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Aravindan A, Singh N, Datta S, Bondili A. Optimal Timing of Cesarean Section Following Two or More Prior Cesareans: An Investigation Into Maternal and Neonatal Outcomes (a Two-Center Study). Cureus 2024; 16:e64291. [PMID: 39130828 PMCID: PMC11316155 DOI: 10.7759/cureus.64291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Objective This study aimed to determine the optimal timing of elective cesarean sections for women with two or more prior cesarean deliveries by investigating maternal and neonatal outcomes across different gestational ages (37 weeks, 38 weeks, and 39 weeks). Methods A retrospective cohort study was conducted at Tawam and Kanad Hospitals in Al Ain, United Arab Emirates, including 435 women with previous cesarean deliveries. Data were collected on patient demographics, obstetric history, maternal complications, and neonatal outcomes, such as birth weight, appearance, pulse, grimace, activity, and respiration (APGAR) scores, neonatal intensive care unit (NICU) admissions, and length of NICU stay. The patients were divided into two groups: those with two prior cesareans and those with three or more. Outcomes were analyzed based on gestational age at delivery. Results Elective cesarean sections constituted 81.0% of the procedures, with no significant difference in the distribution of elective versus emergency cesareans across the studied gestational weeks (P = 0.073). Neonatal outcomes indicated healthy birth weights and low NICU admissions. For women with two prior cesareans, the NICU admission rates were 23.53% for deliveries at 37 weeks, 8.11% at 38 weeks, and 4.35% for deliveries beyond 39 weeks. For women with three or more prior cesareans, NICU admission rates were 18.18% for 37 weeks, 20.00% for 38 weeks, and 10.00% for 39 weeks. The average birth weight increased with gestational age, and NICU stays were longer for earlier deliveries (P = 0.0065 for stays > 5 days). Conclusion The findings suggest that the optimal timing for elective cesarean sections in women with two or more prior cesareans is 39 weeks of gestation. This timing is associated with the best neonatal outcomes, including lower NICU admission rates and healthy birth weights while minimizing the risks associated with earlier deliveries. Scheduling elective cesarean sections at 39 weeks will improve maternal and neonatal health benefits.
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Affiliation(s)
| | | | - Sumita Datta
- Obstetrics and Gynecology, Kanad Hospital, Al Ain, ARE
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Mino Y, Miyahara F, Miura M, Imamoto A, Fujii H, Moriwaki C, Yoshioka K, Namba N. Risk of Transient Tachypnea of the Newborn following Elective Cesarean Section Increases at a Gestational Age of 37 Weeks Compared to That at ≥ 38 Weeks Despite the Exclusion of Pre-Existing Risk Factors for Neonatal Respiratory Disorders. Yonago Acta Med 2024; 67:150-156. [PMID: 38803593 PMCID: PMC11128081 DOI: 10.33160/yam.2024.05.009] [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: 03/22/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
Background Elective cesarean sections (ECSs) for early-term pregnancies at 37 weeks of gestational age (GA) aim to reduce the risk of emergency cesarean sections due to the onset of labor or rupture of membranes. However, resultant increases in neonatal respiratory disorders, including transient tachypnea of the newborn (TTN) have been observed. However, few studies have elucidated the associated risk factors. Consequently, we aimed to determine whether differences existed in the clinical outcomes between neonates delivered via ECS at 37 weeks and those delivered at ≥ 38 weeks of GA. Methods A retrospective analysis was conducted on 259 neonates born via ECS at Tottori University Hospital, between January 2013 and December 2019, with birthweights ≥ 2500 g and GAs > 37 weeks. The neonates were categorized into two cohorts: births at 37 and at ≥ 38 weeks of GA (37-week and 38-week cohorts). The principal clinical outcomes included the appearance, pulse, grimace, activity, and respiration (Apgar) scores, need for positive-pressure ventilation, incidence of TTN, and length of hospital stay. Results No statistically significant differences were observed in the indications for ECS, sex, or birthweight between the two cohorts. The 37-week cohort exhibited a lower 1-min Apgar score than did the 38-week cohort, with no statistically significant differences between the two cohorts, at 5 min. Statistically significant differences were not observed in the need for positive-pressure ventilation during initial resuscitation or length of hospital stay for patients with TTN between the two cohorts. Notably, the 37-week cohort exhibited a significantly higher incidence of TTN than did the 38-week cohort. Conclusion ECSs at 37 weeks of GA exhibited an increased risk of TTN than ECSs at ≥ 38 weeks of GA. Strategic neonatal care and adequate preparation can mitigate this risk without affecting the length of hospital stay.
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Affiliation(s)
- Yoichi Mino
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Fumiko Miyahara
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Mazumi Miura
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Aya Imamoto
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hiromi Fujii
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Chisaki Moriwaki
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kazuki Yoshioka
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Noriyuki Namba
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Takahashi D, Fujino Y, Sato T, Kuramoto A, Kawakami S, Ito M, Goto K. Timing of Elective Cesarean Section and Neonatal Outcomes in Term Singleton Deliveries: A Single-Center Experience. Am J Perinatol 2024; 41:e2776-e2785. [PMID: 37607591 DOI: 10.1055/a-2158-5619] [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] [Indexed: 08/24/2023]
Abstract
OBJECTIVE This study aimed to evaluate the timing of elective cesarean sections at 37 to 41 weeks from a tertiary hospital in Japan. The primary outcome was the rate of adverse neonatal outcomes, especially focusing on neonates delivered at 38 weeks of gestation. STUDY DESIGN The study population was drawn from singleton pregnancies delivered following planned cesarean birth at the Fukuda Hospital from 2012 to 2019. Information on deliveries was obtained from the hospital database, which contains clinical, administrative, laboratory, and operating room databases. RESULTS After excluding women with chronic conditions, maternal complications, indications for multiple births, or a neonate with an anomaly, 2,208 neonates remained in the analysis. Among adverse neonatal outcomes, the rate was significantly higher in neonates delivered at 37 weeks of gestation (unadjusted odds ratio [OR] = 13.22 [95% confidence interval [CI]: 6.28, 27.86], p < 0.001) or 38 weeks of gestation (unadjusted OR = 1.82 [95% CI: 1.04, 3.19], p = 0.036) compared with neonates delivered at 39 to 41 weeks. The adjusted risk of any adverse outcome was significantly higher at 380-1/7 weeks (adjusted OR = 2.40 [95% CI: 1.35, 4.30], p = 0.003) and 382-3/7 weeks (adjusted OR = 1.89 [95% CI: 1.04, 3.44], p = 0.038) compared with neonates delivered at 39 to 41 weeks, respectively. CONCLUSION Our findings suggest that elective cesarean sections might be best scheduled at 39 weeks or later. When considering a cesarean at 38 weeks, it appears that 384/7 weeks of gestation or later could be a preferable timing in the context of reducing neonatal risks. However, as the composite outcome includes mostly minor conditions, the clinical significance of this finding needs to be carefully interpreted. KEY POINTS · Timing of elective cesarean sections from 37 to 41 weeks was evaluated in a Japanese tertiary hospital.. · Neonates delivered at 37 and 38 weeks had higher adverse outcome rates compared with 39 to 41 weeks.. · Scheduling elective cesarean sections at least 384/7 weeks or later may reduce neonatal risk..
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Affiliation(s)
- Daijiro Takahashi
- Division of Neonatology, Fukuda Hospital, Kumamoto, Japan
- Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tomoki Sato
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Akitaka Kuramoto
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Shoichi Kawakami
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Masaharu Ito
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Kei Goto
- Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan
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Hoshino M, Shinozaki H, Kitahara Y, Kameda T, Hayashi K, Ogawa S, Itoh M, Iwase A. Optimal timing of elective repeat cesarean deliveries of term singleton pregnancies: A multicenter cross-sectional study. Taiwan J Obstet Gynecol 2022; 61:317-322. [PMID: 35361394 DOI: 10.1016/j.tjog.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Cesarean deliveries must be optimally timed to minimize their effects on mothers and neonates. This study aimed to determine the optimal timing of elective repeat cesarean deliveries to reduce the incidence of neonatal respiratory disorders and of emergent cesarean deliveries. MATERIALS AND METHODS This multi-center, cross-sectional, retrospective analysis evaluated data on the maternal and neonatal outcomes of 856 singleton pregnancies scheduled for elective repeat cesarean deliveries at 37-39 weeks' gestation. The emergent cesarean delivery and neonatal respiratory disorder risks were analyzed according to the scheduled cesarean delivery times. RESULTS The elective cesarean delivery rates were 91.0% during the first and 92.6% during the second half of the 37th week of gestation, 88.7% during the first and 82.9% during the second half of the 38th week of gestation, and 62.5% during the first and 33.3% during the second half of the 39th week of gestation. The neonatal respiratory disorder rates were 21.8% for elective cesarean deliveries during the first half of the 37th week of gestation and approximately 8% for elective cesarean deliveries during the second half of the 37th week until the first half of the 38th week of gestation. No neonatal respiratory disorders occurred among the babies delivered by elective cesarean deliveries during the 39th week of gestation. CONCLUSION For improved maternal and neonatal outcomes in the Asian population, it may be better to perform scheduled elective repeat cesarean deliveries from the second half of the 37th week of gestation until the 38th week of gestation following confirmation of gestational age by early first trimester ultrasonography.
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Affiliation(s)
- Masamichi Hoshino
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan; Iwajuku Clinic, 1506-3 Azami, Kasakakemachi, Midori, Gunma, 379-2311, Japan
| | - Hiromitsu Shinozaki
- Graduate School of Health Sciences, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8514, Japan.
| | - Yoshikazu Kitahara
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Takashi Kameda
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Kunihiko Hayashi
- Graduate School of Health Sciences, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8514, Japan
| | - Shota Ogawa
- Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Itoh
- Japan Community Health Care Organization, Gunma Chuo Hospital, 1 Chome-7-13 Kouncho, Maebashi, Gunma, 371-0025, Japan
| | - Akira Iwase
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
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Two-port, exteriorized uterus, fetoscopic meningomyelocele closure has fewer adverse neonatal outcomes than open hysterotomy closure. Am J Obstet Gynecol 2021; 225:327.e1-327.e9. [PMID: 33957114 DOI: 10.1016/j.ajog.2021.04.252] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In utero closure of meningomyelocele using an open hysterotomy approach is associated with preterm delivery and adverse neonatal outcomes. OBJECTIVE This study compared the neonatal outcomes in in utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach vs the conventional open hysterotomy approach. STUDY DESIGN This retrospective cohort study included all consecutive patients who underwent in utero meningomyelocele closure using open hysterotomy (n=44) or a 2-port, exteriorized uterus, fetoscopic approach (n=46) at a single institution between 2012 and 2020. The 2-port, exteriorized uterus, fetoscopic closure was composed of the following 3 layers: a bovine collagen patch, a myofascial layer, and a skin. The frequency of respiratory distress syndrome and a composite of other adverse neonatal outcomes, including retinopathy of prematurity, periventricular leukomalacia, and perinatal death, were compared between the study groups. Regression analyses were performed to determine any association between the fetoscopic closure and adverse neonatal outcomes, adjusted for several confounders, including gestational age of <37 weeks at delivery. RESULTS The fetoscopic closure was associated with a lower rate of respiratory distress syndrome than the open hysterotomy closure (11.5% [5 of 45] vs 29.5% [13 of 44]; P=.037). The proportion of neonates with a composite of other adverse neonatal outcomes in the fetoscopic group was half of that observed patients in the open hysterotomy group; however, this difference did not reach statistical significance (4.3% [2 of 46] vs 9.1% [4 of 44]; P=.429). Here, regression analysis has demonstrated that fetoscopic meningomyelocele closure was associated with a lower risk of respiratory distress syndrome (adjusted odds ratio, 0.23; 95% confidence interval, 0.06-0.84; P=.026) than open hysterotomy closure. CONCLUSION In utero meningomyelocele closure using a 2-port, exteriorized uterus, fetoscopic approach was associated with a lower risk of respiratory distress syndrome than the conventional open hysterotomy meningomyelocele closure.
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Stylianou-Riga P, Boutsikou T, Kouis P, Kinni P, Krokou M, Ioannou A, Siahanidou T, Iliodromiti Z, Papadouri T, Yiallouros PK, Iacovidou N. Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case-control study. Ital J Pediatr 2021; 47:129. [PMID: 34082803 PMCID: PMC8176707 DOI: 10.1186/s13052-021-01086-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus. Methods In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017–October 2018. Clinical data were obtained from patients’ files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively. Results During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03–18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80–78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (β:0.75, 95% CI: − 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013). Conclusions This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-01086-5.
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Affiliation(s)
- Paraskevi Stylianou-Riga
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus. .,Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus. .,Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Marina Krokou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Andriani Ioannou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Thalia Papadouri
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus
| | - Panayiotis K Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Timing of term elective cesarean section and adverse neonatal outcomes: A multi-center retrospective cohort study. PLoS One 2021; 16:e0249557. [PMID: 33819296 PMCID: PMC8021177 DOI: 10.1371/journal.pone.0249557] [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: 12/08/2020] [Accepted: 03/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Rate of cesarean section (CS), including elective CS has globally increased. Studies have found that term elective CS before 39 weeks of gestation is associated with increased risk of adverse respiratory outcomes. Objective To determine the rate of elective CS and examine the association between timing of elective term CS and adverse neonatal outcomes in a large population of Lebanese women. Methods A Multi-Center Study was conducted using data from the National Collaborative Perinatal Neonatal Network database. Simple and multivariable logistic regression models were used to examine the association between timing of term elective CS and adverse neonatal outcomes. Some of the neonatal adverse outcomes we examined included respiratory distress syndrome, admission to the NICU, and a composite of respiratory outcomes. Results A total of 28,997 low risk mothers who delivered through primary and repeat elective CS were included in the study. Uncomplicated elective planned term CS constituted 25% of all CS deliveries in Lebanon. Primary and repeat CS at 37 weeks of gestation increased the odds of most of the studied adverse neonatal outcomes. There were few associations between CS and adverse neonatal outcomes at 38 weeks of gestation. Conclusions Term primary and repeat cesarean delivery prior to 39 weeks of gestation is associated with respiratory and other adverse neonatal outcomes. Delaying birth 1–2 weeks till 39 weeks of gestation can prevent 64–77% of adverse respiratory outcomes.
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Hoang DM, Levy EI, Vandenplas Y. The impact of Caesarean section on the infant gut microbiome. Acta Paediatr 2021; 110:60-67. [PMID: 33405258 DOI: 10.1111/apa.15501] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022]
Abstract
AIM Description of the impact of caesarean section on the infant gut microbiome, infant health and solutions to restore the dysbiosis. METHODS We searched PubMed and Google Scholar for relevant articles. Only articles published in English were selected. Separate searches were performed for each topic. We selected 60 articles published between 1999 and 2019 by extracting subject headings and key words of interest for this topic. RESULTS Caesarean section is an obstetrical procedure that is increasing in prevalence worldwide. On top of the maternal and neonatal risks that this procedure carries, it also induces a dysbiosis of the infant intestinal microbiome possibly challenging the health outcome for the infant. Antibiotics administered during Caesarean deliveries contribute to the development of the gut microbiome. Nonetheless, breastfeeding and several interventions such as vaginal seeding and supplementation with probiotics, prebiotics and synbiotics may contribute to the restoration of the dysbiosis. CONCLUSION Caesarean section is associated with the development of an imbalance of the infant gut microbiome. Long-term consequences of this imbalance are debated. Besides breastfeeding, other strategies to restore this dysbiosis need further studies before they can be recommended.
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Affiliation(s)
- Delphine M. Hoang
- KidZ Health Castle Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussels Belgium
| | - Elvira I. Levy
- KidZ Health Castle Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussels Belgium
| | - Yvan Vandenplas
- KidZ Health Castle Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussels Belgium
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Prediger B, Mathes T, Polus S, Glatt A, Bühn S, Schiermeier S, Neugebauer EAM, Pieper D. A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes. BMC Pregnancy Childbirth 2020; 20:395. [PMID: 32641019 PMCID: PMC7341650 DOI: 10.1186/s12884-020-03036-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate of caesarean sections (CS) has increased in the last decades to about 30% of births in high income countries. Many CSs are electively planned without an urgent medical reason for mother or child. An early CS though may harm the newborn. Our aim was to evaluate the gestational time point after the 37 + 0 week of gestation (WG) (after prematurity = term) of performing an elective CS with the lowest morbidity for mother and child by assessing the time course from 37 + 0 to 42+ 6 WG. METHODS We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL in November 2018. We included studies that compared different time points of elective CS at term no matter the reason for elective CS. Our primary outcomes were the rate of admissions to the neonatal intensive care unit (NICU), neonatal death and maternal death in early versus late term elective CS. Various binary and dose response random effects meta-analyses were performed. RESULTS We identified 35 studies including 982,749 women. Except one randomised controlled trial, all studies were cohort studies. We performed a linear time-response meta-analysis on the primary outcome NICU admission on 14 studies resulting in a decrease of the relative risk (RR) to 0.63 (95% CI 0.56, 0.71) from 37 + 0 to 39 + 6 WG. RR for neonatal death showed a decrease to 39 + (0-6) WG (RR 0.59 95% CI 0.43 to 0.83) and increase from then on (RR 2.09 95% CI 1.18 to 3.70) assuming a U-shape course and using a cubic spline model for meta-analysis of four studies. We only identified one study analyzing maternal death resulting in RR of 0.38 (95% CI 0.04 to 3.40) for 37 + 0 + 38 + 6 WG versus ≥39 + 0 WG. CONCLUSION Our systematic review showed that elective CS (primary and repeated) before the 39 + 0 WG lead to more NICU admissions and neonatal deaths, although death is rare and increases again after 39 + 6 WG. We did not find enough evidence on maternal outcomes. There is a need for more research, considering maternal outcomes to provide a balanced decision between neonatal and maternal health. SYSTEMATIC REVIEW REGISTRATION Registered in PROSPERO (CRD42017078231).
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Affiliation(s)
- Barbara Prediger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Stephanie Polus
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Angelina Glatt
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, Witten/Herdecke University, Marien Hospital Witten, Marienplatz 2, 58452 Witten, Germany
| | - Edmund A. M. Neugebauer
- Brandenburg Medical School - Theodor Fontane, Faculty of Health, Campus Neuruppin, Fehrbelliner Str.38, 16816 Neuruppin, Germany
- Interdisciplinary Centre for Health Services Research, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
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Coates D, Thirukumar P, Spear V, Brown G, Henry A. What are women’s mode of birth preferences and why? A systematic scoping review. Women Birth 2020; 33:323-333. [DOI: 10.1016/j.wombi.2019.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022]
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Lemas DJ, Mack JA, Schoch JJ, Cacho N, Plasencia E, Rhoton-Vlasak AS, Neu J, Thompson L, Francois M, Patel K, Hogan WR, Lipori GP, Gurka MJ. Postnatal pediatric systemic antibiotic episodes during the first three years of life are not associated with mode of delivery. PLoS One 2020; 15:e0229861. [PMID: 32130278 PMCID: PMC7055886 DOI: 10.1371/journal.pone.0229861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/16/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Delivery by cesarean section (C-section) is associated with adverse short-term and long-term infant outcomes. Given that antibiotics during early life are prescribed for infant outcomes that are more likely among c-section deliveries, we hypothesized that postnatal antibiotic exposure will be greater among c-section infants compared to vaginally delivered infants. OBJECTIVE The aim of this paper was to evaluate if mode of infant delivery was associated with patterns of systemic antibiotic exposure in children during their first three years. METHODS Pediatric electronic health records from UFHealth, 2011 to 2017 were reviewed. We included singleton, term infants (37-42 weeks gestation) with a birth weight ≥ 2500 grams, with documented mode of delivery and well visits on record. Infants with a neonatal intensive care unit stay were excluded. Both oral and intravenous antibiotics for a 10-day duration were classified as a single episode. The primary outcome was antibiotic episodes in the first three years of life, and a sub-analysis was performed to compare broad-spectrum versus narrow-spectrum antibiotic exposures. RESULTS The mean number of antibiotic episodes in 4,024 full-term infants was 0.34 (SD = 0.79) and 24.1% of infants had at least one antibiotic episode. Penicillins were the most prescribed antibiotic in children 0-1 years (66.9%) and cephalosporins were the most common antibiotic prescribed for children 1-3 years (56.2%). We did not detect a meaningful or significant rate ratio (RR) between mode of delivery and overall antibiotic episodes 1.14 (95% CI 0.99, 1.31), broad-spectrum episodes 1.19 (95% CI 0.93, 1.52, or narrow-spectrum episodes 1.14 (95% CI 0.97, 1.34). CONCLUSION Our results do not support the hypothesis that postnatal antibiotic exposure was greater among infants delivered by cesarean section compare to infants delivered vaginally during the first three years of life.
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Affiliation(s)
- Dominick J. Lemas
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Jasmine A. Mack
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Jennifer J. Schoch
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Nicole Cacho
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Elizabeth Plasencia
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Alice S. Rhoton-Vlasak
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Josef Neu
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Lindsay Thompson
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Magda Francois
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Keval Patel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - William R. Hogan
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Gloria P. Lipori
- University of Florida Health Shands Hospital, Gainesville, Florida, United States of America
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, United States of America
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Migliorelli F, De Oliveira SS, Martínez de Tejada B. The ARRIVE Trial: Towards a universal recommendation of induction of labour at 39 weeks? Eur J Obstet Gynecol Reprod Biol 2020; 244:192-195. [DOI: 10.1016/j.ejogrb.2019.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
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13
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Dumpa V, Avulakunta I, Shelton J, Yu T, Lakshminrusimha S. Induction of labor and early-onset Sepsis guidelines: impact on NICU admissions in Erie County, NY. Matern Health Neonatol Perinatol 2019; 5:19. [PMID: 31844538 PMCID: PMC6894216 DOI: 10.1186/s40748-019-0114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/21/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Elective delivery prior to term gestation is associated with adverse neonatal outcomes. The impact of American College of Obstetricians and Gynecologists (ACOG) guidelines recommending against induction of labor (IOL) < 39 weeks' postmenstrual age (PMA) on the frequency of early-term births and NICU admissions in Erie County, NY was evaluated in this study. METHODS This is a population-based retrospective comparison of all live births and NICU admissions in Erie County, NY between pre-and post-ACOG IOL guideline epochs (2005-2008 vs. 2011-2014). Information on early-term, full/late/post-term births and NICU admissions was obtained. A detailed chart analysis of indications for admission to the Regional Perinatal Center was performed. RESULTS During the 2005-2008 epoch, early-term births constituted 27% (11,968/44,617) of live births. The NICU admission rate was higher for early-term births (1134/11968 = 9.5%) compared to full/late/post-term (1493/27541 = 5.4%).In the 2011-2014 epoch, early-term births decreased to 23% (10,286/44,575) of live births. However, NICU admissions for early-term (1072/10286 = 10.4%) and full/late/post-term births (1892/29508 = 6.4%) did not decrease partly due to asymptomatic infants exposed to maternal chorioamnionitis admitted for empiric antibiotic therapy as per revised early-onset sepsis guidelines. CONCLUSIONS ACOG recommendations against elective IOL or cesarean delivery < 39 weeks PMA were rapidly translated to clinical practice and decreased early-term births in Erie County, NY. This decrease did not translate to reduced NICU admissions partly due to increased NICU admissions for empiric antibiotic therapy.
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Affiliation(s)
- Vikramaditya Dumpa
- Division of Neonatology, Department of Pediatrics, NYU Winthrop Hospital, 259 First St, Mineola, New York, 11501 USA
| | - Indira Avulakunta
- Department of Pediatrics, Brookdale University Hospital and Medical, 1 Brookdale Plaza, Brooklyn, New York, 11212 USA
| | - James Shelton
- Department of Obstetrics and Gynecology, Oishei Children’s Hospital, 1001 Main St, Buffalo, New York, 14203 USA
| | - Taechin Yu
- Department of Obstetrics and Gynecology, Holy Redeemer Health System, 667 Old Welsh Rd, Huntingdon Valley, PA 19006 USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics, UC Davis Children’s Hospital, 2516 Stockton Blvd, Sacramento, California, 95817 USA
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14
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Vigdis Rikhardsdottir J, Hardardottir H, Thorkelsson T. The majority of early term elective cesarean sections can be postponed. J Matern Fetal Neonatal Med 2019; 34:3344-3349. [PMID: 31752568 DOI: 10.1080/14767058.2019.1684467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION To minimize the risk of neonatal respiratory morbidity it is recommended that elective cesarean sections should not be done before 39-week gestation unless medically indicated. However, elective cesarean sections are still being performed at early term (at 370-386 weeks gestation) without sound medical indications. In this study, we evaluated the indications for elective cesarean sections performed at early term to assess the proportion of procedures that could possibly have been postponed until ≥39 weeks to avoid neonatal respiratory morbidity. MATERIAL AND METHODS Maternal and neonatal information was collected from medical records on all elective cesarean sections performed in singleton pregnancies at ≥370 weeks gestation over a 20-year period in a population with secure ultrasound gestational age assignment. Indications were grouped and uterine scar, breech, or transverse presentation and maternal request classified as nonurgent. RESULTS There were 3411 elective cesarean sections performed at ≥37-week gestation, of which 790 (23.2%) were at 370-386 weeks. Medical indications were present for 34% (272/790), but 65.6% (518/790) could possibly have been postponed until ≥390 weeks. Of the neonates 5.7% developed respiratory morbidity if delivery was at 370-386 weeks gestation compared to 2.4% at 390-421 weeks gestation (p < .001). CONCLUSION Of elective cesarean sections before 39-week gestation two-thirds were done without a clear medical indication, thereby exposing the newborn to an increased risk of respiratory morbidity. Scheduling elective cesarean sections at ≥39-week gestation is important to minimize the risk of neonatal respiratory morbidity, unless a clear medical indication dictates earlier delivery.
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Affiliation(s)
| | - Hildur Hardardottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavík, Iceland
| | - Thordur Thorkelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Neonatology, Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
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Pirjani R, Afrakhteh M, Sepidarkish M, Nariman S, Shirazi M, Moini A, Hosseini L. 'Elective caesarean section at 38-39 weeks gestation compared to > 39 weeks on neonatal outcomes: a prospective cohort study. BMC Pregnancy Childbirth 2018; 18:140. [PMID: 29739452 PMCID: PMC5941590 DOI: 10.1186/s12884-018-1785-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background This study was conducted to compare neonatal complications in scheduled cesarean sections (CS) between 38 and 39 gestational weeks with CS performed after 39 gestational weeks in Iranian low -risk pregnant women. Methods In this cohort study, 2086 patients were enrolled based on the inclusion and exclusion criteria. The neonates were evaluated in terms of the following items: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), sepsis, need for NICU hospitalization, birth weight, birth height, head circumference, and the first minute and fifth minute Apgar score. Several multiple logistic regression models were performed for each response variable (adverse outcome) separately. Results The incidence of NICU admission was significantly higher in neonates born at 38–39 gestational weeks than those who were born after 39 gestational weeks. No significant differences were found in the incidence of neonatal sepsis, TTN, and RDS between the two groups. Conclusion According to our study results, elective CS at 38–9 weeks’ gestation is associated with a higher rate of TTN and NICU admission in comparison with elective CS performed after 39 completed gestational weeks.
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Affiliation(s)
- Reihaneh Pirjani
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Research development center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Shahin Nariman
- Department of Pediatrics, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Moini
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR., Tehran, Iran
| | - Ladan Hosseini
- Research development center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Katwa N, Vasudeva A, Lewis LES, Kumar P. There is Only a Modest Increase in Neonatal Respiratory Morbidity Following Early Term Elective Cesarean in a South Indian Population. J Obstet Gynaecol India 2018; 68:104-110. [DOI: 10.1007/s13224-017-0995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/08/2017] [Indexed: 10/19/2022] Open
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Klingenberg C, Kornelisse RF, Buonocore G, Maier RF, Stocker M. Culture-Negative Early-Onset Neonatal Sepsis - At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship. Front Pediatr 2018; 6:285. [PMID: 30356671 PMCID: PMC6189301 DOI: 10.3389/fped.2018.00285] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023] Open
Abstract
Sepsis is a leading cause of mortality and morbidity in neonates. Presenting clinical symptoms are unspecific. Sensitivity and positive predictive value of biomarkers at onset of symptoms are suboptimal. Clinical suspicion therefore frequently leads to empirical antibiotic therapy in uninfected infants. The incidence of culture confirmed early-onset sepsis is rather low, around 0.4-0.8/1000 term infants in high-income countries. Six to 16 times more infants receive therapy for culture-negative sepsis in the absence of a positive blood culture. Thus, culture-negative sepsis contributes to high antibiotic consumption in neonatal units. Antibiotics may be life-saving for the few infants who are truly infected. However, overuse of broad-spectrum antibiotics increases colonization with antibiotic resistant bacteria. Antibiotic therapy also induces perturbations of the non-resilient early life microbiota with potentially long lasting negative impact on the individual's own health. Currently there is no uniform consensus definition for neonatal sepsis. This leads to variations in management. Two factors may reduce the number of culture-negative sepsis cases. First, obtaining adequate blood cultures (0.5-1 mL) at symptom onset is mandatory. Unless there is a strong clinical or biochemical indication to prolong antibiotics physician need to trust the culture results and to stop antibiotics for suspected sepsis within 36-48 h. Secondly, an international robust and pragmatic neonatal sepsis definition is urgently needed. Neonatal sepsis is a dynamic condition. Rigorous evaluation of clinical symptoms ("organ dysfunction") over 36-48 h in combination with appropriately selected biomarkers ("dysregulated host response") may be used to support or refute a sepsis diagnosis.
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Affiliation(s)
- Claus Klingenberg
- Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway.,Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - René F Kornelisse
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University of Marburg, Marburg, Germany
| | - Martin Stocker
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, Lucerne, Switzerland
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18
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Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Carney OO, Neu J, Carson TL. The Neonatal Microbiome and Its Partial Role in Mediating the Association between Birth by Cesarean Section and Adverse Pediatric Outcomes. Neonatology 2018; 114:103-111. [PMID: 29788027 PMCID: PMC6532636 DOI: 10.1159/000487102] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/23/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cesarean sections (CS) are among the most commonly performed surgical procedures in the world. Epidemiologic data has associated delivery by CS with an increased risk of certain adverse health outcomes in children, such as asthma and obesity. OBJECTIVE To explore what is known about the effect of mode of delivery on the development of the infant microbiome and discuss the potentially mediating role of CS-related microbial dysbiosis in the development of adverse pediatric health outcomes. Recommendations for future inquiry are also provided. METHODS This study provides a narrative overview of the literature synthesizing the findings of literature retrieved from searches of PubMed and other computerized databases and authoritative texts. RESULTS Emerging evidence suggests that mode of delivery is involved in the development of the neonatal microbiome and may partially explain pediatric health outcomes associated with birth by CS. Specifically, the gut microbiome of vaginally delivered infants more closely resembles their mothers' vaginal microbiome and thus more commonly consists of potentially beneficial microbiota such as Lactobacillus, Bifidobacterium, and Bacteroides. Conversely, the microbiome of infants born via CS shows an increased prevalence of either skin flora or potentially pathogenic microbial communities such as Klebsiella, Enterococcus, and Clostridium. CONCLUSIONS Mode of delivery plays an important role in the development of the postnatal microbiome but likely tells only part of the story. More comprehensive investigations into all the pre- and perinatal factors that have the potential to contribute to the neonatal microbiome are warranted.
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Affiliation(s)
- Diana Montoya-Williams
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Dominick J Lemas
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Lisa Spiryda
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Keval Patel
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - O'neshia Olivia Carney
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Josef Neu
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Tiffany L Carson
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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19
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Adams N, Gibbons KS, Tudehope D. Authors' reply. Aust N Z J Obstet Gynaecol 2017; 57:E18. [PMID: 29210051 DOI: 10.1111/ajo.12740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nicole Adams
- Mater Research Institute - University of Queensland, South Brisbane, QLD, Australia
| | - Kristen S Gibbons
- Mater Research Institute - University of Queensland, South Brisbane, QLD, Australia
| | - David Tudehope
- Mater Research Institute - University of Queensland, South Brisbane, QLD, Australia
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20
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Muoto I, Darney BG, Lau B, Cheng YW, Tomlinson MW, Neilson DR, Friedman SA, Rogovoy J, Caughey AB, Snowden JM. Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy. Health Serv Res 2017; 53 Suppl 1:2839-2857. [PMID: 29131330 DOI: 10.1111/1475-6773.12797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To assess the use and timing of scheduled cesareans and other categories of cesarean delivery and the prevalence of neonatal morbidity among cesareans in Oregon before and after the implementation of Oregon's statewide policy limiting elective early deliveries. DATA SOURCES Oregon vital statistics records, 2008-2013. STUDY DESIGN Retrospective cohort study, with multivariable logistic regression, regression controlling for time trends, and interrupted time series analyses, to compare the odds of different categories of cesarean delivery and the odds of neonatal morbidity pre- and postpolicy. DATA COLLECTION/EXTRACTION METHODS We analyzed vital statistics data on all term births in Oregon (2008-2013), excluding births in 2011. PRINCIPAL FINDINGS The odds of early-term scheduled cesareans decreased postpolicy (adjusted odds ratio [aOR], 0.70; 95 percent confidence interval [CI], 0.66-0.74). In the postpolicy period, there were mixed findings regarding assisted neonatal ventilation and neonatal intensive care unit admission, with regression models indicating higher postpolicy odds in some categories, but lower postpolicy odds after controlling for time trends. CONCLUSIONS Oregon's hard stop policy limiting elective early-term cesarean delivery was associated with lower odds of cesarean delivery in the category of women who were targeted by the policy; more research is needed on impact of such policies on neonatal outcomes.
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Affiliation(s)
- Ifeoma Muoto
- Kaiser Permanente Northwest-Regional Administration, Portland, OR
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR.,Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Bernard Lau
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Yvonne W Cheng
- Sutter Health, California Pacific Medical Center, Department of Obstetrics and Gynecology, San Francisco, CA.,Department of Surgery, University of California, Davis, CA
| | - Mark W Tomlinson
- Providence Health and Services Women and Children's Program, Portland, OR
| | | | - Steven A Friedman
- Department of Perinatology, Kaiser Permanente, Kaiser Sunnyside Medical Center, Clackamas, OR
| | | | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Jonathan M Snowden
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR.,School of Public Health, Oregon Health & Science University/Portland State University, Portland, OR
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Abstract
Perinatal epidemiology examines the variation and determinants of pregnancy outcomes from a maternal and neonatal perspective. However, improving public and population health also requires the translation of this evidence base into substantive public policies. Assessing the impact of such public policies requires sufficient data to include potential confounding factors in the analysis, such as coexisting medical conditions and socioeconomic status, and appropriate statistical and epidemiological techniques. This review will explore policies addressing three areas of perinatal medicine-elective deliveries prior to 39 weeks' gestation; perinatal regionalization; and mandatory paid maternity leave policies-to illustrate the challenges when assessing the impact of specific policies at the patient and population level. Data support the use of these policies to improve perinatal health, but with weaker and less certain effect sizes when compared to the initial patient-level studies. Improved data collection and epidemiological techniques will allow for improved assessment of these policies and the identification of potential areas of improvement when translating patient-level studies into public policies.
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Affiliation(s)
- Scott A Lorch
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric and Perinatal Health Disparities Research and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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22
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Adams N, Gibbons KS, Tudehope D. Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term. Aust N Z J Obstet Gynaecol 2017; 57:176-185. [PMID: 28326546 DOI: 10.1111/ajo.12591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/10/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prelabour caesarean section (CS) at early term (370 -386 weeks) is associated with higher rates of adverse short-term neonatal outcomes and higher costs than those performed at full term (390 -406 weeks). Prelabour CS is more common in private than in public hospitals in Australia, particularly at early term. AIMS To evaluate the impact of hospital sector (public or private) and timing of delivery on short-term neonatal outcomes following prelabour CS at term. MATERIALS AND METHODS A retrospective cohort study of 22 954 viable singleton prelabour CS births at term (370 -406 weeks) at a single centre encompassing co-located public and private hospitals during 1998-2013 was undertaken. Propensity score analysis was used to adjust for confounding differences between sectors. The primary outcome was Neonatal Critical Care Unit (NCCU) admission with serious morbidity. Secondary outcomes included respiratory distress, vigorous resuscitation and jaundice. RESULTS The private hospital performed prelabour CS at over double the rate of the public hospital (33.7% of all private births vs 14.7% public) and more private than public prelabour CSs occurred at early term (66.8% vs 47.9%). Public babies were more than twice as likely as private babies to require admission to NCCU with serious morbidity (adjusted odds ratio (AOR) 2.54, 95% CI 1.77-3.65) but were less likely to need vigorous resuscitation (AOR 0.53, 95% CI 0.45-0.62). Disparities in outcomes between public and private cohorts were accentuated at full term. CONCLUSION Despite early-term prelabour CSs occurring more often in the private hospital, public babies had more adverse outcomes and treatment escalations.
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Affiliation(s)
- Nicole Adams
- The School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kristen S Gibbons
- Mater Research Office, Mater Research, South Brisbane, Queensland, Australia
| | - David Tudehope
- The School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
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Phaloprakarn C, Tangjitgamol S, Manusirivithaya S. Timing of elective cesarean delivery at term and its impact on maternal and neonatal outcomes among Thai and other Southeast Asian pregnant women. J Obstet Gynaecol Res 2016; 42:936-43. [PMID: 27079277 DOI: 10.1111/jog.13016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 02/01/2016] [Accepted: 02/26/2016] [Indexed: 12/01/2022]
Abstract
AIM The impact of timing of elective cesarean delivery (CD) at term on maternal and neonatal outcomes among Thai and other Southeast Asian pregnancies was investigated. The rate of spontaneous labor before the scheduled CD, as well as maternal characteristics predicting spontaneous labor, was also evaluated. METHODS Data on maternal and neonatal outcomes of 1221 singleton pregnancies scheduled for either an elective repeat CD or an elective primary CD at 37-40 weeks of gestation were studied. The association between maternal characteristics and the risk of spontaneous labor was evaluated by univariate and multivariate analyses. RESULTS There were no significant differences in severe maternal complications between performing an elective CD at 39 weeks and at the other gestational ages. Severe neonatal complications were significantly decreased when a CD was performed electively from 38 weeks onwards. A total of 503 women (41.2 %) went into spontaneous labor before the scheduled CD. Using 39 weeks as the reference group, scheduling a CD at 37 or 38 weeks decreased the risk of spontaneous labor (6.67-fold and 4.55-fold, respectively) while scheduling a CD at 40 weeks had a 2.54-fold increased risk. A history of previous CD and teenage pregnancy were also predictors of spontaneous labor; adjusted odds ratios were 14.27 and 3.93, respectively. CONCLUSION The timing of elective CD at term had impacts on pregnancy outcomes among Thai and other Southeast Asian women. Gestational age at scheduled CD, a previous CD and teenage pregnancy were predictors of spontaneous labor.
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Affiliation(s)
- Chadakarn Phaloprakarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Siriwan Tangjitgamol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sumonmal Manusirivithaya
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Vidic Z, Blickstein I, Štucin Gantar I, Verdenik I, Tul N. Timing of elective cesarean section and neonatal morbidity: a population-based study. J Matern Fetal Neonatal Med 2015; 29:2461-3. [PMID: 26444222 DOI: 10.3109/14767058.2015.1087500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the incidence of neonatal complications related to gestational age at elective cesarean section near term. METHODS We used a population-based dataset to compare neonatal outcomes by gestational age in uncomplicated singleton pregnancies delivered by elective cesarean section ≥37 weeks. RESULTS A total of 7364 mothers had an elective cesarean during 2002-2012; 343 (4.7%) at 37, 21 753 (3.8%) at 38, 3140 (2.6%) at 39, 1718 (23.3%) at 40 and 410 (5.6%) at ≥41 weeks. Infants born at a lower gestational age had a higher rate of Apgar scores <7 (2%, 0.4%, 0.6%, 0,3%, 0.2% at 37, 38, 39, 40 and ≥41 week, p = 0.013), hypoglycemia (1.5%, 1.0%, 0.8%, 0.4%, 0.5% at 37, 38, 39, 40 and ≥ 41 week, p = 0.012), hyperbilirubinemia (12.2%, 9.5%, 6.4%, 4.8%, 4.1% at 37, 38, 39, 40 and ≥ 41 week, p < 0.001), respiratory distress syndrome (5.5%, 2.2%, 1.6%, 0.5%, 0.7% at 37, 38, 39, 40 and ≥ 41 week, p < 0.001), and neonatal intensive care admissions (8.7%, 2.3%, 1.9%, 1.0%, 1.7% at 37, 38, 39, 40 and ≥ 41 week, p < 0.001). CONCLUSIONS Elective cesarean section at ≥ 39 weeks gestation would significantly reduce neonatal complications.
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Affiliation(s)
- Zala Vidic
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
| | - Isaac Blickstein
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
| | - Irena Štucin Gantar
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
| | - Ivan Verdenik
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
| | - Nataša Tul
- a Department of Perinatology , Division of Obstetrics and Gynecology, University Medical Centre Ljubljana , Slovenia and.,b Department of Obstetrics and Gynecology , Kaplan Medical Center , Rehovot , Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem)
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Newnham JP, Dickinson JE, Hart RJ, Pennell CE, Arrese CA, Keelan JA. Strategies to prevent preterm birth. Front Immunol 2014; 5:584. [PMID: 25477878 PMCID: PMC4237124 DOI: 10.3389/fimmu.2014.00584] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/01/2014] [Indexed: 11/13/2022] Open
Abstract
After several decades of research, we now have evidence that at least six interventions are suitable for immediate use in contemporary clinical practice within high-resource settings and can be expected to safely reduce the rate of preterm birth. These interventions involve strategies to prevent non-medically indicated late preterm birth; use of maternal progesterone supplementation; surgical closure of the cervix with cerclage; prevention of exposure of pregnant women to cigarette smoke; judicious use of fertility treatments; and dedicated preterm birth prevention clinics. Quantification of the extent of success is difficult to predict and will be dependent on other clinical, cultural, societal, and economic factors operating in each environment. Further success can be anticipated in the coming years as other research discoveries are translated into clinical practice, including new approaches to treating intra-uterine infection, improvements in maternal nutrition, and lifestyle modifications to ameliorate maternal stress. The widespread use of human papillomavirus vaccination in girls and young women will decrease the need for surgical interventions on the cervix and can be expected to further reduce the risk of early birth. Together, this array of clinical interventions, each based on a substantial body of evidence, is likely to reduce rates of preterm birth and prevent death and disability in large numbers of children. The process begins with an acceptance that early birth is not an inevitable and natural feature of human reproduction. Preventative strategies are now available and need to be applied. The best outcomes may come from developing integrated strategies designed specifically for each health-care environment.
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Affiliation(s)
- John P Newnham
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Roger J Hart
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Craig E Pennell
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Catherine A Arrese
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| | - Jeffrey A Keelan
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
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Dickinson JE. Caesarean delivery: truths and consequences. Aust N Z J Obstet Gynaecol 2014; 54:295-7. [PMID: 25117186 DOI: 10.1111/ajo.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia.
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