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Nelson DB, Alexander JM, McIntire DD, Leveno KJ. "New or not-so-new" labor management practices and cesarean delivery for arrest of progress. Am J Obstet Gynecol 2020; 222:71.e1-71.e6. [PMID: 31336076 DOI: 10.1016/j.ajog.2019.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/21/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Because nearly one-third of births in the United States are now achieved by cesarean delivery, comprising more than 1.27 million women each year, national organizations have recently published revised guidelines for the management of labor. These new guidelines stipulate that labor arrest should not be diagnosed unless ≥6 cm cervical dilatation has been reached or labor has been stimulated for at ≥6 hours. OBJECTIVE To determine the cervical dilatation and hours of labor stimulation prior to cesarean delivery for arrest of dilatation. MATERIALS AND METHODS Between January 1, 1999, andDecember 31, 2000, a prospective observational study of all primary cesarean deliveries was conducted at 13 university centers comprising the Eunice Kennedy Shriver National Institute for Child Health and Human Development, Maternal-Fetal Medicine Units Network. This secondary analysis includes all live-born, singleton, nonanomalous, cephalic gestations delivered by primary cesarean delivery at ≥37 weeks. A cesarean delivery was considered to have been performed for arrest of dilatation if the indication for the procedure was failure to progress, cephalopelvic disproportion, or failed induction. Augmentation was defined as stimulation after spontaneous labor had been previously diagnosed. Analysis included both the latent and active phases of labor. The active phase of labor was diagnosed when cervical dilatation was ≥4 cm in the presence of uterine contractions. RESULTS A total of 13,269 primary cesarean deliveries were available for analysis, 8,546 (65%) of which were performed for inadequate progress of labor with cervical dilatation recorded at the time of cesarean delivery. Of these cesarean deliveries for labor arrest, a total of 719 (8%) were performed in the latent phase of labor and 7827 (92%) were performed when cervical dilatation was ≥4 cm (active phase). Approximately two-thirds (n = =5876; 69%) received intrauterine pressure monitoring. A total of 5636 women (66% of those reaching the active phase of labor) had reached ≥6 cm cervical dilatation before cesarean delivery was performed. Moreover, 7440 (95%) of the 7827 women in active labor had ≥6 cm dilatation or had received labor stimulation ≥6 hours prior to cesarean delivery for arrest of dilatation. CONCLUSION Women undergoing primary cesarean delivery for arrest of dilatation 15 years before the recommendations of the Obstetrics Care Consensus had received bona fide efforts to achieve adequate labor consistent with the recommendations of the Consensus. Because 95% of these women had ≥6 cm dilatation or had received labor stimulation ≥6 hours prior to cesarean delivery for arrest of dilatation, these new recommendations are unlikely to change the cesarean delivery rates.
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Lipschuetz M, Cohen SM, Israel A, Baron J, Porat S, Valsky DV, Yagel O, Amsalem H, Kabiri D, Gilboa Y, Sivan E, Unger R, Schiff E, Hershkovitz R, Yagel S. Sonographic large fetal head circumference and risk of cesarean delivery. Am J Obstet Gynecol 2018; 218:339.e1-339.e7. [PMID: 29305249 DOI: 10.1016/j.ajog.2017.12.230] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Persistently high rates of cesarean deliveries are cause for concern for physicians, patients, and health systems. Prelabor assessment might be refined by identifying factors that help predict an individual patient's risk of cesarean delivery. Such factors may contribute to patient safety and satisfaction as well as health system planning and resource allocation. In an earlier study, neonatal head circumference was shown to be more strongly associated with delivery mode and other outcome measures than neonatal birthweight. OBJECTIVE In the present study we aimed to evaluate the association of sonographically measured fetal head circumference measured within 1 week of delivery with delivery mode. STUDY DESIGN This was a multicenter electronic medical record-based study of birth outcomes of primiparous women with term (37-42 weeks) singleton fetuses presenting for ultrasound with fetal biometry within 1 week of delivery. Fetal head circumference and estimated fetal weight were correlated with maternal background, obstetric, and neonatal outcome parameters. Elective cesarean deliveries were excluded. Multinomial regression analysis provided adjusted odds ratios for instrumental delivery and unplanned cesarean delivery when the fetal head circumference was ≥35 cm or estimated fetal weight ≥3900 g, while controlling for possible confounders. RESULTS In all, 11,500 cases were collected; 906 elective cesarean deliveries were excluded. A fetal head circumference ≥35 cm increased the risk for unplanned cesarean delivery: 174 fetuses with fetal head circumference ≥35 cm (32%) were delivered by cesarean, vs 1712 (17%) when fetal head circumference <35 cm (odds ratio, 2.49; 95% confidence interval, 2.04-3.03). A fetal head circumference ≥35 cm increased the risk of instrumental delivery (odds ratio, 1.48; 95% confidence interval, 1.16-1.88), while estimated fetal weight ≥3900 g tended to reduce it (nonsignificant). Multinomial regression analysis showed that fetal head circumference ≥35 cm increased the risk of unplanned cesarean delivery by an adjusted odds ratio of 1.75 (95% confidence interval, 1.4-2.18) controlling for gestational age, fetal gender, and epidural anesthesia. The rate of prolonged second stage of labor was significantly increased when either the fetal head circumference was ≥35 cm or the estimated fetal weight ≥3900 g, from 22.7% in the total cohort to 31.0%. A fetal head circumference ≥35 cm was associated with a higher rate of 5-minute Apgar score ≤7: 9 (1.7%) vs 63 (0.6%) of infants with fetal head circumference <35 cm (P = .01). The rate among fetuses with an estimated fetal weight ≥3900 g was not significantly increased. The rate of admission to the neonatal intensive care unit did not differ among the groups. CONCLUSION Sonographic fetal head circumference ≥35 cm, measured within 1 week of delivery, is an independent risk factor for unplanned cesarean delivery but not instrumental delivery. Both fetal head circumference ≥35 cm and estimated fetal weight ≥3900 g significantly increased the risk of a prolonged second stage of labor. Fetal head circumference measurement in the last days before delivery may be an important adjunct to estimated fetal weight in labor management.
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Marocchini M, Lauféron J, Quantin C, Sagot P. Postpartum hemorrhage with transfusion: Trends, near misses, risk factors and management at the scale of a perinatal network. J Gynecol Obstet Hum Reprod 2017; 46:455-460. [PMID: 28934089 DOI: 10.1016/j.jogoh.2017.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze temporal trends and management of postpartum hemorrhage (PPH) with transfusion and its related maternal near-miss (MNM) cases between 2006 and 2014 and to study risk factors. MATERIAL AND METHODS This retrospective cohort study from two prospective databases included 156,047 women giving birth in all the maternity hospitals of Burgundy. We analyzed temporal trends and the distribution of PPH with transfusion, the circumstances of transfer of patients between hospitals and factors associated with PPH with transfusion. PPH with massive blood transfusion and/or non-medical treatment was defined as MNM. Statistical analysis included Chi2 tests and logistic regression for multivariate analysis. RESULTS The overall rate of PPH with transfusion was 7.3‰ and globally increased during the study period whereas the MNM rate did not. MNM represented 37% of patients with PPH with transfusion and 71% of transferred patients, but surgical treatments were performed before transfer. Factors associated with PPH with transfusion were maternal age>35 years (odds ratio [OR]=1.3), prematurity (OR=5.0), cesarean section (OR=4.8), placenta previa (OR=22.0), twin pregnancy (OR=6.6), HELLP syndrome (OR=17.9) and severe small-for-gestational-age infants (OR=2.0). The first four were also associated with MNM. CONCLUSION MNM cases of PPH rates were steady in Burgundy while rates of PPH with transfusion increased moderately.
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Affiliation(s)
- M Marocchini
- Department of obstetrics and gynecology, university hospital, Dijon, France.
| | - J Lauféron
- Department of obstetrics and gynecology, university hospital, Dijon, France
| | - C Quantin
- Department of biostatistics and bioinformatics, university hospital, Dijon, France
| | - P Sagot
- Department of obstetrics and gynecology, university hospital, Dijon, France
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O’Neill SM, Agerbo E, Khashan AS, Kearney PM, Henriksen TB, Greene RA, Kenny LC. Trial of labour after caesarean section and the risk of neonatal and infant death: a nationwide cohort study. BMC Pregnancy Childbirth 2017; 17:74. [PMID: 28241870 PMCID: PMC5327578 DOI: 10.1186/s12884-017-1255-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caesarean section (CS) rates are increasing worldwide and as a result repeat CS is common. The optimal mode of delivery in women with one previous CS is widely debated and the risks to the infant are understudied. The aim of the current study was to evaluate if women with a trial of labour after caesarean (TOLAC) had an increased odds of neonatal and infant death compared to women with an elective repeat CS (ERCS). METHODS A population register-based cohort study was conducted in Denmark between 1982 and 2010. All women with two deliveries [in which the first was a CS, and the second was an uncomplicated, term delivery (n = 61,626)] were included in the study. Logistic regression models were used to report adjusted odds ratios (AOR) and 95% confidence intervals (CI) of the odds of death according to mode of delivery. The main outcome measures were neonatal death (early and late) and infant death. RESULTS Women with a TOLAC had an increased odds of neonatal death (AOR 1 · 87, 95% CI 1 · 12 to 3 · 12) due to an increased risk of early neonatal death (AOR 2 · 06, 95% CI 1 · 19 to 3 · 56) and no effect on late neonatal death (AOR 0 · 97, 95% CI 0 · 22 to 4 · 32), or infant death (AOR 1 · 12, 95% CI 0 · 79 to 1 · 59) when compared to the reference group of women with an ERCS. There was evidence of a cohort effect as the increased odds of neonatal death (AOR 3 · 89, 95% CI 1 · 33 to 11 · 39) was most significant in the earlier years (1982-1991) and gradually disappeared (AOR 1 · 01, 95% CI 0 · 44 to 2 · 31) in the later years (2002-2010). CONCLUSIONS Although an increased risk of neonatal death was found in women with a TOLAC, there was evidence of a cohort effect, which showed this increased odds disappearing over time. Advances in modern healthcare including improved monitoring and earlier detection of underlying pregnancy complications may explain the findings.
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Affiliation(s)
- Sinéad M. O’Neill
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- National Perinatal Epidemiology Centre (NPEC), Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, 5th Floor Wilton, Cork, Ireland
| | - Esben Agerbo
- Centre for Integrated Register-based Research (CIRRAU), National Centre for Register-based Research (NCRR), Aarhus University, Aarhus, Denmark
| | - Ali S. Khashan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Patricia M. Kearney
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Department of Paediatrics, Aarhus University Hospital, Skejby, Aarhus N, DK-8200 Denmark
| | - Richard A. Greene
- National Perinatal Epidemiology Centre (NPEC), Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, 5th Floor Wilton, Cork, Ireland
| | - Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
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McCarthy FP, Khashan AS, Murray D, Kiely M, Hourihane JO, Pasupathy D, Kenny LC. Parental physical and lifestyle factors and their association with newborn body composition. BJOG 2016; 123:1824-9. [PMID: 27102226 DOI: 10.1111/1471-0528.14042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the parental physical and lifestyle determinants of newborn body composition. DESIGN Prospective cohort study. SETTING Cork University Maternity Hospital, a tertiary referral hospital in Cork, Ireland. POPULATION All babies were recruited as part of a prospective birth cohort, Babies After SCOPE Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints (BASELINE). These babies were recruited from women who had participated in the Screening of Pregnancy Endpoints (SCOPE) study Ireland, a prospective, multicentre cohort study METHODS Multivariate linear regression was used to analyse the effect of a range of maternal and paternal physical and lifestyle features on neonatal body fat percentage (BF%). MAIN OUTCOME MEASURES Neonatal BF%. Neonatal adiposity was assessed within 48 hours of birth using air displacement plethysmography (PEAPOD(®) ). RESULTS In all, 1243 infants were enrolled in the study. Increasing maternal body mass index (adjusted mean difference 0.09; 0.04, 0.15) and waist height ratio (adjusted mean difference 6.59; 0.27, 12.92) were significantly associated with increased neonatal BF%. In contrast, maternal smoking was associated with reduced neonatal BF% compared with non smokers (adjusted mean difference -0.55; -1.07, -0.03). Infant sex significantly altered neonatal BF%, with female infants having higher neonatal BF% compared with male infants (adjusted mean difference 1.98; 1.54, 2.53). No association was observed between paternal body mass index (BMI), paternal age or paternal smoking and neonatal BF%. CONCLUSIONS Maternal smoking, BMI, waist height ratio and infant sex were associated with altered BF%. TWEETABLE ABSTRACT Maternal smoking, BMI, waist height ratio and infant sex are associated with altered neonatal body fat percentage.
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Affiliation(s)
- F P McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland. .,Division of Women's Health KCL, Women's Health Academic Centre KHP, St Thomas's Hospital, London, UK.
| | - A S Khashan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - D Murray
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - M Kiely
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.,Department of Food Science and Nutrition, University College Cork, Cork, Ireland
| | - J O'B Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - D Pasupathy
- Division of Women's Health KCL, Women's Health Academic Centre KHP, St Thomas's Hospital, London, UK
| | - L C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
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DeVoe JE, Tillotson CJ, Marino M, O'Malley J, Angier H, Wallace LS, Gold R. Trends in Type of Health Insurance Coverage for US Children and Their Parents, 1998-2011. Acad Pediatr 2016; 16:192-9. [PMID: 26297668 PMCID: PMC4758913 DOI: 10.1016/j.acap.2015.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/22/2015] [Accepted: 06/15/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine trends in health insurance type among US children and their parents. METHODS Using the Medical Expenditure Panel Survey (1998-2011), we linked each child (n = 120,521; weighted n ≈ 70 million) with his or her parent or parents and assessed patterns of full-year health insurance type, stratified by income. We examined longitudinal insurance trends using joinpoint regression and further explored these trends with adjusted regression models. RESULTS When comparing 1998 to 2011, the percentage of low-income families with both child and parent or parents privately insured decreased from 29.2% to 19.1%, with an estimated decline of -0.86 (95% confidence interval, -1.10, -0.63) unadjusted percentage points per year; middle-income families experienced a drop from 74.5% to 66.3%, a yearly unadjusted percentage point decrease of -0.73 (95% confidence interval, -0.98, -0.48). The discordant pattern of publicly insured children with uninsured parents increased from 10.4% to 27.2% among low-income families and from 1.4% to 6.7% among middle-income families. Results from adjusted models were similar to joinpoint regression findings. CONCLUSIONS During the past decade, low- and middle-income US families experienced a decrease in the percentage of child-parent pairs with private health insurance and pairs without insurance. Concurrently, there was a rise in discordant coverage patterns-mainly publicly insured children with uninsured parents.
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Affiliation(s)
- Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Ore
| | - Carrie J Tillotson
- Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Ore
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Ore; Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Ore
| | - Jean O'Malley
- Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Ore
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, Ore.
| | - Lorraine S Wallace
- Department of Family Medicine, The Ohio State University, Columbus, Ohio
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente Northwest, Portland, Ore
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Roloff K, Peng S, Sanchez-Ramos L, Valenzuela GJ. Cumulative oxytocin dose during induction of labor according to maternal body mass index. Int J Gynaecol Obstet 2015. [PMID: 26210857 DOI: 10.1016/j.ijgo.2015.04.038] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the cumulative oxytocin dose needed to achieve vaginal delivery among obese and non-obese women. METHODS A retrospective study was undertaken of women with singleton, term (≥37 weeks) pregnancies who delivered at an institution in California, USA, between May 1 and July 31, 2012. Women were deemed to be obese when their body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) was 30 or above. Cumulative oxytocin doses were calculated for women who achieved vaginal delivery. RESULTS Overall, 413 women were included. Among 357 women for whom BMI data were available, 204 (57.1%) were obese. Vaginal delivery was achieved in 379 women. Among women who received augmentation after spontaneous labor onset, obese women trended towards more cumulative oxytocin (minimum: 24.7 ± 100.5 mU among women with a BMI of 18.50-24.99; maximum: 1580.5 ± 2530.5 mU among women with a BMI of 35.00-39.99; P=0.086). Women who underwent induction of labor required significantly more oxytocin with increasing BMI class (P<0.001), despite no difference in length of labor. CONCLUSION Obese women required a larger cumulative oxytocin dose to achieve vaginal birth during labor induction, but not during augmentation of labor. The physiology of spontaneous labor could supersede or influence the metabolic derangement facing obese patients undergoing induction of labor.
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Affiliation(s)
- Kristina Roloff
- Division of Maternal and Fetal Medicine, Department of Women's Health, Arrowhead Regional Medical Center, Colton, CA, USA
| | | | - Luis Sanchez-Ramos
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Guillermo J Valenzuela
- Division of Maternal and Fetal Medicine, Department of Women's Health, Arrowhead Regional Medical Center, Colton, CA, USA.
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Bonet-Carne E, Palacio M, Cobo T, Perez-Moreno A, Lopez M, Piraquive JP, Ramirez JC, Botet F, Marques F, Gratacos E. Quantitative ultrasound texture analysis of fetal lungs to predict neonatal respiratory morbidity. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:427-433. [PMID: 24919442 DOI: 10.1002/uog.13441] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To develop and evaluate the performance of a novel method for predicting neonatal respiratory morbidity based on quantitative analysis of the fetal lung by ultrasound. METHODS More than 13,000 non-clinical images and 900 fetal lung images were used to develop a computerized method based on texture analysis and machine learning algorithms, trained to predict neonatal respiratory morbidity risk on fetal lung ultrasound images. The method, termed 'quantitative ultrasound fetal lung maturity analysis' (quantusFLM™), was then validated blindly in 144 neonates, delivered at 28 + 0 to 39 + 0 weeks' gestation. Lung ultrasound images in DICOM format were obtained within 48 h of delivery and the ability of the software to predict neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, was determined. RESULTS Mean (SD) gestational age at delivery was 36 + 1 (3 + 3) weeks. Among the 144 neonates, there were 29 (20.1%) cases of neonatal respiratory morbidity. Quantitative texture analysis predicted neonatal respiratory morbidity with a sensitivity, specificity, positive predictive value and negative predictive value of 86.2%, 87.0%, 62.5% and 96.2%, respectively. CONCLUSIONS Quantitative ultrasound fetal lung maturity analysis predicted neonatal respiratory morbidity with an accuracy comparable to that of current tests using amniotic fluid.
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Chung SH, Seol HJ, Choi YS, Oh SY, Kim A, Bae CW. Changes in the cesarean section rate in Korea (1982-2012) and a review of the associated factors. J Korean Med Sci 2014; 29:1341-52. [PMID: 25368486 PMCID: PMC4214933 DOI: 10.3346/jkms.2014.29.10.1341] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/02/2014] [Indexed: 12/04/2022] Open
Abstract
Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary.
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Affiliation(s)
- Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soo-young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ahm Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong-Woo Bae
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
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Romero R, Tarca AL, Chaemsaithong P, Miranda J, Chaiworapongsa T, Jia H, Hassan SS, Kalita CA, Cai J, Yeo L, Lipovich L. Transcriptome interrogation of human myometrium identifies differentially expressed sense-antisense pairs of protein-coding and long non-coding RNA genes in spontaneous labor at term. J Matern Fetal Neonatal Med 2014; 27:1397-408. [PMID: 24168098 DOI: 10.3109/14767058.2013.860963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To identify differentially expressed long non-coding RNA (lncRNA) genes in human myometrium in women with spontaneous labor at term. MATERIALS AND METHODS Myometrium was obtained from women undergoing cesarean deliveries who were not in labor (n = 19) and women in spontaneous labor at term (n = 20). RNA was extracted and profiled using an Illumina® microarray platform. We have used computational approaches to bound the extent of long non-coding RNA representation on this platform, and to identify co-differentially expressed and correlated pairs of long non-coding RNA genes and protein-coding genes sharing the same genomic loci. RESULTS We identified co-differential expression and correlation at two genomic loci that contain coding-lncRNA gene pairs: SOCS2-AK054607 and LMCD1-NR_024065 in women in spontaneous labor at term. This co-differential expression and correlation was validated by qRT-PCR, an experimental method completely independent of the microarray analysis. Intriguingly, one of the two lncRNA genes differentially expressed in term labor had a key genomic structure element, a splice site, that lacked evolutionary conservation beyond primates. CONCLUSIONS We provide, for the first time, evidence for coordinated differential expression and correlation of cis-encoded antisense lncRNAs and protein-coding genes with known as well as novel roles in pregnancy in the myometrium of women in spontaneous labor at term.
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH , Bethesda, MD and Detroit, MI , USA
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