Tertiary care improves the chance for vaginal delivery in women with preeclampsia

Informing the patient and the community about the implications of primary cesarean

Education of patients and the community should begin with an acknowledgment of the increase in primary and secondary morbidity and mortality associated with the initial cesarean delivery. Women with cesarean birth have a higher rate of rehospitalization for various indications, including surgical site infections. The direct cost for cesarean-related surgical site infection alone is in the tens of millions of dollars. It is important for patients to appreciate risk factors that lead to an increase the risk for primary cesarean, such as obesity, and medical comorbidities. Education on these factors allows in some instances for preconception interventions that can potentially lower the risk for primary cesarean. The obstetrician and the maternal fetal medicine subspecialist have an obligation to focus on evidence-based obstetrical practices that can lead to a more acceptable primary cesarean rate for the obstetrical population. Patient and community awareness can contribute to the promotion of this expectation in obstetrical practice.

Group B streptococcal colonization and the risk of pre-eclampsia

To determine if there was an association between recto-vaginal group B streptococcus (GBS) colonization and pre-eclampsia, two cross-sectional studies were conducted using statewide hospital databases. The first study analysed data from the state of Florida, USA, and included 190 645 women who were discharged in 2001. This dataset was used to generate the hypothesis that GBS colonization is associated with pre-eclampsia. The second study tested the GBS hypothesis using the records of 577 153 women who delivered in 2004 or 2005 in Texas, USA. Adjusted odds ratios (aOR) for the outcome of pre-eclampsia comparing GBS-positive to GBS-negative women were calculated using logistic regression. The aOR for the association between GBS carriage and pre-eclampsia was 0·71 [95% confidence interval (CI) 0·65–0·77] in the Florida dataset. In the Texas dataset, the overall prevalence of GBS carriage was 14·1% while the overall prevalence of pre-eclampsia was 4·0%. GBS carriers were 31% less likely than non-carriers to have pre-eclampsia (aOR 0·69, 95% CI 0·66–0·72) in Texas. In two large statewide analyses, GBS carriage was inversely associated with pre-eclampsia. A sensitivity analysis revealed that misclassification of GBS status is not a likely explanation of our findings.

Surveillance of cesarean section deliveries, New Jersey, 1999-2004

BACKGROUND

Nationally and in New Jersey, the cesarean delivery rate has been increasing steadily for nearly a decade, and especially since 1999. The purpose of this study was to describe recent trends in cesarean section delivery in New Jersey.

METHODS

Data on delivery method, medical indications and patient characteristics were extracted from electronic birth certificate files.

RESULTS

Cesarean section deliveries increased as a proportion of live births by 6 percent annually. Growth was roughly uniform across Robson's clinical classification. Repeat cesareans contributed only proportionately to the overall trend. The greatest acceleration was observed for procedures without trial of labor, and in medical situations where cesarean delivery had been relatively rare.

CONCLUSIONS

Medical indications recorded on the birth certificate explained little of the rapid growth in utilization of cesarean delivery, since trends were comparable in most categories we examined. A sustained autonomous shift in practice patterns, patient preferences, or both seems the most likely driver of the overall trend.