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Lia M, Martin M, Költzsch E, Stepan H, Dathan-Stumpf A. Mechanics of vaginal breech birth: Factors influencing obstetric maneuver rate, duration of active second stage of labor, and neonatal outcome. Birth 2024; 51:530-540. [PMID: 38115221 DOI: 10.1111/birt.12808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/16/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND We investigated possible parameters that could predict the need for obstetric maneuvers, the duration of the active second stage of labor (i.e., the duration of active pushing), and short-term neonatal outcome in vaginal breech births. MATERIALS AND METHODS We performed a retrospective analysis of 268 successful singleton vaginal breech births in women without previous vaginal births from January 2015 to August 2022. Multivariable regression was used to investigate associations between maternal and fetal characteristics (including antepartum magnetic resonance (MR) pelvimetry) with obstetric maneuvers, the duration of active second stage of labor, pH values, and admission to the neonatal unit. Models for the prediction of obstetric maneuvers were built and internally validated. RESULTS Obstetric maneuvers were performed in a total of 130 women (48.5%). A total of 32 neonates (11.9%) had to be admitted to the neonatal unit. The intertuberous distance (ITD) (p < 0.001), epidural analgesia (p < 0.001), and birthweight (p = 0.026) were associated with the duration of active second stage of labor. ITD (p = 0.028) and birthweight (p = 0.011) were also independently associated with admission to the neonatal unit, while pH values below 7.10 dropped significantly (p = 0.0034) if ITD was ≥13 cm. Furthermore, ITD (p < 0.001) and biparietal diameter (p = 0.002) were independent predictors for obstetric maneuvers. CONCLUSIONS ITD is independently associated with the duration of active second stage of labor. Thus, it can predict suboptimal birth mechanics in the last stage of birth, which may lead to the need for obstetric maneuvers, lower arterial pH values, and admission to the neonatal unit. Consequently, MR pelvimetry gives additional information for practitioners and birthing people preferring a vaginal breech birth.
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Affiliation(s)
- Massimiliano Lia
- Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
| | - Mireille Martin
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Költzsch
- Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
| | - Anne Dathan-Stumpf
- Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
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Yaouzis Olsson N, Bartfai ED, Åmark H, Wallström T. Outcomes in term breech birth according to intended mode of delivery-A Swedish prospective single-center experience of a dedicated breech birth team. Acta Obstet Gynecol Scand 2024. [PMID: 39129446 DOI: 10.1111/aogs.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION The appropriate mode of delivery for breech babies is a topic of ongoing debate. After the publication of the Term Breech Trial in 2000, the proportion of breech babies delivered vaginally in Sweden rapidly dropped to 7% from 26%. In 2015, international guidelines changed to once again recommend offering vaginal breech deliveries in select cases. In 2017, a Swedish hospital established a dedicated Breech Team to provide safe vaginal breech deliveries according to the new guidelines. The aim of this study is to compare neonatal morbidity in the group planned for cesarean breech delivery with the group planned for vaginal breech delivery treated in accordance with the new guidelines. The study adds to the literature by providing insights into the consequences of reintroducing vaginal breech births in a high-resource health-care setting. MATERIAL AND METHODS A prospective observational study was conducted at Södersjukhuset's maternity ward with 1067 women who gave birth to a single breech fetus at term. Outcomes were compared between the planned vaginal and planned cesarean delivery groups using intention-to-treat analysis and multivariate analysis to control for confounders. RESULTS Out of the 1067 women, 78.9% were planned for cesarean delivery and 21.1% were planned for vaginal delivery. The planned vaginal group had a significantly greater risk for neonatal morbidity compared to the planned cesarean group (3.1% vs. 0.7%; OR 4.44, 95% CI 1.48-13.34). The risk difference remained significant after controlling for confounders. CONCLUSIONS Planned vaginal breech delivery was associated with an increased risk of neonatal mortality and short-term morbidity compared to planned cesarean breech delivery in accordance with the new guidelines. The potential risks and benefits of planned vaginal breech delivery should be carefully weighed against those of planned cesarean delivery.
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Affiliation(s)
- Nicolas Yaouzis Olsson
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Emma Debora Bartfai
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Åmark
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Tove Wallström
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
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Jennewein L, Agel L, Hoock SC, Hentrich AE, Louwen F, Zander N. Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT cohort study. Arch Gynecol Obstet 2024; 310:285-292. [PMID: 38498162 PMCID: PMC11168971 DOI: 10.1007/s00404-024-07403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Obesity is a worldwide and growing issue affecting women in childbearing age, complicating surgical procedures as well as pregnancy. Through a reduction of not necessarily required cesarean deliveries-for instance in pregnancies with breech presentation-obesity mediated and surgery-associated morbidity might be contained. Date on the impact of maternal BMI in vaginally attempted breech delivery is not existing. To give insight into whether an elevated BMI leads to an increased perinatal morbidity in vaginally intended deliveries out of breech presentation, we analyzed delivery outcome of laboring women with a singleton baby in breech presentation with overweight and obesity (BMI ≥ 25 kg/m2) in comparison to women with a BMI of below 25 kg/m2. METHODS Based on data from January 2004 to December 2020, a cohort study was performed on 1641 women presenting with breech presentation at term (> 37 weeks). The influence of maternal BMI on perinatal outcome was analyzed with Chi2 testing for group differences and logistic regression analysis. Patients with a hyperglycemic metabolism were excluded from the study. RESULTS Fetal morbidity was not different when patients with a BMI of ≥ 25 kg/m2 (PREMODA morbidity score 2.16%) were compared to patients with a BMI of below 25 kg/m2 (1.97%, p = 0.821). Cesarean delivery rates were significantly higher in overweight and obese women with 43.9% compared to 29.3% (p < 0.0001). BMI and cesarean delivery were significantly associated in a logistic regression analysis (Chi2 coefficient 18.05, p < 0.0001). In successful vaginal deliveries out of breech presentation, maternal perineal injury rates (vaginal birth in normal-BMI women 48.4%; vaginal birth in overweight and obese women: 44.2%; p = 0.273) and rates of manually assisted delivery (vaginal birth in normal-BMI women: 44.4%; vaginal birth in obese and overweight women: 44.2%; p = 0.958) were not different between BMI groups. CONCLUSIONS Obesity and overweight are not associated with peripartum maternal or newborn morbidity in vaginally attempted breech delivery, if the patient cohort is thoroughly selected and vaginal breech delivery is in an upright maternal position. Reduction of cesarean delivery rates, especially in overweight and obese women might, have an important positive impact on maternal and newborn morbidity.
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Affiliation(s)
- Lukas Jennewein
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany.
| | - Lena Agel
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Samira Catharina Hoock
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Anna Elisabeth Hentrich
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Frank Louwen
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Nadja Zander
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
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Schafer R, Dietrich MS, Kennedy HP, Mulvaney S, Phillippi JC. "I had no choice": A mixed-methods study on access to care for vaginal breech birth. Birth 2024; 51:413-423. [PMID: 37968839 DOI: 10.1111/birt.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Although current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision-making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth. METHODS We conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty-five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi-structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care. RESULTS Of 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision-making (n = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt "backed into a corner" and "forced into homebirth," perceiving a lack of access to safe and respectful care in the hospital system. CONCLUSION Some service users believe that home birth is their only option when they cannot access hospital-based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk.
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Affiliation(s)
- Robyn Schafer
- Division of Advanced Nursing Practice, School of Nursing, Rutgers University, Newark, New Jersey, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Shelagh Mulvaney
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
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Alves ÁLL, Nozaki AM, Polido CBA, da Silva LB, Knobel R. Breech birth care: Number 1 - 2024. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgofps1. [PMID: 38765529 PMCID: PMC11075396 DOI: 10.61622/rbgo/2024fps01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Álvaro Luiz Lage Alves
- Universidade Federal de Minas Gerais Hospital das Clínicas Belo HorizonteMG Brazil Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alexandre Massao Nozaki
- Hospital do Servidor Público Municipal São PauloSP Brazil Hospital do Servidor Público Municipal, São Paulo, SP, Brazil
| | - Carla Betina Andreucci Polido
- Universidade Federal de São Carlos Faculdade de Medicina São CarlosSP Brazil Faculdade de Medicina, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Lucas Barbosa da Silva
- Hospital das Clínicas São SebastiãoSP Brazil Hospital das Clínicas, São Sebastião, SP, Brazil
| | - Roxana Knobel
- Universidade Federal de Santa Catarina Faculdade de Medicina FlorianópolisSC Brazil Faculdade de Medicina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Shabani J, Masanja H, Kagoye S, Minja J, Bajaria S, Mlacha Y, Msuya S, Masoud M, Simba D, Pembe AB, Makuwani AM, Ismail H, Chacha M, Kumalija C, Boerma T, Hanson C. Quality of reporting and trends of emergency obstetric and neonatal care indicators: an analysis from Tanzania district health information system data between 2016 and 2020. BMC Pregnancy Childbirth 2023; 23:716. [PMID: 37805475 PMCID: PMC10559477 DOI: 10.1186/s12884-023-06028-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/24/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Routine health facility data provides the opportunity to monitor progress in quality and uptake of health care continuously. Our study aimed to assess the reliability and usefulness of emergency obstetric care data including temporal and regional variations over the past five years in Tanzania Mainland. METHODS Data were compiled from the routine monthly district reports compiled as part of the health management information systems for 2016-2020. Key indicators for maternal and neonatal care coverage, emergency obstetric and neonatal complications, and interventions indicators were computed. Assessment on reliability and consistency of reports was conducted and compared with annual rates and proportions over time, across the 26 regions in of Tanzania Mainland and by institutional delivery coverage. RESULTS Facility reporting was near complete with 98% in 2018-2020. Estimated population coverage of institutional births increased by 10% points from 71.2% to 2016 to 81.7% in 2020 in Tanzania Mainland, driven by increased use of dispensaries and health centres compared to hospitals. This trend was more pronounced in regions with lower institutional birth rates. The Caesarean section rate remained stable at around 10% of institutional births. Trends in the occurrence of complications such as antepartum haemorrhage, premature rupture of membranes, pre-eclampsia, eclampsia or post-partum bleeding were consistent over time but at low levels (1% of institutional births). Prophylactic uterotonics were provided to nearly all births while curative uterotonics were reported to be used in less than 10% of post-partum bleeding and retained placenta cases. CONCLUSION Our results show a mixed picture in terms of usefulness of the District Health Information System(DHIS2) data. Key indicators of institutional delivery and Caesarean section rates were plausible and provide useful information on regional disparities and trends. However, obstetric complications and several interventions were underreported thus diminishing the usefulness of these data for monitoring. Further research is needed on why complications and interventions to address them are not documented reliably.
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Affiliation(s)
| | | | - Sophia Kagoye
- National Institute for Medical Research, Mwanza, Tanzania
| | | | | | | | - Sia Msuya
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | | | - Daudi Simba
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea B Pembe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | | | | | | | - Claudia Hanson
- London School of Hygiene & Tropical Medicine, London, UK
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Johnson DL, Carlo WA, Rahman AKMF, Tindal R, Trulove SG, Watt MJ, Travers CP. Health Insurance and Differences in Infant Mortality Rates in the US. JAMA Netw Open 2023; 6:e2337690. [PMID: 37831450 PMCID: PMC10576209 DOI: 10.1001/jamanetworkopen.2023.37690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
Importance Health insurance status is associated with differences in access to health care and health outcomes. Therefore, maternal health insurance type may be associated with differences in infant outcomes in the US. Objective To determine whether, among infants born in the US, maternal private insurance compared with public Medicaid insurance is associated with a lower infant mortality rate (IMR). Design, Setting, and Participants This cohort study used data from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research expanded linked birth and infant death records database from 2017 to 2020. Hospital-born infants from 20 to 42 weeks of gestational age were included if the mother had either private or Medicaid insurance. Infants with congenital anomalies, those without a recorded method of payment, and those without either private insurance or Medicaid were excluded. Data analysis was performed from June 2022 to August 2023. Exposures Private vs Medicaid insurance. Main Outcomes and Measures The primary outcome was the IMR. Negative-binomial regression adjusted for race, sex, multiple birth, any maternal pregnancy risk factors (as defined by the CDC), education level, and tobacco use was used to determine the difference in IMR between private and Medicaid insurance. The χ2 or Fisher exact test was used to compare differences in categorical variables between groups. Results Of the 13 562 625 infants included (6 631 735 girls [48.9%]), 7 327 339 mothers (54.0%) had private insurance and 6 235 286 (46.0%) were insured by Medicaid. Infants born to mothers with private insurance had a lower IMR compared with infants born to those with Medicaid (2.75 vs 5.30 deaths per 1000 live births; adjusted relative risk [aRR], 0.81; 95% CI, 0.69-0.95; P = .009). Those with private insurance had a significantly lower risk of postneonatal mortality (0.81 vs 2.41 deaths per 1000 births; aRR, 0.57; 95% CI, 0.47-0.68; P < .001), low birth weight (aRR, 0.90; 95% CI, 0.85-0.94; P < .001), vaginal breech delivery (aRR, 0.80; 95% CI, 0.67-0.96; P = .02), and preterm birth (aRR, 0.92; 95% CI, 0.88-0.97; P = .002) and a higher probability of first trimester prenatal care (aRR, 1.24; 95% CI, 1.21-1.27; P < .001) compared with those with Medicaid. Conclusions and Relevance In this cohort study, maternal Medicaid insurance was associated with increased risk of infant mortality at the population level in the US. Novel strategies are needed to improve access to care, quality of care, and outcomes among women and infants enrolled in Medicaid.
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Affiliation(s)
- Desalyn L. Johnson
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | | | | | - Sarah G. Trulove
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Mykaela J. Watt
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Colm P. Travers
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
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Sananès J, Pire S, Feki A, Boulvain M, Faltin DL. Antenatal, Intrapartum and Postpartum Interventions for Preventing Postpartum Urinary and Faecal Incontinence: An Umbrella Overview of Cochrane Systematic Reviews. J Clin Med 2023; 12:6037. [PMID: 37762976 PMCID: PMC10531825 DOI: 10.3390/jcm12186037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Post-partum, women can suffer from urinary and faecal incontinence. It is important to assess interventions to prevent this problem. Cochrane systematic reviews summarize the data available from systematic reviews of randomized trials assessing interventions. We conducted an umbrella overview of Cochrane systematic reviews encompassing antenatal, intrapartum and postpartum interventions for preventing postpartum urinary and faecal incontinence. We searched the Cochrane Database of Systematic Reviews on the 9 May 2023. Results: Our search identified nine Cochrane reviews providing results. Data for urinary and faecal incontinence were available from 77 (72%) trials and included 51,113 women. The reviews assessed antenatal digital perineal massage, pelvic floor muscle training, techniques for repairing anal sphincter tears, routine use of episiotomy, use of endoanal ultrasound prior to repairing perineal tears, caesarean versus vaginal delivery (overall, for breech and for twins), and vaginal delivery with forceps or vacuum. Only the use of a vacuum instead of forceps if an assisted vaginal delivery is needed, the use of an endo-anal ultrasound prior to repairing perineal tears and postpartum pelvic floor muscle training suggest a reduction in postpartum incontinence. Due to the small number of relevant reviews, a consequence of the relatively small number of primary studies, the effect of almost all the tested interventions was found to be imprecise.
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Affiliation(s)
- Juliette Sananès
- Department of Obstetrics and Gynecology, HFR—Cantonal Hospital of Fribourg, 1752 Villars-sur-Glânes, Switzerland
| | - Sophie Pire
- Department of Obstetrics and Gynecology, HFR—Cantonal Hospital of Fribourg, 1752 Villars-sur-Glânes, Switzerland
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR—Cantonal Hospital of Fribourg, 1752 Villars-sur-Glânes, Switzerland
| | - Michel Boulvain
- Department of Obstetrics and Gynecology, HFR—Cantonal Hospital of Fribourg, 1752 Villars-sur-Glânes, Switzerland
| | - Daniel L. Faltin
- Department of Obstetrics and Gynecology, HFR—Cantonal Hospital of Fribourg, 1752 Villars-sur-Glânes, Switzerland
- Centre de Périnéologie Dianuro Geneva, 1227 Carouge, Switzerland
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Azimirad A. What to do when it is breech? A state-of-the-art review on management of breech presentation. World J Obstet Gynecol 2023; 12:1-10. [DOI: 10.5317/wjog.v12.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/15/2022] [Accepted: 12/14/2022] [Indexed: 01/20/2023] Open
Abstract
Any non-cephalic presentation in a fetus is regarded as malpresentation. The most common malpresentation, breech, contributes to 3%-5% of term pregnancies and is a leading indication for cesarean delivery. Identification of risk factors and a proper physical examination are beneficial; however, ultrasound is the gold standard for the diagnosis of malpresentations. External cephalic version (ECV) refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation. This procedure is performed manually through the mother’s abdomen by a trained health care provider, to reduce the likelihood of a cesarean section. Studies have reported a version success rate of above 50% by ECV. The main objective of this review is to present a broad perspective on fetal malpresentation, ECV, and delivery of a breech fetus. The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them. After discussing breech prevalence, risk factors, diagnosis, and management, an updated review of ECV is presented. Moreover, ECV indications/contraindications, alternatives, clinical techniques on how to perform ECV and breech vaginal delivery, and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.
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Affiliation(s)
- Afshin Azimirad
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA 02111, United States
- Diabetes Clinical Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
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10
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Schauer M, Latartara E, Alonso-Espias M, Rossetti E, Gebert P, Henrich W, Hinkson L. Depression, anxiety and stress in women with breech pregnancy compared to women with cephalic presentation-a cross-sectional study. Arch Gynecol Obstet 2023; 307:409-419. [PMID: 35344082 PMCID: PMC9918572 DOI: 10.1007/s00404-022-06509-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to evaluate the level of psychological distress for women with breech compared to cephalic presentation. We hypothesized, that women with breech presentation have higher levels of depression, stress and anxiety. Secondary objectives were to analyze potential demographic risk factors and comorbidity of psychological distress in breech pregnancy. METHODS The breech study group was formed by 379 women with breech presentation. A sample of 128 women with cephalic presentation was recruited during routine clinical care. Depression, anxiety and stress symptoms were ascertained by means of the Depression-Anxiety-Stress-Score (DASS)-21 questionnaire. Categorial data was analyzed with Chi-square or exact test, continuous data with unpaired t test or Mann-Whitney U test. Demographic risk factors were identified using a binary logistic regression model. RESULTS Prevalence of psychological distress among women with breech was not higher compared to those of other pregnant women. Symptomatic depression, anxiety and stress affected 5.8%, 14.5% and 11.9% of women with breech, respectively. Decreasing age was identified as a risk factor for anxiety (p = 0.006). Multiparity increased risk for depression (p = 0.001), for anxiety (p = 0.026) and for perinatal stress (p = 0.010). More than 80% of women with depressive symptoms had comorbidities of psychological distress. CONCLUSIONS Breech presentation compared to cephalic presentation was not associated with higher levels of psychological distress. However, breech pregnancies are affected by symptoms of potential mental disorder. Multiparous women and younger women may need additional support and would benefit from a standardized screening tool for the assessment of perinatal psychological distress. CLINICAL TRIAL REGISTRATION Ethical approval (EA2/241/18) was granted by the Ethics Commission of the Charité University Hospital on the 23.01.2019 (ClinicalTrials.gov Identifier: NCT03827226).
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Affiliation(s)
- Madeleine Schauer
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
| | - Elisabetta Latartara
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
- Università Cattolica del Sacro Cuore Largo Francesco Vito, Rome, Italy
| | - Maria Alonso-Espias
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
- La Paz University Hospital, Madrid, Spain
| | - Emma Rossetti
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
- University of Udine, Udine, Italy
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
| | - Larry Hinkson
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany.
- , 8. Floor, Bettenhochhaus, Campus Mitte, Chariteplatz 1, 10117, Berlin, Germany.
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11
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Dathan-Stumpf A, Hausmann C, Thome U, Stepan H. Neonatal admission rate after vaginal breech delivery. J Perinat Med 2022; 50:1248-1255. [PMID: 35844089 DOI: 10.1515/jpm-2022-0202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The safest mode of delivery for fetuses in breech presentations is still an ongoing debate. The aim of this study was to analyze neonatal admission rates after vaginal breech delivery and compare it to other modes of delivery in order to counsel pregnant women with breech presentation adequately. METHODS We performed a retrospective monocentric analysis of all deliveries with singleton pregnancies in breech presentation > 36.0 weeks of gestation between 01/2018-12/2019. Short-term neonatal morbidity data was collected for vaginal delivery and primary as well as secondary cesarean sections from breech presentations. RESULTS A total of n=41/482 (8.5%) neonates had to be admitted to NICU: vaginal breech delivery n=18/153 (11.8%), primary cesarean section n=9/101 (8.9%, OR 0.73; CI 0.32-1.70; p=0.47), secondary cesarean section n=10/76 (13.2%, OR 1.14; CI 0.50-2.60, p=0.76) and vaginal vertex delivery n=4/152 (2.6%, OR 0.20; CI 0.06-0.51; p=0.005). There was no significant difference in transfer to NICU between all breech position delivery modes. Despite significantly lower pH and 5' APGAR values after vaginal delivery, neonates delivered by primary cesarean section and NICU admission had to be treated there significantly longer (mean 80.9 vs. 174.0 h). No significant difference in terms of ventilation parameters and infections were found between the vaginal delivery, primary and secondary cesarean section from breech presentation. CONCLUSIONS Vaginal breech delivery does not result in a higher neonatal admission rate in comparison to primary and secondary section. In contrast, there is a shorter NICU duration in case of neonatal admission after vaginal delivery.
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Affiliation(s)
| | | | - Ulrich Thome
- Department of Neonatology, University Hospital, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University Hospital, Leipzig, Germany
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12
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Fernández-Carrasco FJ, Cristóbal-Cañadas D, Gómez-Salgado J, Vázquez-Lara JM, Rodríguez-Díaz L, Parrón-Carreño T. Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: A systematic review and meta-analysis. J Glob Health 2022; 12:04055. [PMID: 35976004 PMCID: PMC9284475 DOI: 10.7189/jogh.12.04055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies. Methods Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity. Results The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group. Conclusions An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.
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Affiliation(s)
- Francisco J Fernández-Carrasco
- Department of Gynaecology and Obstetrics, Punta de Europa Hospital, Cádiz, Spain
- Nursing and Physiotherapy Department, Faculty of Nursing, University of Cádiz, Algeciras, Spain
| | - Delia Cristóbal-Cañadas
- Neonatal and Paediatric Intensive Care Unit, Torrecárdenas University Hospital, Almeria, Spain
| | - Juan Gómez-Salgado
- Department of Gynaecology and Obstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
- Safety and Health Postgraduate Programme, Espíritu Santo University, Guyaquil, Ecuador
| | - Juana M Vázquez-Lara
- Department of Gynaecology and Obbstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
| | - Luciano Rodríguez-Díaz
- Department of Gynaecology and Obbstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
| | - Tesifón Parrón-Carreño
- School of Health Sciences, University of Almeria, Almeria, Spain
- Territorial Delegation of Equality, Health and Social Policies, Health Delegation of Almeria, Almeria, Spain
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13
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A prospective study using an individualized nomogram to predict the success rate of external cephalic version. Sci Rep 2022; 12:11795. [PMID: 35821248 PMCID: PMC9276686 DOI: 10.1038/s41598-022-16112-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/05/2022] [Indexed: 12/03/2022] Open
Abstract
To establish a clinical-based nomogram for predicting the success rate of external cephalic version (ECV) through a prospective study. This was a single-center prospective study that collected eligible breech pregnant women. 152 participants were enrolled in the training cohort, who received ECV procedures performed by a single operator. We used the training cohort to establish regression equations and prediction models. These variables include maternal factors (age, operation gestational age, pre-pregnancy BMI (Body Mass Index), operation BMI, BMI increase, multipara), ultrasound factors (fetal weight estimation, amniotic fluid index, placental location, type of breech presentation, spinal position), and anesthesia. Univariate and multivariable analyses were used to screen the factors affecting the success of ECV. A nomogram scoring model was established based on these factors. And C-index, DCA (Decision Curve Analysis) and calibration curve, Hosmer–Lemeshow test was used to verify the prediction effect of the model. Finally, 33 participants were enrolled in the testing cohort who received ECV with an unrestricted operator. We used C-index, DCA (decision curve analysis), and Hosmer–Lemeshow to verify the application value of the prediction model. The calibration curves and ROC curves of both the training cohort and testing cohort are plotted for internal and external validation of the model. The ECV success rate of the training cohort was 62.5%. Univariate analysis showed that the predictors related to the success rate of ECV were age, BMI increase value, AFI (amniotic fluid index), breech type, placental location, spinal position, anesthesia, and multipara. The prediction thresholds of the corresponding indexes were calculated according to the Youden index. Multivariate logistic regression analysis showed that BMI increase ≥ 3.85 kg/m2, AFI ≥ 10.6 cm, anesthesia, multipara, and non-anterior placenta were independent predictors of ECV success. Through the internal and external validation, it is confirmed that the model has a good calibration and prediction ability. Our nomogram has a good ability to predict the success rate of ECV.
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Colomar M, Colistro V, Sosa C, de Francisco LA, Betrán AP, Serruya S, De Mucio B. Cesarean section in Uruguay from 2008 to 2018: country analysis based on the Robson classification. An observational study. BMC Pregnancy Childbirth 2022; 22:471. [PMID: 35672663 PMCID: PMC9175367 DOI: 10.1186/s12884-022-04792-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of caesarean section has steadily increased, with Latin America being the region with the highest rates. Multiple factors account for that increase and the Robson classification is appropriate to compare determinants at the clinical level for caesarean section rates over time. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database. Methods We included the records of all women giving birth in Uruguay (pregnancies ≥22 weeks and weights ≥500 g) with valid data in the mode of childbirth recorded in the Perinatal Information System database between 2008 and 2018. Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital), with time trends and their significance analyzed using linear regression models. Results Of the total 485,263 births included in this research, the overall caesarean section rate was 43,1%. In 2018, among the groups at lower risk of caesarean section (1 to 4), the highest rates were seen in women in group 2B (98,8%), followed by those in group 4B (97,9%). A significant increase in the number of caesarean sections was seen in groups 2B (97,9 to 98,8%), 3 (8,36 to 11,1%) and 4 (A (22,7 to 26,9%) and B (95,4 to 97,9%) Significant growth was also observed in groups 5 (74,3 to 78,1%), 8 (90,6 to 95,5%), and 10 (39,1 to 46,7%). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section (1, 2A, 3 and 4A), followed by the private sector outside of the capital. Conclusion Uruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04792-y.
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Affiliation(s)
- Mercedes Colomar
- Montevideo Clinical and Epidemiological Research Unit, Montevideo, Uruguay. .,Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), PAHO/WHO, Montevideo, Uruguay.
| | - Valentina Colistro
- Department of Quantitative Methods, School of Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Claudio Sosa
- Department of Obstetrics and Gynecology, Pereira Rossell Hospital, School of Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Luis Andres de Francisco
- Family, Health Promotion and Life Course, Pan American Health Organization, World Health Organization, Washington, United States
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Suzanne Serruya
- Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), PAHO/WHO, Montevideo, Uruguay
| | - Bremen De Mucio
- Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), PAHO/WHO, Montevideo, Uruguay
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15
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Fuxe V, Brismar Wendel S, Bohm-Starke N, Mühlrad H. Delivery mode and severe maternal and neonatal morbidity among singleton term breech births: A population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2022; 272:166-172. [PMID: 35325690 DOI: 10.1016/j.ejogrb.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between delivery mode and severe maternal and neonatal morbidity in singleton term breech births. STUDY DESIGN This nationwide population-based cohort study includes 41 319 singleton term and post-term breech births (37 + 0-42 + 6 gestational weeks) in Sweden from 1998 to 2016. Data was retrieved from the Swedish Medical Birth Register. The primary outcomes were two separate composite outcomes, maternal and neonatal severe morbidity. Secondary outcomes were separate severe maternal and neonatal morbidity outcomes. Hospitalization and out-patient visits during childhood were also analyzed in ages 0-5 years. Logistic regression was used to estimate unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals (CI) of severe maternal and neonatal morbidity in women with vaginal breech birth or intrapartum cesarean section. Women with a prelabor breech cesarean section was used as the reference group. RESULTS No difference between vaginal delivery and prelabor cesarean section was seen regarding maternal morbidity. Intrapartum cesarean section was associated with elevated odds for maternal morbidity (aOR 1.27, 95% CI 1.10-1.47) compared with prelabor cesarean section. A similar result was observed for vaginal delivery and intrapartum cesarean section combined (aOR 1.29, 95% CI 1.11-1.50). Vaginal delivery was associated with higher odds for composite neonatal morbidity (aOR 1.85, CI 1.54-2.21) and most separate outcomes, as well as increased number of hospital nights and out-patient visits during first year of life, compared with prelabor cesarean section. CONCLUSIONS Prelabor cesarean section in breech births improved short-term neonatal health without increasing risks for severe maternal short-term complications.
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Affiliation(s)
- Vendela Fuxe
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, S-182 88 Stockholm, Sweden
| | - Sophia Brismar Wendel
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, S-182 88 Stockholm, Sweden
| | - Nina Bohm-Starke
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, S-182 88 Stockholm, Sweden
| | - Hanna Mühlrad
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, S-182 88 Stockholm, Sweden; The Institute for Evaluation of Labor Market and Education Policy (IFAU), S-751 20 Uppsala, Sweden.
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16
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Walker S, Dasgupta T, Shennan A, Sandall J, Bunce C, Roberts P. Development of a core outcome set for effectiveness studies of breech birth at term (Breech-COS)—an international multi-stakeholder Delphi study: study protocol. Trials 2022; 23:249. [PMID: 35379305 PMCID: PMC8978154 DOI: 10.1186/s13063-022-06136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Women pregnant with a breech-presenting foetus at term are at increased risk of adverse pregnancy outcomes. The most common intervention used to improve neonatal outcomes is planned delivery by caesarean section. But this is not always possible, and some women prefer to plan a vaginal birth. A number of providers have proposed alternative interventions, such as delivery protocols or specialist teams, but heterogeneity in reported outcomes and their measurements prevents meaningful comparisons. The aim of this paper is to present a protocol for a study to develop a Breech Core Outcome Set (Breech-COS) for studies evaluating the effectiveness of interventions to improve outcomes associated with term breech birth.
Methods
The development of a Breech-COS includes three phases. First, a systematic literature review will be conducted to identify outcomes previously used in effectiveness studies of breech birth at term. A focus group discussion will be conducted with the study’s pre-established Patient and Public Involvement (PPI) group, to enable service user perspectives on the results of the literature review to influence the design of the Delphi survey instrument. Second, an international Delphi survey will be conducted to prioritise outcomes for inclusion in the Breech-COS from the point of view of key stakeholders, including perinatal care providers and families who have experienced a term breech pregnancy. Finally, a consensus meeting will be held with stakeholders to ratify the Breech-COS and disseminate findings for application in future effectiveness studies.
Discussion
The expectation is that the Breech-COS will always be collected in all clinical trials, audits of practice and other forms of observation research that concern breech birth at term, along with other outcomes of interest. This will facilitate comparing, contrasting and combining studies with the ultimate goal of improved maternal and neonatal outcomes.
Trial registration
Core Outcome Measures in Effectiveness Trials (COMET) #1749
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17
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Caesarean delivery and its association with educational attainment, wealth index, and place of residence in Sub-Saharan Africa: a meta-analysis. Sci Rep 2022; 12:5554. [PMID: 35365718 PMCID: PMC8975863 DOI: 10.1038/s41598-022-09567-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
Caesarean delivery (C-section) has been increasing worldwide; however, many women from developing countries in Sub-Saharan Africa are deprived of these lifesaving services. This study aimed to explore the impact of certain socioeconomic factors, including respondent's education, husband's education, place of residence, and wealth index, on C-section delivery for women in Sub-Saharan Africa. We used pooled data from 36 demographic and health surveys (DHS) in Sub-Saharan Africa. Married women aged 15-49 years who have at least one child in the last five years were considered in this survey. After inclusion and excluding criteria, 234,660 participants were eligible for final analysis. Binary logistic regression was executed to determine the effects of selected socioeconomic factors. The countries were assembled into four sub-regions (Southern Africa, West Africa, East Africa, and Central Africa), and a meta-analysis was conducted. We performed random-effects model estimation for meta-analysis to assess the overall effects and consistency between covariates and utilization of C-section delivery as substantial heterogeneity was identified (I2 > 50%). Furthermore, the meta-regression was carried out to explain the additional amount of heterogeneity by country levels. We performed a sensitivity analysis to examine the effects of outliers in this study. Findings suggest that less than 15% of women in many Sub-Saharan African countries had C-section delivery. Maternal education (OR 4.12; CI 3.75, 4.51), wealth index (OR 2.05; CI 1.94, 2.17), paternal education (OR 1.71; CI 1.57, 1.86), and place of residence (OR 1.51; CI 1.44, 1.58) were significantly associated with the utilization of C-section delivery. These results were also consistent in sub-regional meta-analyses. The meta-regression suggests that the total percentage of births attended by skilled health staff (TPBASHS) has a significant inverse association with C-section utilization regarding educational attainment (respondent & husband), place of residence, and wealth index. The data structure was restricted to define the distinction between elective and emergency c-sections. It is essential to provide an appropriate lifesaving mechanism, such as C-section delivery opportunities, through proper facilities for rural, uneducated, impoverished Sub-Saharan African women to minimize both maternal and infant mortality.
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18
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Levin G, Cahan T, Weill Y, Axelrod M, Pollack RN, Meyer R. Ritodrine versus salbutamol for external cephalic version. Minerva Obstet Gynecol 2022; 74:337-342. [PMID: 35107244 DOI: 10.23736/s2724-606x.22.05035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Treatment with beta-agonist tocolytics preceding external cephalic version (ECV) attempt increases success rates. Most studies have focused on intravenously and orally administered beta-agonists, while other administration routes including intramuscularly (IM) and subcutaneously (SC) are understudied. We aimed to compare the efficacy of IM ritodrine to SC salbutamol given prior to ECV. METHODS A retrospective study of patients who underwent ECV between 1/2012 and 12/2019 at two medical centers. We compared patients undergoing ECV following IM ritodrine versus SC salbutamol. We matched the two groups by parity and placental location. Maternal, pregnancy, ECV procedure and neonatal characteristics were compared. RESULTS Overall, 601 women were included in each group. Median maternal age and amniotic fluid index (AFI) were lower in the Ritodrine group (27 vs. 32 years, p<0.001, 11 vs. 15 AFI cm, p<0.001, respectively). The median gestational age at ECV was higher in the Ritodrine group (380/7 vs. 370/7 weeks gestation). Success rate was higher in the Ritodrine group (71.7% vs. 63.8%, p=0.003). Vaginal delivery rate was higher in the Ritodrine group (70.7% vs. 60.1%, p<0.001). The number needed to treat to benefit was 10. In a multivariate analysis, Ritodrine was independently associated with higher ECV success rates as compared with Salbutamol (aOR 2.1, 95%CI 1.52-2.89). CONCLUSIONS Intramuscular ritodrine significantly improved the success rate of ECV compared to SC salbutamol, and both drugs were safe and acceptable before ECV.
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Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel -
| | - Tal Cahan
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Tel-Aviv University, Tel-Aviv, Israel
| | - Yishay Weill
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michal Axelrod
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Tel-Aviv University, Tel-Aviv, Israel
| | - Raphael N Pollack
- Department of Obstetrics and Gynecology, Meuhedet HMO, Jerusalem, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Tel-Aviv University, Tel-Aviv, Israel
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Morris SE, Sundin D, Geraghty S. Women’s experiences of breech birth decision making: An integrated review. Eur J Midwifery 2022; 6:2. [PMID: 35118350 PMCID: PMC8784975 DOI: 10.18332/ejm/143875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Currently, caesarean section is the primary mode of birth for a breech presenting fetus, leading to a deskilling of clinicians and limitation of birth choices for women. The aim of this review is to present a synthesized summary of existing literature related to women’s experiences of breech birth mode decision-making. METHODS A systematic search of the literature was conducted in April 2021, utilizing five databases to identify and obtain peer-reviewed articles meeting the predetermined selection criteria. RESULTS Four major categories were synthesized from the integrated review: 1) Women who desire a vaginal birth may experience a range of negative emotions such as feelings of disempowerment, loss, uncertainty and a sense of isolation; 2) Women who experience a breech presentation at term experience significant pressures to conform to expectations of medical professionals and their families due to perceptions of risk related to breech birth; 3) Breech birth decision-making in a limiting system; and 4) Overall satisfaction with the decision to plan a vaginal breech birth. CONCLUSION Women with a breech presenting fetus at term experience a complex range of emotions and internal and external pressures due to perceptions of risk around breech birth. Midwives were seen as helpful throughout the breech experience. The reduced caesarean section rate for breech, observed in studies exploring specialized care pathways or dedicated services, could reduce the incidence of Severe Acute Maternal Morbidity.
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Affiliation(s)
- Sara E. Morris
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
- King Edward Memorial Hospital, Perth, Australia
| | - Deborah Sundin
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Sadie Geraghty
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
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20
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Lin J, Yuan S, Dong B, Zhang J, Zhang L, Wu J, Chen J, Tang M, Zhang B, Wang H, Dai Y, Liu S, Hu Y, Qi X, Xu L, Zhao L, Yin Y. The Associations of Caesarean Delivery With Risk of Wheezing Diseases and Changes of T Cells in Children. Front Immunol 2022; 12:793762. [PMID: 34970272 PMCID: PMC8712489 DOI: 10.3389/fimmu.2021.793762] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to assess the associations of caesarean delivery (CD) with risk of wheezing diseases and changes of immune cells in children. Design The cross-sectional study was conducted between May, 2020 and April, 2021. Setting and participants The study was conducted in Shanghai Children’s Medical Center, Shanghai, China. A total of 2079 children with a mean age of 36.97 ± 40.27 months and their guardians were included in the present study via face-to-face inquiry and physical examination by clinicians. Methods Logistic regression was applied to estimate odds ratio (ORs) and 95% confidence intervals (CIs) for the association between CD and first episode of wheezing (FEW) or asthma. Models were adjusted for premature or full-term delivery, exclusive breastfeeding (at least 4 months) or not. Results Among the 2079 children, 987 children (47.47%) were born by CD and 1092 (52.53%) by vaginal delivery (VD). Children delivered by caesarean had significantly lower gestational age (P<0.01) compared with those who delivered vaginally. Our results also showed that CD was related to increased risk of FEW by the age of 3(adjusted OR 1.50, 95%CI 1.06, 2.12) and increased tendency to develop asthma by the age of 4 (adjusted OR 3.16, 95%CI 1.25, 9.01). The subgroup analysis revealed that the negative effects of CD on asthma were more obvious in children without exclusive breastfeeding (adjusted OR 4.93, 95%CI 1.53, 21.96) or without postnatal smoking exposure (adjusted OR 3.58, 95%CI 1.20, 13.13). Furthermore, compared with children born through VD, a significant change of the T cells (increased proportion of CD4+ T cells and decreased number and proportion of CD8+ T cells) were observed before the age of one in the CD group. However, the changes were insignificant in children over 1 year old. Conclusions This study showed age-dependent associations of CD with asthma and FEW in offspring. Moreover, CD appeared to have an effect on the cellular immunity in infants, the disorder of which may contribute to the development of asthma in children.
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Affiliation(s)
- Jilei Lin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuhua Yuan
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Dong
- Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
| | - Jing Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jinhong Wu
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiande Chen
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mingyu Tang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Zhang
- Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
| | - Hansong Wang
- Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
| | - Yuanyuan Dai
- Department of Neonatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinyi Qi
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liangye Xu
- Department of information, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liebin Zhao
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
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21
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Slavov SS. Malpresentation of the Fetus in Singleton Pregnancies after In Vitro Fertilization. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: There are some data in the literature that show an increased incidence of breech presentation and other non-cephalic presentations in vitro fertilization (IVF) singleton pregnancies compared to spontaneous ones.
AIM: The purpose of our study was to compare IVF and spontaneous singleton pregnancies in terms of frequency of breech presentation and its impact on the mode of delivery. Furthermore, we wanted to study the rate of transverse and oblique lie in both groups.
MATERIALS AND METHODS: We conducted a prospective and retrospective study at “Maichin Dom” University Hospital in Sofia, Bulgaria for the period from January 2013 to December 2017 and analyzed 402 singleton IVF pregnancies and compared them with 523 spontaneous singleton pregnancies. The primary outcome was a breech presentation of the fetus.
RESULTS: We found a significantly higher rate of breech presentation in IVF compared to spontaneous pregnancies (p < 0.001). According to gestational age, the difference between the groups persisted when the pregnancy was at least the 32nd week of gestation. We found no difference in the frequency of vaginal birth in the two groups when the fetus was in breech presentation
CONCLUSION: IVF singleton pregnancies are associated with a higher risk of breech presentation. Further research is needed to determine the factors contributing to the higher incidence of breech presentation among patients undergoing IVF.
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22
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Liao JA, Shao SC, Chang CT, Chai PYC, Owang KL, Huang TH, Yang CH, Lee TJ, Chen YC. Correction of Breech Presentation with Moxibustion and Acupuncture: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2021; 9:healthcare9060619. [PMID: 34067379 PMCID: PMC8224784 DOI: 10.3390/healthcare9060619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022] Open
Abstract
Acupuncture-type interventions (such as moxibustion and acupuncture) at Bladder 67 (BL67, Zhiyin point) have been proposed to have positive effects on breech presentation. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of moxibustion and acupuncture in correcting breech presentation. We searched PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Electronic Periodical Services (CEPS), and databases at ClinicalTrials.gov to identify relevant randomized controlled trials (RCTs). In this study, sixteen RCTs involving 2555 participants were included. Compared to control, moxibustion significantly increased cephalic presentation at birth (RR = 1.39; 95% CI = 1.21–1.58). Moxibustion also seemed to elicit better clinical outcomes in the Asian population (RR = 1.42; 95% CI = 1.21–1.67) than in the non-Asian population (RR = 1.20; 95% CI = 1.01–1.43). The effects of acupuncture on correcting breech presentation after sensitivity analysis were inconsistent relative to control. The effect of moxibustion plus acupuncture was synergistic for correcting breech presentation (RR = 1.53; 95% CI = 1.26–1.86) in one RCT. Our findings suggest that moxibustion therapy has positive effects on correcting breech presentation, especially in the Asian population.
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Affiliation(s)
- Jian-An Liao
- Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-A.L.); (T.-H.H.); (T.-J.L.)
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (S.-C.S.); (C.-T.C.); (P.Y.-C.C.); (K.-L.O.)
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center of Evidence-Based Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan;
| | - Chian-Ting Chang
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (S.-C.S.); (C.-T.C.); (P.Y.-C.C.); (K.-L.O.)
| | - Pony Yee-Chee Chai
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (S.-C.S.); (C.-T.C.); (P.Y.-C.C.); (K.-L.O.)
| | - Kok-Loon Owang
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (S.-C.S.); (C.-T.C.); (P.Y.-C.C.); (K.-L.O.)
| | - Tse-Hung Huang
- Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-A.L.); (T.-H.H.); (T.-J.L.)
| | - Chung-Han Yang
- Center of Evidence-Based Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Tsai-Jen Lee
- Department of Traditional Chinese Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-A.L.); (T.-H.H.); (T.-J.L.)
| | - Yung-Chih Chen
- Center of Evidence-Based Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- Division of General Internal Medicine, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Correspondence: ; Tel.: +886-2-24329292
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23
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Abstract
Objective This study aimed to investigate the success rate, complications, and success-related factors of external cephalic version (ECV) of singleton breech pregnancies after 37 gestational weeks without anesthesia. Methods We studied 40 singleton breech pregnancies in women who underwent ECV without anesthesia after 37 gestational weeks from October 2018 to March 2020. On the basis of success of ECV, the women were divided into two groups of the successful group and the failed group. Various factors were analyzed to determine those that affect the success of ECV. Results Of the 40 attempts of ECV, 24 (60.0%) were successful and 16 (40.0%) failed. With regard to success-related factors, parity was significantly different between the two groups, with more multiparous women in the successful group than in the failed group. However, none of the other factors were significantly different between the groups. Fetal outcome was good in all of the cases. Ultimately, 3 cesarean sections were performed in the successful group and 16 were performed in the failed group. Conclusions ECV of breech presentation after the 37th week of pregnancy without anesthesia is an effective and relatively safe alternative, and can effectively reduce the cesarean section rate.
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Affiliation(s)
- Zheng Zhi
- Department of Obstetrics and Gynecology, Wenzhou People's Hospital, Wenzhou, China
| | - Lin Xi
- Department of Chinese Medicine, Wenzhou People's Hospital, Wenzhou, China
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24
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Smith GC, Moraitis AA, Wastlund D, Thornton JG, Papageorghiou A, Sanders J, Heazell AE, Robson SC, Sovio U, Brocklehurst P, Wilson EC. Universal late pregnancy ultrasound screening to predict adverse outcomes in nulliparous women: a systematic review and cost-effectiveness analysis. Health Technol Assess 2021; 25:1-190. [PMID: 33656977 PMCID: PMC7958245 DOI: 10.3310/hta25150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Currently, pregnant women are screened using ultrasound to perform gestational aging, typically at around 12 weeks' gestation, and around the middle of pregnancy. Ultrasound scans thereafter are performed for clinical indications only. OBJECTIVES We sought to assess the case for offering universal late pregnancy ultrasound to all nulliparous women in the UK. The main questions addressed were the diagnostic effectiveness of universal late pregnancy ultrasound to predict adverse outcomes and the cost-effectiveness of either implementing universal ultrasound or conducting further research in this area. DESIGN We performed diagnostic test accuracy reviews of five ultrasonic measurements in late pregnancy. We conducted cost-effectiveness and value-of-information analyses of screening for fetal presentation, screening for small for gestational age fetuses and screening for large for gestational age fetuses. Finally, we conducted a survey and a focus group to determine the willingness of women to participate in a future randomised controlled trial. DATA SOURCES We searched MEDLINE, EMBASE and the Cochrane Library from inception to June 2019. REVIEW METHODS The protocol for the review was designed a priori and registered. Eligible studies were identified using keywords, with no restrictions for language or location. The risk of bias in studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Health economic modelling employed a decision tree analysed via Monte Carlo simulation. Health outcomes were from the fetal perspective and presented as quality-adjusted life-years. Costs were from the perspective of the public sector, defined as NHS England, and the costs of special educational needs. All costs and quality-adjusted life-years were discounted by 3.5% per annum and the reference case time horizon was 20 years. RESULTS Umbilical artery Doppler flow velocimetry, cerebroplacental ratio, severe oligohydramnios and borderline oligohydramnios were all either non-predictive or weakly predictive of the risk of neonatal morbidity (summary positive likelihood ratios between 1 and 2) and were all weakly predictive of the risk of delivering a small for gestational age infant (summary positive likelihood ratios between 2 and 4). Suspicion of fetal macrosomia is strongly predictive of the risk of delivering a large infant, but it is only weakly, albeit statistically significantly, predictive of the risk of shoulder dystocia. Very few studies blinded the result of the ultrasound scan and most studies were rated as being at a high risk of bias as a result of treatment paradox, ascertainment bias or iatrogenic harm. Health economic analysis indicated that universal ultrasound for fetal presentation only may be both clinically and economically justified on the basis of existing evidence. Universal ultrasound including fetal biometry was of borderline cost-effectiveness and was sensitive to assumptions. Value-of-information analysis indicated that the parameter that had the largest impact on decision uncertainty was the net difference in cost between an induced delivery and expectant management. LIMITATIONS The primary literature on the diagnostic effectiveness of ultrasound in late pregnancy is weak. Value-of-information analysis may have underestimated the uncertainty in the literature as it was focused on the internal validity of parameters, which is quantified, whereas the greatest uncertainty may be in the external validity to the research question, which is unquantified. CONCLUSIONS Universal screening for presentation at term may be justified on the basis of current knowledge. The current literature does not support universal ultrasonic screening for fetal growth disorders. FUTURE WORK We describe proof-of-principle randomised controlled trials that could better inform the case for screening using ultrasound in late pregnancy. STUDY REGISTRATION This study is registered as PROSPERO CRD42017064093. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gordon Cs Smith
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Alexandros A Moraitis
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - David Wastlund
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Aris Papageorghiou
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Alexander Ep Heazell
- Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Stephen C Robson
- Reproductive and Vascular Biology Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Edward Cf Wilson
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
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25
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Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis. Obstet Gynecol Int 2020; 2020:4039140. [PMID: 33299421 PMCID: PMC7701206 DOI: 10.1155/2020/4039140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/17/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P=0.043). Conclusion The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.
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26
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Marcus TA, Jeyapaul S, David SM, Jamkhandi D, Cherian AG. Outcomes of external cephalic version for antenatal women with breech presentation in a secondary hospital in Vellore, Tamil Nadu - a retrospective review. J Turk Ger Gynecol Assoc 2020; 21:236-242. [PMID: 33274567 PMCID: PMC7726455 DOI: 10.4274/jtgga.galenos.2020.2020.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/01/2020] [Indexed: 12/01/2022] Open
Abstract
Objective Breech presentation is the most common fetal malpresentation at term, with an incidence of 3-4%. External cephalic version (ECV) is a procedure that can be offered to women with breech presentation beyond 36 weeks of gestation to convert it to cephalic presentation, reducing the risks of a vaginal breech delivery and the morbidities associated with caesarean section. Material and Methods We retrospectively reviewed the records of women who underwent ECV between October 2012 and June 2020 with the objectives of determining the success rate of the procedure, the mode of delivery, the maternal and neonatal outcomes, periprocedural complications and their management. Results Among the 200 women who underwent the procedure with a 64% success rate (128 women), there were 110 vaginal deliveries (56.7%) including five vaginal breech deliveries, and 84 women (43.2%) underwent caesarean section, which included 24 women who had successful ECV but needed emergency caesarean for other indications. There was no significant difference in the neonatal APGAR scores in those who had a successful ECV and those who did not. Only three women (1.5%) experienced any significant periprocedural complication. Conclusion These results suggest that ECV improves the possibility of a vaginal delivery with an overall low complication rate, reducing the neonatal risks associated with vaginal breech delivery and the maternal morbidity of a caesarean section. It may thus contribute to reducing the primary caesarean section rate, making it a useful intervention, especially in limited resource settings.
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Affiliation(s)
- Tobey Ann Marcus
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
| | - Shalini Jeyapaul
- Department of Community Medicine, Christian Medical College and Hospital, Vellore, India
| | - Sam Marconi David
- Department of Community Medicine, Christian Medical College and Hospital, Vellore, India
| | - Dimple Jamkhandi
- Department of Family Medicine, Christian Medical College and Hospital, Vellore, India
| | - Anne George Cherian
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
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27
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Kamiński M, Łoniewski I, Łoniewska B. 'Dr. Google, is caesarean section good for me?' - the global Internet searches associated with mode of birth methods: Retrospective analysis of Google trends data. Midwifery 2020; 89:102787. [PMID: 32619852 DOI: 10.1016/j.midw.2020.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We investigated Google queries in the years 2004-2019 as related to mode of birth methods in scope of global and local popularity, secular trends, and associations with real-world data. DESIGN We retrieved data from Google Trends (GT) over time and regional interest in (n = 9) topics related to birth. We calculated the interest of all the topics in proportion to the Relative Search Volume (RSV) of 'Caesarean section'"(CS). We retrieved WHO data on the CS rate and the World Bank data on the fertility rate. We analysed secular trends. FINDINGS Globally, the highest popularity was observed for these topics: 'Childbirth' (6.93 [times higher than CS]), 'Caesarean section' (1.00), and 'Preterm birth' (0.59). The regional RSV of 'Caesarean section' was associated with the real CS rate (r = 0.29; p = 0.016) and the interest in 'Childbirth' was associated with the regional fertility rate (r = 0.48; p < 0.001). Globally, the most dynamic rate of increase of interest was observed for 'Vaginal delivery' (+4.96 RSV/year) and 'Caesarean section' (+4.88 RSV/year), while a decrease was noted only for 'Home birth' (-3.04 RSV/year) and 'Water birth' (-1.84 RSV/year). CONCLUSIONS The interest of Google users in most of the birth-related topics increased over time and is associated with real-world data. Using GT may provide insight into the interest of Google users regarding different birth-related matters. IMPLICATION FOR PRACTICE Health professionals should be active in e-discourse to provide reliable information and recommend trustworthy websites to women and those who support them.
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Affiliation(s)
| | - Igor Łoniewski
- Sanprobi Sp.z o.o. Sp K., Szczecin, Poland; Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland
| | - Beata Łoniewska
- Department of Neonatal Diseases, Pomeranian Medical University, Szczecin, Poland
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28
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Lindblad M, Josefsson A, Bladh M, Sydsjö G, Johansson T. Risk factors during pregnancy and delivery for the development of Perthes' disease, a nationwide Swedish study of 2.1 million individuals. BMC Pregnancy Childbirth 2020; 20:192. [PMID: 32228493 PMCID: PMC7106730 DOI: 10.1186/s12884-020-2849-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/28/2020] [Indexed: 12/02/2022] Open
Abstract
Background To ascertain or disprove a correlation between suboptimal birth characteristics, breech position at delivery and development of Perthes’ disease. Methods Study material was collected from nationwide registers regarding diagnoses, birth statistics and delivery data. As study population were included children with a diagnosis code for Perthes’ disease who were alive and living in Sweden at age 13. Children with missing birth statistics were excluded. All children with no Perthes’ disease diagnosis were used as control group. Both single and multiple logistical regression analyses were used to calculate OR for the included characteristics. Results Children in breech position had a higher risk for developing Perthes’ disease. Children with Perthes’ disease had also a higher probability of having been born pre-term, very pre-term or post-term. Lower than normal birth weight and a lower Apgar-score were also associated with Perthes’ disease. Conclusions There is a correlation between breech birth and development of Perthes’ disease. There is also correlation to suboptimal birth characteristics. Despite our findings this should not be used for screening of Perthes’ disease as the percentage of children who actually develop it is very low. Also, as of yet there is no possibility to diagnose Perthes’ disease before the presence of skeletal changes. Our findings could be important in finding the cause of Perthes’ disease and therefore developing better diagnostics, treatment and prevention.
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Affiliation(s)
- Maria Lindblad
- Department of Orthopedics, Norrköping, Sweden. .,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Ann Josefsson
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Torsten Johansson
- Department of Orthopedics, Norrköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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29
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Wastlund D, Moraitis AA, Dacey A, Sovio U, Wilson ECF, Smith GCS. Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis. PLoS Med 2019; 16:e1002778. [PMID: 30990808 PMCID: PMC6467368 DOI: 10.1371/journal.pmed.1002778] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/11/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the relative ease with which breech presentation can be identified through ultrasound screening, the assessment of foetal presentation at term is often based on clinical examination only. Due to limitations in this approach, many women present in labour with an undiagnosed breech presentation, with increased risk of foetal morbidity and mortality. This study sought to determine the cost effectiveness of universal ultrasound scanning for breech presentation near term (36 weeks of gestational age [wkGA]) in nulliparous women. METHODS AND FINDINGS The Pregnancy Outcome Prediction (POP) study was a prospective cohort study between January 14, 2008 and July 31, 2012, including 3,879 nulliparous women who attended for a research screening ultrasound examination at 36 wkGA. Foetal presentation was assessed and compared for the groups with and without a clinically indicated ultrasound. Where breech presentation was detected, an external cephalic version (ECV) was routinely offered. If the ECV was unsuccessful or not performed, the women were offered either planned cesarean section at 39 weeks or attempted vaginal breech delivery. To compare the likelihood of different mode of deliveries and associated long-term health outcomes for universal ultrasound to current practice, a probabilistic economic simulation model was constructed. Parameter values were obtained from the POP study, and costs were mainly obtained from the English National Health Service (NHS). One hundred seventy-nine out of 3,879 women (4.6%) were diagnosed with breech presentation at 36 weeks. For most women (96), there had been no prior suspicion of noncephalic presentation. ECV was attempted for 84 (46.9%) women and was successful in 12 (success rate: 14.3%). Overall, 19 of the 179 women delivered vaginally (10.6%), 110 delivered by elective cesarean section (ELCS) (61.5%) and 50 delivered by emergency cesarean section (EMCS) (27.9%). There were no women with undiagnosed breech presentation in labour in the entire cohort. On average, 40 scans were needed per detection of a previously undiagnosed breech presentation. The economic analysis indicated that, compared to current practice, universal late-pregnancy ultrasound would identify around 14,826 otherwise undiagnosed breech presentations across England annually. It would also reduce EMCS and vaginal breech deliveries by 0.7 and 1.0 percentage points, respectively: around 4,196 and 6,061 deliveries across England annually. Universal ultrasound would also prevent 7.89 neonatal mortalities annually. The strategy would be cost effective if foetal presentation could be assessed for £19.80 or less per woman. Limitations to this study included that foetal presentation was revealed to all women and that the health economic analysis may be altered by parity. CONCLUSIONS According to our estimates, universal late pregnancy ultrasound in nulliparous women (1) would virtually eliminate undiagnosed breech presentation, (2) would be expected to reduce foetal mortality in breech presentation, and (3) would be cost effective if foetal presentation could be assessed for less than £19.80 per woman.
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Affiliation(s)
- David Wastlund
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, Cambridge, United Kingdom
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Alexandros A. Moraitis
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
| | - Alison Dacey
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
| | - Edward C. F. Wilson
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, Cambridge, United Kingdom
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Gordon C. S. Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, United Kingdom
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30
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Abdulghani SH. Is the art of assisted breech delivery still fading in the Kingdom of Saudi Arabia? Saudi Med J 2019; 39:1054-1056. [PMID: 30284591 PMCID: PMC6201025 DOI: 10.15537/smj.2018.10.23152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
[No Abstract Available].
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Affiliation(s)
- Sahar H Abdulghani
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University Hospital, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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31
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Duffy CR, Moore JL, Saleem S, Tshefu A, Bose CL, Chomba E, Carlo WA, Garces AL, Krebs NF, Hambidge KM, Goudar SS, Derman RJ, Patel A, Hibberd PL, Esamai F, Liechty EA, Wallace DD, McClure EM, Goldenberg RL. Malpresentation in low- and middle-income countries: Associations with perinatal and maternal outcomes in the Global Network. Acta Obstet Gynecol Scand 2018; 98:300-308. [PMID: 30414270 DOI: 10.1111/aogs.13502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies. MATERIAL AND METHODS Using the NICHD Global Network's prospective, population-based registry of pregnancy outcomes from 2010 to 2016, we studied outcomes in 436 112 singleton pregnancies. Robust Poisson regressions were used to estimate the risk of adverse outcomes associated with malpresentation. We examined rates of cesarean delivery for malpresentation and compared outcomes between cesarean and vaginal delivery by region. RESULTS Across all regions, stillbirth and neonatal mortality rates were higher among deliveries with malpresentation. In adjusted analysis, malpresentation was significantly associated with stillbirth (adjusted relative risk [aRR] 4.0, 95% confidence interval [CI] 3.7-4.5) and neonatal mortality (aRR 2.3, 95% CI 2.1-2.6). Women with deliveries complicated by malpresentation had higher rates of morbidity and mortality. Rates of cesarean delivery for malpresentation ranged from 27% to 87% among regions. Compared with cesarean delivery, vaginal delivery for malpresentation was associated with increased maternal risk, especially postpartum hemorrhage (aRR 5.0, 95% CI; 3.6-7.1). CONCLUSIONS In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with increased perinatal and maternal risk. Further research is needed to determine the best management of these pregnancies.
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Affiliation(s)
- Cassandra R Duffy
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Janet L Moore
- Social, Statistical and Environmental Health Sciences, Durham, NC, USA
| | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Ana L Garces
- Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, India
| | | | | | | | | | | | - Dennis D Wallace
- Social, Statistical and Environmental Health Sciences, Durham, NC, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Farmen AH, Grundt JH, Nakling JO, Mowinckel P, Nakken KO, Lossius MI. Increased rate of acute caesarean sections in women with epilepsy: results from the Oppland Perinatal Database in Norway. Eur J Neurol 2018; 26:617-623. [PMID: 30414297 PMCID: PMC6590210 DOI: 10.1111/ene.13865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Abstract
Background and purpose Studies in women with epilepsy (WWE) regarding pregnancy and labour complications have disclosed contradictory results. Our purpose was to investigate whether WWE have a higher risk of acute caesarean section (CS) or pregnancy complications than women without epilepsy or women with other chronic diseases and, if we found a higher risk, to explore potential explanations. Methods The study used prospectively registered obstetric data from the Oppland Perinatal Database in the period 2001–2011, containing information on 18 244 births, including 110 singleton pregnancies in mothers with validated epilepsy. Data regarding epilepsy were collected retrospectively from medical records. Results Epilepsy was a significant risk factor for acute CS, breech presentation and low birth weight in offspring [odds ratio (OR), 1.93, 95% confidence interval (CI), 1.2–3.1; OR, 2.29, 95% CI, 1.2–4.6 and OR, 2.10, 95% CI, 1.0–4.2, respectively]. In multivariate logistic regression analysis, antiepileptic drug exposure was an independent risk factor for acute CS (OR, 2.00; 95% CI, 1.06–3.77) and polytherapy was a significant risk factor for breech presentation (OR, 5.37; 95% CI, 1.13–25.57). Seizure frequency during pregnancy had no influence on the complication rate. Conclusions We found that WWE using antiepileptic drugs during pregnancy had increased rates of acute CS, breech presentation and low birth weight, and that seizure frequency during pregnancy did not influence the complication rate.
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Affiliation(s)
- A H Farmen
- Department of Neurology, Innlandet Hospital, Lillehammer
| | - J H Grundt
- Department of Paediatrics, Oslo University Hospital, Oslo
| | - J O Nakling
- Department of Gynaecology, Innlandet Hospital, Lillehammer
| | - P Mowinckel
- Department of Paediatrics, Oslo University Hospital, Oslo
| | - K O Nakken
- National Centre for Epilepsy, Oslo University Hospital, Oslo
| | - M I Lossius
- National Centre for Epilepsy, Oslo University Hospital, Oslo.,Oslo University, Oslo, Norway
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Fischbein SJ, Freeze R. Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births. BMC Pregnancy Childbirth 2018; 18:397. [PMID: 30305050 PMCID: PMC6180643 DOI: 10.1186/s12884-018-2033-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2018] [Indexed: 01/17/2023] Open
Abstract
Background Research on outcomes of out-of-hospital breech birth is scarce. This study evaluates the outcomes of singleton term breech and cephalic births in a home or birth center setting. Methods This is a retrospective observational cohort study of 60 breech and 109 cephalic planned out-of-hospital term singleton births during a 6 year period with a single obstetrician. Outcomes measured included mode of delivery; birth weights; 1 & 5-min Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; and other maternal and neonatal morbidity. Results 50 breech and 102 cephalic presentations were still in the obstetrician’s care at the onset of labor; of those, 10 breech and 11 cephalic mothers required transport during labor. 76% of breech and 92.2% of cephalic births were planned to occur at home, with the remainder at a freestanding birth center. When compared to the cephalic group, the breech group had a higher rate of antepartum and in-labor transfer of care and cesarean section. Among completed out-of-hospital births, the breech group had a significantly higher rate of 1-min Apgar scores < 7 but no significant difference at 5 min. Rates of vaginal birth for both groups were high, with 84% of breech and 97.1% of cephalic mothers giving birth vaginally in this series. Compared to primiparas, multiparas in both groups had less perineal trauma and higher rates of out-of-hospital birth, vaginal birth, and spontaneous vaginal birth. No breech infant or mother required postpartum hospital transport, while one cephalic infant and one cephalic mother required postpartum transport. Of the babies born out-of-hospital, there was one short-term and one longer-term birth injury among the breech group and one short-term brachial plexus injury in the cephalic group. Conclusions A home or birth center setting leads to high rates of vaginal birth and good maternal outcomes for both breech and cephalic term singleton presentations. Out-of-hospital vaginal breech birth under specific protocol guidelines and with a skilled provider may be a reasonable choice for women wishing to avoid a cesarean section—especially when there is no option of a hospital breech birth. However, this study is underpowered to calculate uncommon adverse neonatal outcomes.
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Affiliation(s)
| | - Rixa Freeze
- Wabash College, 211 Center Hall, Crawfordsville, IN, 47933, USA.
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Zhang JW, Branch W, Hoffman M, De Jonge A, Li SH, Troendle J, Zhang J. In which groups of pregnant women can the caesarean delivery rate likely be reduced safely in the USA? A multicentre cross-sectional study. BMJ Open 2018; 8:e021670. [PMID: 30082355 PMCID: PMC6078266 DOI: 10.1136/bmjopen-2018-021670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/19/2018] [Accepted: 06/18/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To identify obstetrical subgroups in which (1) the caesarean delivery (CD) rate may be reduced without compromising safety and (2) CD may be associated with better perinatal outcomes. DESIGN A multicentre cross-sectional study. SETTING 19 hospitals in the USA that participated in the Consortium on Safe Labor. PARTICIPANTS 228 562 pregnant women in 2002-2008. MAIN OUTCOME MEASURES Maternal and neonatal safety was measured using the individual Weighted Adverse Outcome Score. METHODS Women were divided into 10 subgroups according to a modified Robson classification system. Generalised estimated equation model was used to examine the relationships between mode of delivery and Weighted Adverse Outcome Score in each subgroup. RESULTS The overall caesarean rate was 31.2%. Repeat CD contributed 29.5% of all CD, followed by nulliparas with labour induction (15.3%) and non-cephalic presentation (14.3%). The caesarean rates in induced nulliparas with a term singleton cephalic pregnancy and women with previous CD were 31.6% and 82.0%, respectively. CD had no clinically meaningful association with perinatal outcomes in most subgroups. However, in singleton preterm breech presentation and preterm twin gestation with the first twin in non-cephalic presentation, CD was associated with substantially improved maternal and perinatal outcomes. CONCLUSIONS Women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births may be the potential targets for safely reducing prelabour CD rate, while nulliparas or multiparas with spontaneous or induced labour, women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births are potential targets for reducing intrapartum CD rate without compromising maternal and neonatal safety in the USA. On the other hand, CD may still be associated with better perinatal outcomes in women with singleton preterm breech presentation or preterm twins with the first twin in non-cephalic presentation.
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Affiliation(s)
- Jin-Wen Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ware Branch
- Intermountain Healthcare and University of Utah, Utah, USA
| | | | - Ank De Jonge
- AVAG and the Amsterdam University Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Sheng-Hui Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - James Troendle
- National Institute of Heart, Lung and Blood Institute, National Institutes of Health, Maryland, USA
| | - Jun Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Maskey S, Dwa Y. Predisposing Factors and Outcome of Malpresentations in an Institute. JNMA J Nepal Med Assoc 2018; 56:674-677. [PMID: 30381763 PMCID: PMC8997271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION This study was done to find out the incidence of malpresentation among all deliveries with various types of Malpresentations, its mode of delivery , maternal and fetal predisposing factors with outcome. METHODS This was a cross sectional descriptive study done at KIST Medical College and Teaching Hospital. Review cases of women admitted in labor after 22 weeks with malpresentation was done. Maternal/fetal predisposing factors were recorded. RESULTS Total delivery in study period was 4009 where 101 (2.5%) were of malpresentation. Breech was the commonest malpresentation 83 (82.1%). Assisted vaginal delivery occurred in 16 (15.8%) and 953 (84.2%) caesarian section. Malpresentations was common in primigravida 62 (61.3%). Half (47.2%) cases had one/more predisposing factors, commonest being oligohydramnious 7 (6.9%). Out of 108 babies with malpresentation, 10 had perinatal deaths and 10 had NICU admissions. Congenital anomaly was found in 4 babies. CONCLUSIONS The most common type of malpresentation was breech common in primigravida with oligohydramnios as contributing factor.
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Affiliation(s)
- Smrity Maskey
- Department of Obstetrics and Gynaecology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Yam Dwa
- Department of Obstetrics and Gynaecology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
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Dohbit JS, Foumane P, Tochie JN, Mamoudou F, Temgoua MN, Tankeu R, Aletum V, Mboudou E. Maternal and neonatal outcomes of vaginal breech delivery for singleton term pregnancies in a carefully selected Cameroonian population: a cohort study. BMJ Open 2017; 7:e017198. [PMID: 29170287 PMCID: PMC5719268 DOI: 10.1136/bmjopen-2017-017198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. Very few studies on the subject have been carried out in poor-resource settings. The aim of this study was to determine maternal and neonatal outcomes in carefully selected cases of VBD for singleton term pregnancies in a tertiary centre in Cameroon. DESIGN A retrospective cohort study. SETTING A tertiary hospital in Yaounde, Cameroon. PARTICIPANTS Cases of VBD of newborns weighing 2500-3500 g were matched in a ratio of 1:4 to consecutive vaginal cephalic deliveries (VCDs) of newborns weighing 2500-3500 g over a 5-year period. Both groups were matched for maternal age and parity. We excluded cases of multiple gestations, footling breech, clinically inadequate maternal pelvis, preterm delivery, post-term pregnancies, fetal demise prior to the onset of labour, placenta praevia and fetal anomaly incompatible with vaginal delivery. OUTCOME MEASURES Neonatal and maternal adverse outcomes of VBD observed till 6 weeks after delivery analysed using Bonferroni correction. RESULTS Fifty-three (53) VBDs were matched against 212 VCD. Unlike women who had VCD, those who underwent VBD were more likely to have prolonged labour (OR 8.05; 95% CI 3.00 to 11.47; P<0.001), and their newborns were more likely to suffer from birth asphyxia (OR 10.24; 95% CI 4.92 to 21.31; P<0.001). CONCLUSION The study infers a strong association between VBD of singleton term pregnancies and maternofetal morbidity when specific protocols are applied. This, however, failed to translate into higher differences in perinatal mortality. This finding does not discount the role of VBD in low-income countries, but we emphasise the need for specific precautions like close monitoring of labour and adequate anticipation for neonatal resuscitation in order to reduce these complications.
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Affiliation(s)
- Julius Sama Dohbit
- Department of Obstetrics and Gynaecology, Gynaeco-Obstetric and Paediatric Hospital, Yaounde, Cameroon
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Pascal Foumane
- Department of Obstetrics and Gynaecology, Gynaeco-Obstetric and Paediatric Hospital, Yaounde, Cameroon
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Joel Noutakdie Tochie
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Fadimatou Mamoudou
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Mazou N Temgoua
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Ronni Tankeu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Veronica Aletum
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Department of Obstetrics and Gynaecology, Elig-Mfomo District Hospital, Centre Region, Cameroon
| | - Emile Mboudou
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Department of Obstetrics and Gynaecology, Gynaeco-Obstetric and Paediatric Hospital, Douala, Cameroon
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Ekéus C, Norman M, Åberg K, Winberg S, Stolt K, Aronsson A. Vaginal breech delivery at term and neonatal morbidity and mortality – a population-based cohort study in Sweden. J Matern Fetal Neonatal Med 2017; 32:265-270. [DOI: 10.1080/14767058.2017.1378328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C. Ekéus
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - M. Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - K. Åberg
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - S. Winberg
- BB Stockholm, Danderyd Hospital, Stockholm, Sweden
| | - K. Stolt
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - A. Aronsson
- Karolinska University Hospital, Stockholm, Sweden
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Petrovska K, Sheehan A, Homer CSE. Media Representations of Breech Birth: A Prospective Analysis of Web-Based News Reports. J Midwifery Womens Health 2017; 62:434-441. [PMID: 28703897 DOI: 10.1111/jmwh.12609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/08/2017] [Accepted: 01/13/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Recent research has demonstrated that the media presentation of childbirth is highly medicalized, often portraying birth as risky and dramatic. Media representation of breech presentation and birth is unexplored in this context. This study aimed to explore the content and tone of news media reports relating to breech presentation and breech birth. METHODS Google alerts were created using the terms breech and breech birth in online English-language news sites over a 3-year period from January 1, 2013, to December 31, 2015. Alerts were received daily and filed for analysis, and data were analyzed to generate themes. RESULTS A total of 138 web-based news reports were gathered from 9 countries. Five themes that arose from the data included the problem of breech presentation, the high drama of vaginal breech birth, the safe option of cesarean birth versus dangers of vaginal breech birth, the defiant mother versus the saintly mother, and vaginal breech birth and medical misadventure. DISCUSSION Media reports in this study predominantly demonstrated negative views toward breech presentation and vaginal breech birth. Cesarean birth was portrayed as the safe option for breech birth, while vaginal breech birth was associated with poor outcomes. Media presentations may impact decision making about mode of birth for pregnant women with a breech fetus. Health care providers can play an important role in balancing the media depiction of planned vaginal breech birth by providing nonjudgmental, evidence-based information to such women to facilitate informed decision making for birth.
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Althabe F, Belizán JM. Rising Trend in Non-Indicated Caesarean Deliveries: Can the Trend be Reversed? Paediatr Perinat Epidemiol 2017; 31:263-266. [PMID: 28618044 DOI: 10.1111/ppe.12369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Fernando Althabe
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - José M Belizán
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
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Petrovska K, Sheehan A, Homer CS. The fact and the fiction: A prospective study of internet forum discussions on vaginal breech birth. Women Birth 2017; 30:e96-e102. [DOI: 10.1016/j.wombi.2016.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/13/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
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Wildschut HIJ, van Belzen‐Slappendel H, Jans S. The art of vaginal breech birth at term on all fours. Clin Case Rep 2017; 5:182-186. [PMID: 28174647 PMCID: PMC5290512 DOI: 10.1002/ccr3.808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/20/2016] [Accepted: 12/08/2016] [Indexed: 11/21/2022] Open
Abstract
Despite a shift in clinical practice favouring cesarean section for breech presentation, adequate skills are still needed for a safe vaginal breech birth. This case report illustrates the physiological mechanism of vaginal breech birth. The accompanying pictures are a testimony to the "hands-off" approach and could be used for educational purposes.
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Affiliation(s)
- Hajo I. J. Wildschut
- Department of Obstetrics and GynecologyErasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | | | - Suze Jans
- Department of Clinical GeneticsSection Community Genetics and EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
- Royal Dutch Organisation of Midwives (KNOV)UtrechtThe Netherlands
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Petrovska K, Watts N, Sheehan A, Bisits A, Homer C. How do social discourses of risk impact on women’s choices for vaginal breech birth? A qualitative study of women’s experiences. HEALTH RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2016.1256378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Karolina Petrovska
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Nicole Watts
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Athena Sheehan
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Andrew Bisits
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Department of Obstetrics and Gynaecology, Royal Hospital for Women, Randwick, Australia
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Kaboré C, Ridde V, Kouanda S, Queuille L, Somé PA, Agier I, Dumont A. DECIDE: a cluster randomized controlled trial to reduce non-medically indicated caesareans in Burkina Faso. BMC Pregnancy Childbirth 2016; 16:322. [PMID: 27769190 PMCID: PMC5073955 DOI: 10.1186/s12884-016-1112-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 10/13/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Since 2006, Burkina Faso has subsidized the cost of caesarean sections to increase their accessibility. Caesareans are performed by obstetricians, general practitioners, and nurses trained in emergency surgery. While the national caesarean rate is still too low (only 2 % in 2010), 12 to 24 % of caesareans performed in hospital are, in fact, not medically indicated. The objective of this study is to evaluate the effectiveness and analyze the implementation of a multi-faceted intervention to lower the rate of non-medically indicated caesareans in Burkina Faso. METHODS This study combines a multicentre cluster randomized controlled trial with an implementation analysis in a mixed-methods approach. The evidence-based intervention will consist of three strategies to improve the competencies of maternity teams: 1) clinical audits based on objective criteria; 2) training of personnel; and 3) decision-support reminders of indications for caesareans via text messages. The unit of randomization and of intervention is the public hospital equipped with a functional operating room. Using stratified randomization on hospital type and staff qualifications, 11 hospitals have been assigned to the intervention group and 11 to the control group. The intervention will cover 1 year. Every patient who delivered by caesarean during a 6-month period in the year preceding the intervention and the 6 months following its end will be included in the trial. The change in the rate of non-medically indicated caesareans is the main criterion by which the intervention's impact will be assessed. To analyze the intervention process, a longitudinal qualitative study consisting of deliberative workshops and individual in-depth interviews will be conducted. The target outcome is a 50 % reduction in the rate of non-medically indicated caesareans. DISCUSSION This study will provide evidence regarding the effectiveness of a multi-faceted intervention for reducing non-medically indicated caesareans in a low-income country. By combining qualitative and quantitative methods, the study's findings will allow understanding the factors that could influence the intervention process and ultimately the intended outcomes. TRIAL REGISTRATION The DECIDE trial is registered on the Current Controlled Trials website under the number ISRCTN48510263 on January 28, 2014.
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Affiliation(s)
- Charles Kaboré
- Institut de recherche pour le développement (IRD), Université Paris Descartes, UMR 196 Centre Population et Développement (CEPED), Paris, France
- Institut de Recherche en Science de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Valéry Ridde
- Department of Preventive Medicine, University of Montreal School of Public Health (ESPUM) and University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Séni Kouanda
- Institut de Recherche en Science de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Ludovic Queuille
- Department of Preventive Medicine, University of Montreal School of Public Health (ESPUM) and University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | | | - Isabelle Agier
- Department of Preventive Medicine, University of Montreal School of Public Health (ESPUM) and University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Alexandre Dumont
- Institut de recherche pour le développement (IRD), Université Paris Descartes, UMR 196 Centre Population et Développement (CEPED), Paris, France
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Toivonen E, Palomäki O, Huhtala H, Uotila J. Cardiotocography in breech versus vertex delivery: an examiner-blinded, cross-sectional nested case-control study. BMC Pregnancy Childbirth 2016; 16:319. [PMID: 27769196 PMCID: PMC5073907 DOI: 10.1186/s12884-016-1115-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/14/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The safety of vaginal breech delivery has been debated for decades. Although it has been shown to predispose infants to immediate depression, several observational studies have also shown that attempting vaginal breech delivery does not increase perinatal morbidity or low Apgar score at the age of five minutes. Cardiotocography monitoring is recommended during vaginal breech delivery, but comparative data describing differences between cardiotocography tracings in breech and vertex deliveries is scarce. This study aims to evaluate differences in intrapartum cardiotocography tracings between breech and vertex deliveries in the final 60 min of delivery. A secondary goal is to identify risk factors for suboptimal neonatal outcome in the study population. METHODS One hundred eight breech and 108 vertex singleton, intended vaginal deliveries at term from a tertiary hospital with 5000 annual deliveries were included. Two experienced obstetricians, blinded to fetal presentation, neonatal outcome and actual mode of delivery, evaluated traces recorded 60 min before delivery. They provided a three-tier classification and evaluated different trace features according to FIGO (1987) guidelines. Factors associated with acidemia and low Apgar scores were identified by univariate and multivariable analyses performed with binary logistic regression. Student's T-test and chi-square test were used, as appropriate. RESULTS Late decelerations were seen in 13.9 % of breech and 2.8 % of vertex deliveries (p = 0.003) and decreased variability in 26.9 % of breech and 8.3 % of vertex deliveries (p < 0.001). In multivariable analysis complicated variable decelerations and breech presentation were identified as risk factors for neonatal acidemia and low Apgar score at the age of five minutes. Pathological trace and breech presentation were independent risk factors for low Apgar score at the age of one minute. CONCLUSIONS Decreased variability and late decelerations were more prevalent in breech compared to vertex deliveries. Pathological trace predicts immediate neonatal depression and especially complicated variable decelerations may signal more severe distress. Further research is needed to create guidelines for safe management of vaginal breech delivery.
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Affiliation(s)
- Elli Toivonen
- School of Medicine, University of Tampere, 33014 Tampere, Finland
| | - Outi Palomäki
- Department of Obstetrics and Gynecology, Tampere University Hospital, PL 2000, 33521 Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, 33014 Tampere, Finland
| | - Jukka Uotila
- School of Medicine, University of Tampere, 33014 Tampere, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, PL 2000, 33521 Tampere, Finland
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Sloman R, Wanat M, Burns E, Smith L. Midwives’ views, experiences and feelings of confidence surrounding vaginal breech birth: A qualitative study. Midwifery 2016; 41:61-67. [DOI: 10.1016/j.midw.2016.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 07/18/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
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Cavallaro FL, Cresswell JA, Ronsmans C. Obstetricians' Opinions of the Optimal Caesarean Rate: A Global Survey. PLoS One 2016; 11:e0152779. [PMID: 27031516 PMCID: PMC4816518 DOI: 10.1371/journal.pone.0152779] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/19/2016] [Indexed: 11/19/2022] Open
Abstract
Background The debate surrounding the optimal caesarean rate has been ongoing for several decades, with the WHO recommending an “acceptable” rate of 5–15% since 1997, despite a weak evidence base. Global expert opinion from obstetric care providers on the optimal caesarean rate has not been documented. The objective of this study was to examine providers’ opinions of the optimal caesarean rate worldwide, among all deliveries and within specific sub-groups of deliveries. Methods A global online survey of medical doctors who had performed at least one caesarean in the last five years was conducted between August 2013 and January 2014. Respondents were asked to report their opinion of the optimal caesarean rate—defined as the caesarean rate that would minimise poor maternal and perinatal outcomes—at the population level and within specific sub-groups of deliveries (including women with demographic and clinical risk factors for caesareans). Median reported optimal rates and corresponding inter-quartile ranges (IQRs) were calculated for the sample, and stratified according to national caesarean rate, institutional caesarean rate, facility level, and respondent characteristics. Results Responses were collected from 1,057 medical doctors from 96 countries. The median reported optimal caesarean rate was 20% (IQR: 15–30%) for all deliveries. Providers in private for-profit facilities and in facilities with high institutional rates reported optimal rates of 30% or above, while those in Europe, in public facilities and in facilities with low institutional rates reported rates of 15% or less. Reported optimal rates were lowest among low-risk deliveries and highest for Absolute Maternal Indications (AMIs), with wide IQRs observed for most categories other than AMIs. Conclusions Three-quarters of respondents reported an optimal caesarean rate above the WHO 15% upper threshold. There was substantial variation in responses, highlighting a lack of consensus around which women are in need of a caesarean among obstetric care providers worldwide.
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Affiliation(s)
- Francesca L. Cavallaro
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Jenny A. Cresswell
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Walker S, Scamell M, Parker P. Standards for maternity care professionals attending planned upright breech births: A Delphi study. Midwifery 2016; 34:7-14. [DOI: 10.1016/j.midw.2016.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
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Kahansim ML, Changkat LL, Eya AE. Breech deliveries in a secondary health-care facility in South-South Nigeria. TROPICAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2016. [DOI: 10.4103/0189-5117.199814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
BACKGROUND Twin pregnancies are associated with increased perinatal mortality, mainly related to prematurity, but complications during birth may contribute to perinatal loss or morbidity. The option of planned caesarean section to avoid such complications must therefore be considered. On the other hand, randomised trials of other clinical interventions in the birth process to avoid problems related to labour and birth (planned caesarean section for breech, and continuous electronic fetal heart rate monitoring), have shown an unexpected discordance between short-term perinatal morbidity and long-term neurological outcome. The risks of caesarean section for the mother in the current and subsequent pregnancies must also be taken into account. OBJECTIVES To determine the short- and long-term effects on mothers and their babies, of planned caesarean section for twin pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (18 November 2015) and reference lists of retrieved studies. SELECTION CRITERIA Randomised trials comparing a policy of caesarean section with planned vaginal birth for women with twin pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility, quality and extracted data. Data were checked for accuracy. For important outcomes the quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included two trials comparing planned caesarean section versus planned vaginal birth for twin pregnancies.Most of the data included in the review were from a multicentre trial where 2804 women were randomised in 106 centres in 25 countries. All centres had facilities to perform emergency caesarean section and had anaesthetic, obstetrical, and nursing staff available in the hospital at the time of planned vaginal delivery. In the second trial carried out in Israel, 60 women were randomised. We judged the risk of bias to be low for all categories except performance (high) and outcome assessment bias (unclear).There was no clear evidence of differences between women randomised to planned caesarean section or planned vaginal birth for maternal death or serious morbidity (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.67 to 1.11; 2844 women; two studies; moderate quality evidence). There was no significant difference between groups for perinatal or neonatal death or serious neonatal morbidity (RR 1.15, 95% CI 0.80 to 1.67; data for 5565 babies, one study, moderate quality evidence). No studies reported childhood disability.For secondary outcomes there was no clear evidence of differences between groups for perinatal or neonatal mortality (RR 1.41, 95% CI 0.76 to 2.62; 5685 babies; two studies, moderate quality evidence), serious neonatal morbidity (RR 1.03, 95% CI 0.65 to 1.64; 5644 babies; two studies, moderate quality evidence) or any of the other neonatal outcomes reported.The number of women undergoing caesarean section was reported in both trials. Most women in the planned caesarean group had treatment as planned (90.9% underwent caesarean section), whereas in the planned vaginal birth group 42.9% had caesarean section for at least one twin. For maternal mortality; no events were reported in one trial and two deaths (one in each group) in the other. There were no significant differences between groups for serious maternal morbidity overall (RR 0.86, 95% CI 0.67 to 1.11; 2844 women; two studies) or for different types of short-term morbidity. There were no significant differences between groups for failure to breastfeed (RR 1.14, 95% CI 0.95 to 1.38; 2570 women, one study; moderate quality evidence) or the number of women with scores greater than 12 on the Edinbugh postnatal depression scale (RR 0.95, 95% CI 0.78 to 1.14; 2570 women, one study; moderate quality evidence). AUTHORS' CONCLUSIONS Data mainly from one large, multicentre study found no clear evidence of benefit from planned caesarean section for term twin pregnancies with leading cephalic presentation. Data on long-term infant outcomes are awaited. Women should be informed of possible risks and benefits of labour and vaginal birth pertinent to their specific clinical presentation and the current and long-term effects of caesarean section for both mother and babies. There is insufficient evidence to support the routine use of planned caesarean section for term twin pregnancy with leading cephalic presentation, except in the context of further randomised trials.
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Affiliation(s)
- G Justus Hofmeyr
- Walter Sisulu University, University of Fort Hare, University of the Witwatersrand, Eastern Cape Department of HealthEast LondonSouth Africa
| | - Jon F Barrett
- Sunnybrook Health Sciences Centre60 Grosvenor StreetTorontoONCanadaM5S 1B6
| | - Caroline A Crowther
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
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Vervoort AJMW, Uittenbogaard LB, Hehenkamp WJK, Brölmann HAM, Mol BWJ, Huirne JAF. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod 2015; 30:2695-702. [PMID: 26409016 PMCID: PMC4643529 DOI: 10.1093/humrep/dev240] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/26/2015] [Accepted: 09/04/2015] [Indexed: 11/24/2022] Open
Abstract
Caesarean section (CS) results in the occurrence of the phenomenon 'niche'. A 'niche' describes the presence of a hypoechoic area within the myometrium of the lower uterine segment, reflecting a discontinuation of the myometrium at the site of a previous CS. Using gel or saline instillation sonohysterography, a niche is identified in the scar in more than half of the women who had had a CS, most with the uterus closed in one single layer, without closure of the peritoneum. An incompletely healed scar is a long-term complication of the CS and is associated with more gynaecological symptoms than is commonly acknowledged. Approximately 30% of women with a niche report spotting at 6-12 months after their CS. Other reported symptoms in women with a niche are dysmenorrhoea, chronic pelvic pain and dyspareunia. Given the association between a niche and gynaecological symptoms, obstetric complications and potentially with subfertility, it is important to elucidate the aetiology of niche development after CS in order to develop preventive strategies. Based on current published data and our observations during sonographic, hysteroscopic and laparoscopic evaluations of niches we postulate some hypotheses on niche development. Possible factors that could play a role in niche development include a very low incision through cervical tissue, inadequate suturing technique during closure of the uterine scar, surgical interventions that increase adhesion formation or patient-related factors that impair wound healing or increase inflammation or adhesion formation.
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Affiliation(s)
| | | | | | - H A M Brölmann
- VU University medical Centre, Amsterdam, The Netherlands
| | - B W J Mol
- VU University medical Centre, Amsterdam, The Netherlands
| | - J A F Huirne
- VU University medical Centre, Amsterdam, The Netherlands
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