1
|
Ma K, Yang M, Feng X, Liu L, Li L, Li Y. Predictors of vaginal delivery following balloon catheter for labor induction in women with one previous cesarean. BMC Pregnancy Childbirth 2023; 23:417. [PMID: 37277699 DOI: 10.1186/s12884-023-05734-y] [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: 02/16/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The aim of this study was to estimate predictors for vaginal birth following balloon catheter induction of labor (IOL) in women with one previous cesarean section (CS) and an unfavorable cervix. METHODS This 4-year retrospective cohort study was conducted in Longhua District Central Hospital in Shenzhen China, between January 2015 and December 2018. Patients with one previous CS and a current singleton-term pregnancy who underwent balloon catheter cervical ripening and IOL were enrolled. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean section (VBAC). Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. The primary outcome was VBAC, which was a successful trial of labor after cesarean delivery (TOLAC) following IOL. RESULTS A total of 69.57% (208/299) of the women who planned for IOL had VBAC. In the final binary logistic regression equation, lower fetal weight (< 4000 g) (odds ratio [OR]5.26; 95% confidence interval [CI] 2.09,13.27), lower body mass index (BMI,<30 kg/m2) (OR 2.27; CI 1.21, 4.26), Bishop score after cervical ripening > 6 (OR 1.94; CI 1.37, 2.76) remained independently associated with an increased chance of VBAC. CONCLUSIONS The influencing factors of VBAC following IOL were fetal weight, BMI, and Bishop score after cervical ripening. Adequate individualized management and assessment of the IOL may help improve the VBAC rate.
Collapse
Affiliation(s)
- Kaidong Ma
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Ming Yang
- Obstetrics department, The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, China
| | - Xiaoling Feng
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Liyuan Liu
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Liangliang Li
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Yunxiu Li
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China.
| |
Collapse
|
2
|
Kammies JD, De Waard L, Muller CJB, Hall DR. Delivery outcomes in women with morbid obesity, where induction of labour was planned to prevent post-term complications. J OBSTET GYNAECOL 2022; 42:3450-3455. [PMID: 36194089 DOI: 10.1080/01443615.2022.2128730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Morbid obesity and prolonged pregnancy are independently associated with adverse delivery and perinatal outcomes. We conducted a retrospective observational study on otherwise uncomplicated women with a body mass index (BMI) ≥ 40 kg/m2 where, having reached term, induction of labour (IOL) was planned, to prevent prolonged pregnancy. The primary aim was to describe delivery outcomes and short-term maternal and perinatal adverse events. Of 117 cases included, 69 (59%) laboured spontaneously before the induction date, while 48 (41%) required an IOL. Of 48 patients that underwent an IOL, 22 (45.8%) achieved vaginal delivery, compared to 55 (79.7%) who laboured spontaneously (p = <.001). Twenty-two (18.8%) of the 117 babies weighed more than 4000 g, with 13 of these delivered vaginally. Overall, term patients with morbid obesity who laboured spontaneously before requiring induction, had a high rate of vaginal delivery. However, when IOL was required, the rate of caesarean delivery rose dramatically.Impact statementWhat is already known on this subject? Morbid obesity and prolonged pregnancy are independently associated with adverse delivery and perinatal outcomes. Induction of labour (IOL) increases the workload in busy units.What do the results of this study add? These results help inform accurate counselling on delivery outcomes, which is integral to respectful care, for the continuously increasing numbers of morbidly obese pregnant women.What the implications are of these findings for clinical practice and/or further research? It is preferable to avoid semi- or urgent caesarean deliveries in morbidly obese women after IOL. The outcomes of earlier induction of labour from 39- or 40-weeks' gestation requires investigation. Earlier induction may reduce the numbers of caesarean deliveries for abnormal cardiotocograph during the process.
Collapse
Affiliation(s)
- J D Kammies
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L De Waard
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C J B Muller
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - D R Hall
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
3
|
Ferris L, de Vries B, Sweeting A. Management of obesity in pregnancy. Aust N Z J Obstet Gynaecol 2022; 62:623-625. [DOI: 10.1111/ajo.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Lauren Ferris
- Royal Prince Alfred Hospital Women and Babies Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Brad de Vries
- Royal Prince Alfred Hospital Women and Babies Royal Prince Alfred Hospital Sydney New South Wales Australia
- NHMRC Clinical Trials Centre University of Sydney Sydney New South Wales Australia
| | - Arianne Sweeting
- Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
- Department of Endocrinology Royal Prince Alfred Hospital Sydney New South Wales Australia
| |
Collapse
|
4
|
Taha Z, Hassan AA, Papandreou D. Epidemiology of pre-pregnancy body mass index (BMI) among mothers in Abu Dhabi, the United Arab Emirates. Front Glob Womens Health 2022; 3:893808. [PMID: 36177337 PMCID: PMC9513227 DOI: 10.3389/fgwh.2022.893808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Pre-pregnancy obesity is a risk factor for several health problems such as gestational diabetes, preeclampsia, labor induction, postpartum hemorrhage, and neonatal hypoglycemia. Being underweight is a risk factor for fetal growth restriction. Despite the negative impact of abnormal pre-pregnancy body mass index (BMI) (over and underweight) on pregnancy outcomes, a limited amount of studies has been conducted on the prevalence of pre-pregnancy over and underweight and associated factors in the United Arab Emirates (UAE). Thus, the aim of this study was to investigate the prevalence and factors associated with underweight, overweight, and obesity among mothers with children under the age of 2 years in Abu Dhabi, the UAE. A cross-sectional multicenter study was conducted in 2017 and included data from seven government health care centers in Abu Dhabi. Maternal pre-pregnancy BMI was calculated as the weight in kilograms (kg) divided by the square of the height in meters (m), (kg/m2). A total of 1,622 mother–child pairs were included in this study. Out of the 1,622 mothers, 43 (2.7%) were underweight, 1,068 (65.8%) were normal weight, 412 (25.4%) were overweight, and 99 (6.1%) were obese. Mothers with advanced maternal age (AMA) (≥35 years) were more likely to be overweight, odds ratio [OR] = 1.93, (95% confidence interval [CI] 1.52–2.3), p ≤ 0.001, and obese OR = 2.15 (95% CI 1.32–3.39), p = 0.001. Mothers with lower family income were more likely to be obese OR = 2.72 (95% CI 1.44–5.93), p = 0.002. Mothers with high parity (≥2) were more likely to be overweight OR = 1.91 (95% CI 1.49–2.50), p ≤ 0.001; obese OR = 1.76 (95% CI 1.06–2.92), p = 0.024; and less likely to be underweight OR = 0.52 (95% CI 0.27–0.94), p = 0.037. Obese mothers were more likely to deliver via cesarean section (CS) OR = 1.95 (95% CI 1.27–2.96), p = 0.002. This study provides valuable baseline information on the epidemiology of pre-pregnancy BMI in the UAE. The sociodemographic factors identified in the study can be used to target at-risk women. The study findings can also be used to develop contextualized strategies to prevent and manage complications associated with abnormal pre-pregnancy BMI in Emirati women.
Collapse
Affiliation(s)
- Zainab Taha
- College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
- *Correspondence: Zainab Taha
| | | | - Dimitrios Papandreou
- College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
| |
Collapse
|
5
|
Maroyi R, Naomi B, Moureau MK, Marceline BS, Ingersoll C, Nerville R, Mukwege D. Factors Associated with Successful Vaginal Birth After a Primary Cesarean Section in Women with an Optimal Inter-Delivery Interval. Int J Womens Health 2021; 13:903-909. [PMID: 34675688 PMCID: PMC8502045 DOI: 10.2147/ijwh.s334269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose We sought to determine the success rate of VBAC and factors associated with achieving VBAC at a referral hospital in the Democratic Republic of Congo in women with a subsequent pregnancy greater than or equal to 18 months from their primary cesarean section (CS). Patients and Methods Patients were included for participation if they had an inter-delivery interval (IDI) of at least 18 months from their primary CS, accepted TOLAC, and had no contraindications. Information was collected about patients' demographics, obstetric history, and factors impacting their labor process. Descriptive analyses compared patients that had a successful VBAC and those who did not. Univariate and multivariate binary logistic regression models identified factors associated with a successful VBAC. Results Among 231 eligible patients who attempted a VBAC, 57.6% (133) achieved VBAC. Participants had a mean age of 29 (SD 6), with the majority having a prior vaginal delivery (68.8%). VBAC was positively associated with a higher Bishop score (AOR 1.12, 95% CI 1.02, 1.23) and a spontaneous labor onset (AOR 3.06, 95% CI 1.52, 6.17). VBAC was negatively associated with a macrosomic fetus (AOR 0.21, 95% CI 0.08, 0.58). Conclusion TOLAC results in VBAC more than half the time and is associated with a spontaneous labor onset and a higher Bishop score. Women with a macrosomic fetus were more likely to have an unsuccessful VBAC, resulting in an RCS. An optimal IDI was not enough to ensure a successful VBAC. Upon patients' arrival to the hospital, practitioners should re-evaluate their eligibility to attempt a VBAC based on their Bishop score and if they had a spontaneous labor onset to decrease the health risks of an RCS.
Collapse
Affiliation(s)
- Raha Maroyi
- Department of Obstetrics and Gynecology, Panzi Referral Hospital, Bukavu, South Kivu, Democratic Republic of Congo.,Université Evangélique en Afrique (UEA), Bukavu, South Kivu, Democratic Republic of Congo
| | - Bahaya Naomi
- Université Evangélique en Afrique (UEA), Bukavu, South Kivu, Democratic Republic of Congo
| | - Madeline K Moureau
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Balungwe Sifa Marceline
- Department of Obstetrics and Gynecology, Panzi Referral Hospital, Bukavu, South Kivu, Democratic Republic of Congo
| | | | | | - Denis Mukwege
- Department of Obstetrics and Gynecology, Panzi Referral Hospital, Bukavu, South Kivu, Democratic Republic of Congo.,Université Evangélique en Afrique (UEA), Bukavu, South Kivu, Democratic Republic of Congo.,International Center for Advanced Research and Training (ICART), Bukavu, South Kivu, Democratic Republic of Congo
| |
Collapse
|
6
|
Ledbetter A. Considering Labor After Cesarean in a Woman with Class 3 Obesity. J Midwifery Womens Health 2020; 65:382-386. [PMID: 32424974 DOI: 10.1111/jmwh.13117] [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: 09/08/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
Because of the high cesarean rate in the United States, perinatal care providers are increasingly called upon to counsel women considering labor after cesarean. This counseling can be more complicated for women with class 3 obesity, defined as a body mass index at or exceeding 40. Although labor after cesarean may be less likely to result in successful vaginal birth after cesarean (VBAC) for this population, the risks of repeat cesarean are also higher for these women. This case report describes the benefits and risks of labor after cesarean, the chance of successful VBAC, and clinical recommendations to aid women in achieving VBAC when class 3 obesity is present.
Collapse
Affiliation(s)
- Ann Ledbetter
- Department of Midwifery, Sixteenth Street Community Health Centers, Milwaukee, Wisconsin
| |
Collapse
|