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Rasmussen OB, Lauszus FF. Risk of complications in post-term pregnancies: Spontaneous labor should not be included in the intervention group. Acta Obstet Gynecol Scand 2022; 101:839. [PMID: 35211954 DOI: 10.1111/aogs.14330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Finn Friis Lauszus
- Department of Obstetrics and Gynecology, Aabenraa Hospital, Aabenraa, Denmark
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2
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Chen C, Yang M, Zheng W, Yang X, Chen Y, Dong T, Lv M, Xi F, Jiang Y, Ying X, Li W, Xu J, Zhao B, Luo Q. Magnetic Resonance Imaging-Based Nomogram to Antenatal Predict Cesarean Delivery for Cephalopelvic Disproportion in Primiparous Women. J Magn Reson Imaging 2022; 56:1145-1154. [PMID: 35302271 DOI: 10.1002/jmri.28164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cephalopelvic disproportion (CPD)-related obstructed labor is associated with maternal and neonatal morbidity and mortality. Accurate prediction of whether a primiparous woman is at high risk of an unplanned cesarean delivery would be a major advance in obstetrics. PURPOSE To develop and validate a predictive model assessing the risk of cesarean delivery in primiparous women based on MRI findings. STUDY TYPE Prospective. POPULATION A total of 150 primiparous women with clinical findings suggestive of CPD. FIELD STRENGTH/SEQUENCE T1-weighted fast spin-echo sequences, single-shot fast spin-echo (SSFSE) T2-weighted sequences at 1.5 T. ASSESSMENT Pelvimetry and fetal biometry were assessed independently by two radiologists. A nomogram model combined that the clinical and MRI characteristics was constructed. STATISTICAL TESTS Univariable and multivariable logistic regression analyses were applied to select independent variables. Receiver operating characteristic (ROC) analysis was performed, and the discrimination of the model was assessed by the area under the curve (AUC). Calibration was assessed by calibration plots. Decision curve analysis was applied to evaluate the net clinical benefit. A P value below 0.05 was considered to be statistically significant. RESULTS In multivariable modeling, the maternal body mass index (BMI) before delivery, bilateral femoral head distance, obstetric conjugate, fetal head circumference, and fetal abdominal circumference was significantly associated with the likelihood of cesarean delivery. The discrimination calculated as the AUC was 0.838 (95% confidence interval [CI]: 0.774-0.902). The sensitivity and specificity of the nomogram model were 0.787 and 0.764, and the positive predictive and negative predictive values were 0.696 and 0.840, respectively. The model demonstrated satisfactory calibration (calibration slope = 0.945). Moreover, the decision curve analysis proved the superior net benefit of the model compared with each factor included. DATA CONCLUSION Our study might provide a nomogram model that could identify primiparous women at risk of cesarean delivery caused by CPD based on MRI measurements. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Cheng Chen
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengmeng Yang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weizeng Zheng
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofu Yang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Chen
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian Dong
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Lv
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangfang Xi
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Jiang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Ying
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Li
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Xu
- Reproductive Medicine Center, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Baihui Zhao
- Department of Obstetrics, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Fox H, Topp SM, Lindsay D, Callander E. A cascade of interventions: A classification tree analysis of the determinants of primary cesareans in Australian public hospitals. Birth 2021; 48:209-220. [PMID: 33570208 DOI: 10.1111/birt.12530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both globally and in Australia, there has been a sharp rise in cesarean births (CB). Commonly, this rise has been attributed to the changing epidemiology of women giving birth. A significant body of knowledge exists on the risk factors associated with a greater need for cesarean. Yet, we have little information on the reasons recorded by clinicians as to why cesareans are provided. This study aimed to explore the drivers of primary cesareans in Australian public hospitals. METHODS Using a linked administrative data set, the frequency and percent of mothers' characteristics were compared between those who had a cesarean birth and those who had a vaginal birth (n = 98 967) with no history of previous cesareans in Queensland public hospitals between July 1, 2012, and June 30, 2015. The top 10 reasons recorded by clinicians for a primary cesarean were reported. Using a machine-learning algorithm, two decision trees were built to determine factors driving primary cesarean birth. RESULTS "Labour and delivery complicated by fetal heart rate anomaly" (23%) and "primary inadequate contractions" (22.8%) were the top two reasons for a primary cesarean birth. The most common characteristics among mothers who had fetal heart rate anomalies were as follows: artificial rupture of membranes (39%), oxytocin (32%), no obstruction of labor (42%), and epidural (52%). For women who had primary inadequate contractions, the most common characteristics were as follows: epidural (33%), oxytocin (49%), artificial rupture of membranes (45%), and fetal stress (56%). CONCLUSIONS Efforts should be made by health practitioners during the antenatal period to maximize the use of preventative measures that minimize the need for medical interventions.
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Affiliation(s)
- Haylee Fox
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Emily Callander
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Qld, Australia
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Andrikopoulou M, Wen T, Sheen JJ, Krenitsky N, Baptiste CD, Goffman D, Staniczenko AP, D'Alton ME, Friedman AM. Population risk factors for nulliparous, term, singleton, vertex caesarean birth: a national cross-sectional study. BJOG 2021; 128:1456-1463. [PMID: 33660911 DOI: 10.1111/1471-0528.16684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterise medical, obstetric and demographic risk factors associated with nulliparous, term, singleton, vertex (NTSV) caesarean birth. STUDY DESIGN Cross-sectional study. SETTING United States delivery hospitalisations. POPULATION NTSV births in 2016-18 US natality data. METHODS This study analysed a national sample of natality data generated by the United States National Vital Statistics System. NTSV deliveries were identified. The primary outcome was caesarean birth. Risk factors including maternal age, body mass index (BMI) and pregestational diabetes were analysed. Multivariable log-linear regression models analysed factors associated with NTSV caesarean with adjusted risk ratios (aRR) as measures of effect. RESULTS Of 11 622 400 deliveries, 3 764 707 met NTSV criteria, and their caesarean section rate was 25.9%. Maternal age 35-39 years (aRR 1.51, 95% CI 1.50-1.52) and 40-54 years (aRR 2.03, 95% 2.00-2.05) compared with age 19-34 years; BMI 25 to <30 kg/m2 (aRR 1.32, 95% CI 1.31-1.33), 30 to <35 kg/m2 (aRR 1.57 95% CI 1.56-1.58), 35 to <40 kg/m2 (aRR 1.82, 95% CI 1.80-1.83) and ≥40 kg/m2 (aRR 2.17, 95% CI 2.15-2.19) compared with BMI 18.5-24.9 kg/m2; and pregestational diabetes (aRR 1.54, 95% CI 1.51-1.57) were all associated with increased risk. Risk factors allowed stratification of patients into high-risk versus low-risk groups. The NTSV caesarean rate was 37.9% in women who had one or more of the following characteristics: age ≥35 years, BMI ≥30 kg/m2 or pregestational diabetes. In comparison, the NTSV caesarean rate was 20.8% among women without any of these three risk factors (P < 0.01). CONCLUSION Among NTSV births, BMI, maternal age and medical conditions are important risk factors for caesarean delivery.
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Affiliation(s)
- M Andrikopoulou
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - T Wen
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - J-J Sheen
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - N Krenitsky
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - C D Baptiste
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - D Goffman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - A P Staniczenko
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - M E D'Alton
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - A M Friedman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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5
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Ramadan MK, Ramadan K, El Tal R, Salem Wehbe GR, Itani S, Badr DA. How safe is high-order repeat cesarean delivery? An 8-year single-center experience in Lebanon. J Obstet Gynaecol Res 2020; 46:1370-1377. [PMID: 32500639 DOI: 10.1111/jog.14311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/28/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
Abstract
AIM To quantify the impact of the number of prior cesarean deliveries (CD) on operative complications and preterm birth. Then to investigate the presence of a threshold, beyond which complications tend to be disproportionately dangerous. METHODS This was a retrospective cohort observational study, where data corresponding to all CD done at our service, during an 8-year period, were collected and analyzed. In total, 1840 CD were performed. Patients were divided into five categories that corresponded to the number of CD. Primary outcome was the composite adverse maternal outcome, while preterm birth and individual complications were secondary outcomes. RESULTS The composite adverse maternal outcome, preterm birth, as well as all individual complications related to CD, except for placental abruption, showed a significant rise in frequency that paralleled the increase in the number of CD. Furthermore, this increase tended to be continuous as the number of CD increased, with an evident surge after the fourth. CONCLUSION In our population, increasing number of prior CD was a risk factor for a parallel increase in the rate of composite adverse maternal outcome, preterm birth and almost all intraoperative complications attributable to CD. Decreasing exposure to such surgeries by limiting family size to four offspring should be considered seriously in patient counseling.
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Affiliation(s)
- Mohamad K Ramadan
- Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
| | - Khalil Ramadan
- Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon
| | - Rana El Tal
- Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon
| | - Georges R Salem Wehbe
- Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Saadeddine Itani
- Department of Obstetrics and Gynecology, Makassed General Hospital, Beirut, Lebanon
| | - Dominique A Badr
- Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Pierce SL, Maxted ME, Peck JD, Lutz JS, Lopez-Davila MF, Vieira F, Atchley CB, Edwards RK. Impact of a Policy to Deliver at 39 Weeks for the Indication of Class III Obesity. Obesity (Silver Spring) 2020; 28:563-569. [PMID: 32020789 PMCID: PMC7042037 DOI: 10.1002/oby.22729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of a policy to deliver at 39 weeks for class III obesity. METHODS This was a retrospective cohort study of women with class III obesity delivering at ≥ 37 weeks before (May 2012 to April 2014) and after the policy (September 2014 to August 2016). The primary outcome was the cesarean rate. Secondary outcomes included maternal morbidities and a neonatal morbidity composite. Modified Poisson regression was used to adjust for demographic differences between groups. RESULTS The study included a total of 1,210 patients, 580 before the policy and 630 after the policy. Before and after the policy, cesarean rates were similar (41.6% vs. 47.1%; risk ratio [RR]: 1.13 [95% CI: 1.00-1.29]; adjusted RR [aRR]: 1.03 [95% CI: 0.92-1.14]). In adjusted comparisons of women undergoing labor induction, parous women had lower cesarean rates (aRR: 0.62; 95% CI: 0.41-0.94) but nulliparous women had higher cesarean rates (aRR: 1.32; 95% CI: 1.04-1.68) after the policy (P for interaction = 0.01). Rates of chorioamnionitis, endometritis, and cesarean wound infection were not different between groups. Composite neonatal morbidity was not different between pre- and postpolicy groups. CONCLUSIONS A policy of delivery at 39 weeks for class III obesity did not affect overall cesarean rate or rates of maternal or neonatal morbidity. Further investigation should evaluate subsets of women who may have a higher cesarean rate with this policy.
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Affiliation(s)
- Stephanie L Pierce
- Department of Obstetrics and Gynecology, College of Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Marta E Maxted
- Department of Obstetrics and Gynecology, College of Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jennifer D Peck
- College of Public Health, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Jessica S Lutz
- Department of Obstetrics and Gynecology, College of Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Maria F Lopez-Davila
- Department of Obstetrics and Gynecology, College of Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Frederico Vieira
- Department of Pediatrics, College of Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Courtney B Atchley
- Department of Pediatrics, College of Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Rodney K Edwards
- Department of Obstetrics and Gynecology, College of Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
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Carlson NS. Current resources for evidence-based practice, November/December 2014. J Midwifery Womens Health 2014; 59:660-665. [PMID: 25533709 DOI: 10.1111/jmwh.12257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Bartlett JM, Wypij D, Bellinger DC, Rappaport LA, Heffner LJ, Jonas RA, Newburger JW. Effect of prenatal diagnosis on outcomes in D-transposition of the great arteries. Pediatrics 2004; 113:e335-40. [PMID: 15060264 DOI: 10.1542/peds.113.4.e335] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND By decreasing preoperative morbidity, prenatal diagnosis could improve neurodevelopmental outcomes in infants with critical congenital heart disease. We explored the impact of prenatal diagnosis on perinatal and perioperative variables and on outcomes at 1 year of age. METHODS We analyzed a database of children enrolled in prospective studies on surgical support techniques from 1988 to 2000. Selection criteria included a diagnosis of D-transposition of the great arteries with intact ventricular septum or ventricular septal defect, no extracardiac congenital anomalies, birth weight >2.3 kg, and repair by arterial switch procedure. RESULTS Of 346 patients at enrollment, 25 had a prenatal diagnosis, and 321 did not. Children with prenatal diagnosis, compared with those without, had a lower likelihood of birth by spontaneous labor, lower birth weights, lower Apgar 5 scores, a higher rate of preoperative endotracheal intubation, and surgery at a younger age. They tended to have a lower incidence of fetal distress during labor. At 1 year of age, 272 patients were tested with the Psychomotor Development Index and Mental Development Index of the Bayley Scales. Mean z scores were similar in those with and without prenatal diagnosis for both Psychomotor Development Index (-0.92 +/- 0.93 vs -0.88 +/- 1.05) and Mental Development Index (-0.29 +/- 1.13 vs -0.41 +/- 0.93). CONCLUSIONS Infants with D-transposition of the great arteries with and without prenatal diagnosis differed with respect to perinatal and perioperative variables, but their development at 1 year of age was similar. Future studies should include a greater number of children with prenatal diagnosis and a variety of congenital heart lesions.
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Affiliation(s)
- Jodi M Bartlett
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts 02115, USA
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