs 40.5 h). Twin pregnancies were related to a higher risk of CRM (OR 4.3, 95% CI 2.6-7.3), but not independent of gestational age (GA). Cesarean section (CS) was associated with higher risk of CRM independently of GA, but the OR was lower in CS with labour (2.2, 95% CI 1.4-3.4 vs 3.0, 95% CI 2.1-4.2). Conclusions In this single third level care study late preterm births, pulmonary diseases and supportive respiratory interventions were lower than previously documented. LPI are at a higher risk of developing pulmonary disease than TI. Infants born from elective cesarean sections, late preterm twins in particular and 37 weekers too might benefit from preventive intervention.
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Affiliation(s)
| | | | | | | | | | | | | | - Paolo Tagliabue
- Neonatology and Neonatal Intensive Care Unit, MBBM Foundation, via Pergolesi 33, 20900 Monza, Italy.
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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] [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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Dadlez NM, Brubaker SG, Simpson LL, Yilmaz B, Williams IA. Impact of Change in Delivery Practice on Neonatal and Maternal Outcomes in Cases of Significant Congenital Heart Disease. CONGENIT HEART DIS 2014; 9:368-72. [DOI: 10.1111/chd.12167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nina M. Dadlez
- Division of Pediatric Cardiology; Department of Pediatrics; Morgan Stanley Children's Hospital of New York-Presbyterian; Columbia University Medical Center; New York NY USA
| | - Sara G. Brubaker
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; College of Physicians and Surgeons Columbia University; New York NY USA
| | - Lynn L. Simpson
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; College of Physicians and Surgeons Columbia University; New York NY USA
| | - Betul Yilmaz
- Division of Pediatric Cardiology; Department of Pediatrics; Morgan Stanley Children's Hospital of New York-Presbyterian; Columbia University Medical Center; New York NY USA
| | - Ismée A. Williams
- 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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Jozwiak M, van de Lest HA, Burger NB, Dijksterhuis MGK, De Leeuw JW. Cervical ripening with Foley catheter for induction of labor after cesarean section: a cohort study. Acta Obstet Gynecol Scand 2014; 93:296-301. [PMID: 24354335 DOI: 10.1111/aogs.12320] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 12/09/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate spontaneous vaginal delivery and complication rates after induction of labor with a transcervical Foley catheter in women with a previous cesarean delivery. DESIGN Retrospective cohort study. SETTING Secondary teaching hospital in the second largest city of the Netherlands. POPULATION Women with a history of cesarean delivery (n = 208), undergoing induction of labor with a Foley catheter in a subsequent pregnancy. MATERIAL AND METHODS The women who had induction of labor with a transcervical Foley catheter in the Ikazia Hospital, Rotterdam, between January 2003 and January 2012, were identified in a computerized database. Patient's records were checked for accuracy. MAIN OUTCOME MEASURES Vaginal delivery rate, cesarean section rate, uterine rupture and maternal and neonatal (infectious) morbidity. RESULTS Of the women 60% had a spontaneous vaginal delivery and 11% were delivered by vacuum extraction. Uterine rupture occurred in one woman. Postpartum hemorrhage was the most common maternal complication (12%). Maternal intrapartum and postpartum infections occurred in 5% and 1%. Proven neonatal infection was found in 3% of the cases. Two perinatal deaths occurred (1%), of which one was related to uterine rupture. CONCLUSION Induction of labor with a transcervical Foley catheter is an effective method to achieve vaginal delivery in women with a previous cesarean delivery. There is a low risk of uterine rupture and maternal and neonatal (infectious) morbidity in this cohort.
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Affiliation(s)
- Marta Jozwiak
- Department of Obstetrics and Gynecology, Ikazia Hospital, Rotterdam, the Netherlands
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77
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Bergman J, Bergman N. Whose Choice? Advocating Birthing Practices According to Baby's Biological Needs. J Perinat Educ 2014; 22:8-13. [PMID: 24381471 DOI: 10.1891/1058-1243.22.1.8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Modern western society and media often present the mother's choices for her birth as paramount. Various gurus provide the mother with often conflicting advice. But the reality is that childbirth often becomes a medicalized event with many interventions and less than ideal outcomes. In many instances, the choices are made to suit health professionals and hospital routines rather than the mother. All the aforementioned are based on ideas and assumptions which predate evidence-based medicine and recent neuroscience. In reproductive biology, the newborn is an active participant and agent in birthing (Alberts, 1994). Based on this, the perspective which has been lacking is what is best for the baby; our choices should be primarily based on the basic biological needs of the infant.
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78
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Mahoney AD, Jain L. Respiratory disorders in moderately preterm, late preterm, and early term infants. Clin Perinatol 2013; 40:665-78. [PMID: 24182954 DOI: 10.1016/j.clp.2013.07.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Even when it is just a few weeks before term gestation, early birth has consequences, resulting in higher morbidity and mortality. Respiratory issues related to moderate prematurity include delayed neonatal transition to air breathing, respiratory distress resulting from delayed fluid clearance (transient tachypnea of the newborn), surfactant deficiency (respiratory distress syndrome), and pulmonary hypertension. Management approaches emphasize appropriate respiratory support to facilitate respiratory transition and minimize iatrogenic injury. Studies are needed to determine the impact of respiratory distress coupled with mild-moderate prematurity on long-term outcome.
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Affiliation(s)
- Ashley Darcy Mahoney
- Nell Hodgson Woodruff School of Nursing, Emory University School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA; South Dade Neonatology, Miami, FL, USA.
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79
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Sahni R, Polin RA. Physiologic underpinnings for clinical problems in moderately preterm and late preterm infants. Clin Perinatol 2013; 40:645-63. [PMID: 24182953 DOI: 10.1016/j.clp.2013.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article highlights some of the important developmental characteristics that underpin common problems seen in moderate and late preterm infants. Preterm birth is associated with an increased prevalence of clinical problems caused by functional immaturities in a wide variety of organ systems, acquired problems, and problems associated with inadequate monitoring and/or follow-up plans. There are variations in the degree of maturation among infants of similar gestational ages because the developmental process is nonlinear. Therefore, different organ systems mature at rates and trajectories that are specific to their functions. A better understanding of these principles can help guide optimal treatment strategies.
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Affiliation(s)
- Rakesh Sahni
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, 3959 Broadway, MSCHN-1201, New York, NY 10032, USA
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80
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Guittier MJ, Guillemin F, Brandao Farinelli E, Irion O, Boulvain M, de Tejada BM. Hypnosis for the Control of Pain Associated with External Cephalic Version: A Comparative Study. J Altern Complement Med 2013; 19:820-5. [DOI: 10.1089/acm.2012.0945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marie-Julia Guittier
- University of Applied Sciences Western Switzerland, Geneva, Switzerland
- Lorraine & Paris Descartes University, Apemac, Nancy, France
| | | | - Edith Brandao Farinelli
- Department of Anesthesiology, Pharmacology, and Critical Care, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Irion
- Department of Gynecology and Obstetrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Michel Boulvain
- Department of Gynecology and Obstetrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Department of Gynecology and Obstetrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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81
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Abstract
Late preterm (LP) infants are defined as those born at 34-0/7 to 36-6/7 weeks' gestational age. LP infants were previously referred to as near term infants. The change in terminology resulted from the understanding that these infants are not fully mature and that the last 6 weeks of gestation represent a critical period of growth and development of the fetal brain and lungs, and of other systems. There is accumulating evidence of higher risks for health complications in these infants, including serious morbidity and a threefold higher infant mortality rate compared with term infants. This information is of critical importance because of its scientific merits and practical implications. However, it warrants a critical and balanced review, given the apparent overall uncomplicated outcome for the majority of LP infants. Others reviewed the characteristics of LP infants that predispose them to a higher risk of morbidity at the neonatal period. This review focuses on the long-term neurodevelopmental and respiratory outcomes, with the main aim to suggest putative prenatal, neonatal, developmental, and environmental causes for these increased morbidities. It demonstrates parallelism in the trajectories of pulmonary and neurologic development and evolution as a model for fetal and neonatal maturation. These may suggest the critical developmental time period as the common pathway that leads to the outcomes. Disruption in this pathway with potential long-term consequences in both systems may occur if the intrauterine milieu is disturbed. Finally, the review addresses the practical implications on perinatal and neonatal care during infancy and childhood.
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Affiliation(s)
- Amir Kugelman
- Bnai Zion Medical Center, Department of Neonatology and Pediatric Pulmonary Unit, 47 Golomb Street, Haifa, 31048, Israel.
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82
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Melamed N, Hadar E, Keidar L, Peled Y, Wiznitzer A, Yogev Y. Timing of planned repeat cesarean delivery after two or more previous cesarean sections – Risk for unplanned cesarean delivery and pregnancy outcome. J Matern Fetal Neonatal Med 2013; 27:431-8. [DOI: 10.3109/14767058.2013.818130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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83
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Ray KN, Lorch SA. Hospitalization of early preterm, late preterm, and term infants during the first year of life by gestational age. Hosp Pediatr 2013; 3:194-203. [PMID: 24313087 DOI: 10.1542/hpeds.2012-0063] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The goal of this study was to describe hospitalizations of infants during the first year of life according to week of gestational age (GA). We hypothesized that odds of any hospitalization would generally decrease with increasing GA, with late preterm infants experiencing additional increased risk of specific hospitalizations, such as hyperbilirubinemia. METHODS Birth certificates for > 6.6 million infants born in California hospitals between 1993 and 2005 and surviving to discharge were linked to hospital discharge records during the first year of life. Odds of any hospitalization and any hospitalization for specific diagnoses during the first year of life were determined for infants 23 to 44 weeks' GA. Further analysis determined odds of any hospitalization within 14, 30, and 90 days of birth discharge, and observed odds were compared with expected odds obtained through quadratic modeling. RESULTS Odds of any hospitalization within the first year of life decreased with advancing GA, but observed odds of any hospitalization exceeded expected odds for 35-, 36-, and 37-week GA infants for all time periods after discharge. Odds of any hospitalization for hyperbilirubinemia were greatest for infants 33 to 38 weeks' GA (peak odds ratio at 36 weeks' GA: 2.86 [95% confidence interval: 2.73-3.00]), and a relative peak in odds of any hospitalization for specific infections was observed among infants 33 to 36 weeks' GA. CONCLUSIONS Odds of any hospitalization during the first year of life exceeded expected odds of hospitalization for 35-, 36-, and 37-week GA infants. GAs at risk overlapped with, but were not identical to, GAs identified as late preterm infants.
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Affiliation(s)
- Kristin N Ray
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 15213, USA.
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84
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Caesarean section at term: the relationship between neonatal respiratory morbidity and microviscosity in amniotic fluid. Eur J Obstet Gynecol Reprod Biol 2013; 169:239-43. [PMID: 23727222 DOI: 10.1016/j.ejogrb.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 04/16/2013] [Accepted: 05/01/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The incidence of neonatal respiratory morbidity following an elective caesarean section is 2-3 times higher than after a vaginal delivery. The microviscosity of surfactant phospholipids, as measured with fluorescence polarisation, is linked with the functional characteristics of fetal surfactant and thus fetal lung maturity, but so far this point has received little attention in newborns at term. The aim of the study is to evaluate the correlation between neonatal respiratory morbidity and amniotic microviscosity (Fluorescence Polarisation Index) in women undergoing caesarean section after 37 weeks' gestation. STUDY DESIGN The files of 136 women who had undergone amniotic microviscosity studies during elective caesarean deliveries at term were anonymised. Amniotic fluid immaturity (AFI) was defined as a Fluorescence Polarisation Index higher than 0.335. RESULTS Respiratory morbidity was observed in 10 babies (7.3%) and was independently associated with AFI (OR: 6.11 [95% CI, 1.20-31.1] with p=0.029) and maternal body mass index (OR: 1.12 [95% CI, 1.02-1.22] with p=0.019). Gestational age at the time of caesarean delivery was inversely associated with AFI (odds ratio, 0.46 [95% confidence interval, 0.29-0.71], p<0.001), especially before 39 weeks, and female gender was associated with an increased risk (odds ratio, 3.29 [95% confidence interval, 1.48-7.31], p=0.004). CONCLUSIONS AFI assessed by amniotic microviscosity was significantly associated with respiratory morbidity and independently correlated with shorter gestational age especially before 39 weeks. This finding provides a physiological rationale for recommending delaying elective caesarean section delivery until 39 weeks of gestation to decrease the risk for respiratory morbidity.
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85
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Teixeira C, Correia S, Barros H. Risk of caesarean section after induced labour: do hospitals make a difference? BMC Res Notes 2013; 6:214. [PMID: 23714240 PMCID: PMC3668278 DOI: 10.1186/1756-0500-6-214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background There is a well-known relationship between induced labour and caesarean rates. However, it remains unknown whether this relationship reflects the impact of more complex obstetric conditions or the variability in obstetric practices. We sought to quantify the independent role of the hospital as a variable that can influence the occurrence of caesarean section after induced labour. Methods As part of the Portuguese Generation XXI birth cohort, we evaluated 2041 consecutive women who underwent singleton pregnancies with labour induction, at five public level III obstetric units (April 2005-August 2006). The indications for induction were classified according to the guidelines of the American and the Royal Colleges of Obstetricians and Gynaecologists. Poisson regression models were adjusted to estimate the association between the hospital and surgical delivery after induction. Crude and adjusted prevalence ratios (PR) and a 95% confidence interval (95% CI) were computed. Results The proportion of women who were induced without formal clinical indications varied among hospitals from 20.3% to 45.5% (p < 0.001). After adjusting for confounders, the risk of undergoing a caesarean section after induced labour remained significantly different between the hospitals, for the cases in which there was no evident indication for induction [the highest PR reaching 1.86 (95% CI, 1.23–2.82)] and also when at least one such indication was present [1.53 (95% CI, 1.12–2.10)]. This pattern was also observed among the primiparous cephalic term induced women [the highest PR reaching 2.06 (95% CI, 1.23–2.82) when there was no evident indication for induction and 1.61 (95% CI, 1.11–2.34) when at least one such indication was present]. Conclusions Caesarean section after induced labour varied significantly across hospitals where similar outcomes were expected. The effect was more evident when the induction was not based on the unequivocal presence of commonly accepted indications.
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86
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Greenberg MB, Penn AA, Whitaker KR, Kogut EA, El-Sayed YY, Caughey AB, Lyell DJ. Effect of magnesium sulfate exposure on term neonates. J Perinatol 2013; 33:188-93. [PMID: 22836873 DOI: 10.1038/jp.2012.95] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare neonatal intensive care unit and special care unit (NICU) admission rates between term neonates exposed to antenatal magnesium sulfate (MS) and those unexposed. STUDY DESIGN We performed a retrospective cohort study of all singleton neonates ≥37 weeks born to women with pre-eclampsia from August 2006 to July 2008. Cases were defined by antenatal exposure to MS and controls by absence of MS exposure. The primary outcome was NICU admission. Data were analyzed via univariable and multivariable regression analyses. RESULT In all, 28 (14.7%) out of 190 MS-exposed neonates ≥37 weeks were admitted to the NICU, compared with 4 (5.4%) of 74 non-exposed neonates (P=0.04). This association persisted after controlling for potential confounding variables including severe pre-eclampsia and cesarean delivery (AOR 3.69, 1.13 to 11.99). NICU admission was associated in a dose-dependent relationship with total hours and mean dose of MS exposure. Number needed to harm with MS was 11 per NICU admission. Among neonates admitted to the NICU, MS-exposed were more likely to require fluid and nutritional support than unexposed neonates (60.7 vs 0%, P=0.04), and trended toward more frequent requirement for respiratory support and greater length of stay. CONCLUSION In term neonates, MS exposure may be associated independently with NICU admission in a dose-dependent relationship. Requirements for fluid and nutritional support are common in this group, likely due to feeding difficulties in exposed neonates. Assessment of acute care needs among all neonates exposed to MS for maternal eclampsia prophylaxis should be considered.
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Affiliation(s)
- M B Greenberg
- Department of Obstetrics & Gynecology, Lucile Packard Children's Hospital at Stanford University, Stanford, CA 94110, USA.
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87
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Chiossi G, Lai Y, Landon MB, Spong CY, Rouse DJ, Varner MW, Caritis SN, Sorokin Y, O'Sullivan MJ, Sibai BM, Thorp JM, Ramin SM, Mercer BM. Timing of delivery and adverse outcomes in term singleton repeat cesarean deliveries. Obstet Gynecol 2013; 121:561-569. [PMID: 23635619 PMCID: PMC4066022 DOI: 10.1097/aog.0b013e3182822193] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the maternal and neonatal risks of elective repeat cesarean delivery compared with pregnancy continuation at different gestational ages, starting from 37 weeks. METHODS We analyzed the composite maternal and neonatal outcomes of repeat cesarean deliveries studied prospectively over 4 years at 19 U.S. centers. Maternal outcome was a composite of pulmonary edema, cesarean hysterectomy, pelvic abscess, thromboembolism, pneumonia, transfusion, or death. Composite neonatal outcome consisted of respiratory distress, transient tachypnea, necrotizing enterocolitis, sepsis, ventilation, seizure, hypoxic-ischemic encephalopathy, neonatal intensive care unit admission, 5-minute Apgar of 3 or lower, or death. Outcomes after elective repeat cesarean delivery without labor at each specific gestational age were compared with outcomes for all who were delivered later as a result of labor onset, specific obstetric indications, or both. RESULTS Twenty-three thousand seven hundred ninety-four repeat cesarean deliveries were included. Elective delivery at 37 weeks of gestation had significantly higher risks of adverse maternal outcome (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.06-2.31), whereas elective delivery at 39 weeks of gestation was associated with better maternal outcome when compared with pregnancy continuation (OR 0.51, 95% CI 0.36-0.72). Elective repeat cesarean deliveries at 37 and 38 weeks of gestation had significantly higher risks of adverse neonatal outcome (37 weeks OR 2.02, 95% CI 1.73-2.36; 38 weeks OR 1.39 95% CI 1.24-1.56), whereas delivery at 39 and 40 weeks of gestation presented better neonatal outcome as opposed to pregnancy continuation (39 weeks OR 0.79, 95% CI 0.68-0.92; 40 weeks OR 0.57, 95% CI 0.43-0.75). CONCLUSION In women with prior cesarean delivery, 39 weeks of gestation is the optimal time for repeat cesarean delivery for both mother and neonate.
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Affiliation(s)
- Giuseppe Chiossi
- Departments of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, The Ohio State University, Columbus, Ohio, University of Alabama at Birmingham, Birmingham, Alabama, University of Utah, Salt Lake City, Utah, University of Pittsburgh, Pittsburgh, Pennsylvania, Wayne State University, Detroit, Michigan, University of Miami, Miami, Florida, University of Tennessee, Memphis, Tennessee, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, The University of Texas Health Science Center at Houston, Houston, Texas, and Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio; The George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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88
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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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89
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Altman M, Vanpée M, Cnattingius S, Norman M. Risk factors for acute respiratory morbidity in moderately preterm infants. Paediatr Perinat Epidemiol 2013; 27:172-81. [PMID: 23374062 DOI: 10.1111/ppe.12035] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants born preterm account for a substantial part of neonatal morbidity, with acute respiratory disorders being a dominating clinical problem. Whereas focus in recent studies has been on extremely and very preterm infants, less is known about contemporary rates and risk factors for acute respiratory morbidity in moderately and late preterm infants. The objective of this population-based Swedish study was to establish rates for different acute respiratory diseases in moderately preterm infants, and to identify maternal, obstetric and neonatal risk factors for the two most common diagnoses, transient tachypnoea of the newborn (TTN) and respiratory distress syndrome (RDS). METHODS The study included 4679 moderately preterm [gestational age (GA): 30 to 34 weeks], 15 036 late preterm infants (GA 35 to 36 weeks) and 451 479 term infants (GA: 37 to 41 weeks). All infants were born in 2004-2008. RESULTS In moderately preterm infants, risk factors for TTN in multivariable analyses were multiparity, caesarean section before and after onset of labour, male sex, Apgar score 4-6 at 5 min and lower GA. Risk factors for RDS were multiparity, caesarean section before and after onset of labour, male sex, Apgar score <7 at 5 min and lower GA. Preterm rupture of membranes, antenatal corticosteroid treatment and being small for gestational age reduced the risk of RDS. CONCLUSION We conclude that acute respiratory morbidity in moderately preterm infants is common and predicted by multiparity, caesarean section, low Apgar score and male sex.
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Affiliation(s)
- Maria Altman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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90
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The impact of gestational age on resource utilization after open heart surgery for congenital cardiac disease from birth to 1 year of age. Pediatr Cardiol 2013; 34:686-93. [PMID: 23086189 DOI: 10.1007/s00246-012-0528-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
Abstract
The impact of gestational age on perioperative morbidity was examined using a novel construct, the resource utilization index (RUI). The medical records of subjects from birth to 1 year of age entered into a pediatric cardiothoracic surgery database from a major academic medical center between 2007 and 2011 were reviewed. The hypothesis tested was that infants born at 37-38 weeks (early-term infants) experience greater resource utilization after open heart surgery than those born at 39 completed weeks and that this association can be observed until 1 year of age. The results support the premise that resource utilization increases linearly with declining gestational age among infants at 0-12 months who undergo cardiac surgery. Five of the six variables comprising the RUI showed statistically significant linear associations with gestational age in the predicted direction. Multivariate linear regression analysis showed that gestational age was a significant predictor of an increased RUI composite. Further investigation is needed to test the concept and to expand on these findings.
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91
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McAlister BS. A case study of maternal response to the implied antepartum diagnosis of inevitable labor dystocia. J Obstet Gynecol Neonatal Nurs 2013; 42:138-47. [PMID: 23323692 DOI: 10.1111/1552-6909.12005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Two pregnant women, one obese and one of extremely small stature, received antepartum recommendations from their health care providers to schedule cesarean births. In response, both women sought providers who would support their desire to attempt vaginal birth. The women's perspectives on their birth experiences along with the pertinent medical record data from their pregnancies and births provide a reminder about the inherent normalcy of birth amid the current culture of interventive obstetrical practices.
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Affiliation(s)
- Barbara S McAlister
- Texas Woman's University, The Houston J. and Florence A. Doswell College of Nursing, 5500 Southwestern Medical Avenue, Dallas, TX 75235, USA.
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92
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Abstract
Although approximately 10% of all newborn infants receive some form of assistance after birth, only 1% of neonates require more advanced measures of life support. Because such situations cannot always be anticipated, paediatricians and neonatologists are frequently unavailable and resuscitation is delegated to the anaesthesiologist. The International Liaison Committee on Resuscitation, the European Resuscitation Council and the American Heart Association have recently updated the guidelines on neonatal resuscitation. The revised guidelines propose a simplified resuscitation algorithm that highlights the central role of respiratory support and promotes an increasing heart rate as the best indicator for effective ventilation. The most striking change in the new guidelines is the recommendation to start resuscitation in term infants with room air rather than 100% oxygen. Continuous pulse oximetry is recommended to monitor both heart rate and an appropriate increase in preductal oxygen saturation. Supplemental oxygen should only be used if, despite effective ventilation, the heart rate does not increase above 100 beats min(-1), or if oxygenation as indicated by pulse oximetry, remains unacceptably low. This review will focus on foetal physiology and pathophysiological aspects of neonatal adaptation and, thus, attempt to provide a solid basis for understanding the new resuscitation guidelines.
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93
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Berthelot-Ricou A, Lacroze V, Courbiere B, Guidicelli B, Gamerre M, Simeoni U. Respiratory distress syndrome after elective caesarean section in near term infants: a 5-year cohort study. J Matern Fetal Neonatal Med 2012; 26:176-82. [PMID: 23013109 DOI: 10.3109/14767058.2012.733743] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE to assess the incidence of respiratory distress syndrome (RDS) in late preterm (34(0/7)-36(6/7)) and just term (37(0/7)-37(6/7)) infants born via elective caesarean section (CS) in a tertiary care maternity facility. METHODS retrospective cohort study between 2005 and 2009. Hundred and eighty-eight near term infants, divided in two groups: group A: 125 late preterm (34(0/7)-36(6/7)) and group B: 63 just term (37(0/7)-37(6/7)), from elective CS (except CS after pre-mature rupture of membranes and foetuses presenting congenital malformation) were included. RESULTS In group A the overall incidence of RDS (RDS at or shortly after birth, requiring respiratory support or oxygen therapy) was 44% (n = 55) vs. 15.9% (n = 10) in group B (p < 0.01). The incidence of SRDS (requiring admission in the neonatal intensive care unit (NICU)) in group A was 13.6% (n = 17) and 3.2% (n = 2) group B (p < 0.01). The risk decreased significantly as gestational age (GA) increased: for RDS, 50.9% at 34 weeks of gestation (WG), 52.5% at 35 WG, 21.5% at 36 WG, and 15.9% at 37 WG; for admission, 30.2% at 34 WG, 25% at 35 WG, 9.4% at 36 WG, and 6.3% at 37 WG. Among late preterm infants with RDS, 30.9% (n = 17) developed severe RDS (SRDS). CONCLUSIONS Late preterm infants born via elective CS are at high risk for RDS and NICU admission. The risk is influenced by each additional week spent in utero. As the incidence of CS is increasing within this population, new preventative strategies must be sought.
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Affiliation(s)
- Anais Berthelot-Ricou
- Faculté de Médecine, Université de la Méditerranée-Assistance Publique Hôpitaux de Marseille, Pôle de Gynécologie-Obstétrique et Reproduction, Marseille, France.
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94
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Briand V, Dumont A, Abrahamowicz M, Sow A, Traore M, Rozenberg P, Watier L, Fournier P. Maternal and perinatal outcomes by mode of delivery in senegal and mali: a cross-sectional epidemiological survey. PLoS One 2012; 7:e47352. [PMID: 23056633 PMCID: PMC3466276 DOI: 10.1371/journal.pone.0047352] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 09/11/2012] [Indexed: 11/28/2022] Open
Abstract
Objective In the context of rapid changes regarding practices related to delivery in Africa, we assessed maternal and perinatal adverse outcomes associated with the mode of delivery in 41 referral hospitals of Mali and Senegal. Study Design Cross-sectional survey nested in a randomised cluster trial (1/10/2007–1/10/2008). The associations between intended mode of delivery and (i) in-hospital maternal mortality, (ii) maternal morbidity (transfusion or hysterectomy), (iii) stillbirth or neonatal death before Day 1 and (iv) neonatal death between 24 hours after birth and hospital discharge were examined. We excluded women with immediate life threatening maternal or fetal complication to avoid indication bias. The analyses were performed using hierarchical logistic mixed models with random intercept and were adjusted for women's, newborn's and hospitals' characteristics. Results Among the 78,166 included women, 2.2% had a pre-labor cesarean section (CS) and 97.8% had a trial of labor. Among women with a trial of labor, 87.5% delivered vaginally and 12.5% had intrapartum CS. Pre-labor CS was associated with a marked reduction in the risk of stillbirth or neonatal death before Day 1 as compared with trial of labor (OR = 0.2 [0.16–0.36]), though we did not show that maternal mortality (OR = 0.3 [0.07–1.32]) and neonatal mortality after Day 1 (OR = 1.3 (0.66–2.72]) differed significantly between groups. Among women with trial of labor, intrapartum CS and operative vaginal delivery were associated with higher risks of maternal mortality and morbidity, and neonatal mortality after Day 1, as compared with spontaneous vaginal delivery. Conclusions In referral hospitals of Mali and Senegal, pre-labor CS is a safe procedure although intrapartum CS and operative vaginal delivery are associated with increased risks in mothers and infants. Further research is needed to determine what aspects of obstetric care contribute to a delay in the provision of intrapartum interventions so that practices may be made safer when they are needed.
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95
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Abstract
AIM Caesarean section (CS) deliveries have increased, mostly because of patient/obstetrician preference. Although CS decreases the risk of delivery-related injuries, it increases the risk for respiratory and neurological complications. Complication rates are reportedly higher for elective CSs for term infants performed at 37-38 gestational weeks than later. We investigated this difference in an Israeli cohort. METHODS Data on all births in our medical centre during 2007-2009 were reviewed. Those on elective CSs for term infants were retrieved and divided into 'early' (37-38 gestational weeks) or 'late' (week 39 or later) groups whose epidemiological and outcome characteristics were compared. RESULT Of the 12,276 births, 596 were early and 454 were late elective CSs. There were no differences in gender, ethnicity, Apgar score or length of hospital stay. Twenty-six infants from the early group and 11 infants from the late group were transferred to the neonatal intensive care unit. Within them, compared with all elective CSs, the morbidity rate was higher for the former infants than for the latter. CONCLUSION Morbidity was higher among infants who were delivered at 37-38 gestational weeks by elective CS. We recommend postponing elective CSs to ≥39 weeks.
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Affiliation(s)
- Vered Nir
- Department of Neonatology, Hillel Yaffe Medical Center, Hadera, Israel
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96
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Cruz MO, Gao W, Hibbard JU. What is the optimal time for delivery in women with gestational hypertension? Am J Obstet Gynecol 2012; 207:214.e1-6. [PMID: 22831812 DOI: 10.1016/j.ajog.2012.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/10/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the optimal timing of delivery for women with gestational hypertension. STUDY DESIGN A multicenter database that contained 228,668 deliveries was used to extract data on gravidas with gestational hypertension. The week-specific rates of maternal and neonatal morbidity/mortality were calculated after induction of labor. Point wise 95% confidence intervals were calculated around each of these gestational age-specific rates. RESULTS After induction of labor, the rate of maternal morbidity/mortality reached a nadir of 89.9 per 1000 live births (95% confidence interval, 68.1-111.8) at 38-38 6/7 weeks' gestation, although the rate of neonatal morbidity/mortality fell to 10.5 per 1000 live births (95% confidence interval, 2.8-18.2) at 39-39 6/7 weeks. There were only 3 total stillbirths in our study cohort. CONCLUSION In women with gestational hypertension, induction of labor between 38- and 39-weeks' balances the lowest maternal and neonatal morbidity/mortality.
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97
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Abstract
OBJECTIVES To study the maternal risk factors, morbidity, mortality of late preterm in comparison to term neonates. METHODS This Cohort study involved two hundred fifty consecutively born late preterm and equal number of term newborns delivered in a tertiary care hospital. They were followed till discharge for morbidities and mortality. Detailed maternal and neonatal factors were studied and compared between the two groups. RESULTS Late preterm babies constituted 55% of all live preterm births during the study period. The odds of babies developing major morbidity was significantly more in those whose mothers had hypertension and infections (OR 2.69 95% CI: 1.55, 4.68 and 2.08, 95% CI: 1.6, 2.71 respectively). In the study group, 42.4% and 20.8% babies suffered major and minor morbidity compared to 8.4% and 6.8% of term controls respectively. Late preterm neonates had significantly higher odds of developing morbidity like respiratory distress (12.4% vs. 5.6%, OR 2.21, 95%CI 1.21,4.11), need for non invasive(17.3% vs. 5.7%, OR 3.05 95% CI 1.69, 5.47) and invasive ventilation (14.6% vs. 1.7%, OR 8.62, 95% CI 3.09, 24.04), sepsis (20.8% vs. 5.2%, OR 5.20, 95% CI 2.71, 9.99), seizures (22.8% vs. 4.8%, OR 4.75 95%CI 2.61, 8.63), shock (17.6% vs. 4.4%, OR 4.00 95% CI 2.12,7.56), and jaundice (26% vs. 6%, OR 4.33 95%CI 2.54, 7.39). By logistic regression, the odds of developing major morbidity decreased with increasing gestational age (aOR 0.28 95% CI 0.18, 0.45; p < 0.001) and increased with hypertensive disease of pregnancy (aOR 2.16 95% CI 1.09, 4.260; p = 0.026). CONCLUSIONS Late preterm neonates have significantly more mortality and morbidity compared to term controls. Maternal hypertension and lower gestational age are the strongest predictors of morbidity.
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MESH Headings
- Adult
- Case-Control Studies
- Cohort Studies
- Female
- Gestational Age
- Humans
- Hypertension, Pregnancy-Induced
- India/epidemiology
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/therapy
- Logistic Models
- Odds Ratio
- Pregnancy
- Pregnancy Complications
- Pregnancy Complications, Infectious
- Premature Birth
- Prospective Studies
- Risk Factors
- Term Birth
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Affiliation(s)
- P Femitha
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India
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98
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Abstract
It is well recognised that birth before 32 weeks of gestation is associated with substantial neonatal morbidity and mortality and these risks have been extensively reported. The focus of perinatal research for many years has therefore been very preterm and extremely preterm delivery, since the likelihood and severity of adverse neonatal outcomes are highest within this group. In contrast, until recently, more mature preterm infants have been understudied and indeed, almost ignored by researchers.
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99
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Abstract
Late and moderate preterm infants account for >80% of premature births. These newborns experience considerable mortality and morbidity in comparison with full-term born infants. The purpose of this paper is to summarise the most common morbidities of late and moderate preterm infants in the neonatal period, their incidence, severity, risk factors and need for admission to the different levels of care. The recent findings on preventive strategies and management priorities for clinical care of these vulnerable babies are also reviewed.
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100
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Bonneau C, Nizard J. [Management of pregnancies with a previous cesarean]. ACTA ACUST UNITED AC 2012; 41:497-511. [PMID: 22609031 DOI: 10.1016/j.jgyn.2012.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 04/04/2012] [Accepted: 04/10/2012] [Indexed: 11/29/2022]
Abstract
The cesarean rate in France has reached 21% in 2010. With a maintained fertility rate, management of a pregnant woman with a previous caesarean scar is becoming a daily situation for most obstetrical teams. Considering the small rate of vaginal birth after cesarean (VBAC), we will try to establish an up-to-date review of the benefits and risks of encouraging trial of VBAC. This information can help professionals provide adequate counselling women or couples.
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Affiliation(s)
- C Bonneau
- Service de gynécologie obstétrique, UPMC Paris-6, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 83, boulevard de l'Hôpital, 75013 Paris, France
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