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Daskalakis G, Pergialiotis V, Domellöf M, Ehrhardt H, Di Renzo GC, Koç E, Malamitsi-Puchner A, Kacerovsky M, Modi N, Shennan A, Ayres-de-Campos D, Gliozheni E, Rull K, Braun T, Beke A, Kosińska-Kaczyńska K, Areia AL, Vladareanu S, Sršen TP, Schmitz T, Jacobsson B. European guidelines on perinatal care: corticosteroids for women at risk of preterm birth. J Matern Fetal Neonatal Med 2023; 36:2160628. [PMID: 36689999 DOI: 10.1080/14767058.2022.2160628] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
of recommendationsCorticosteroids should be administered to women at a gestational age between 24+0 and 33+6 weeks, when preterm birth is anticipated in the next seven days, as these have been consistently shown to reduce neonatal mortality and morbidity. (Strong-quality evidence; strong recommendation). In selected cases, extension of this period up to 34+6 weeks may be considered (Expert opinion). Optimal benefits are found in infants delivered within 7 days of corticosteroid administration. Even a single-dose administration should be given to women with imminent preterm birth, as this is likely to improve neurodevelopmental outcome (Moderate-quality evidence; conditional recommendation).Either betamethasone (12 mg administered intramuscularly twice, 24-hours apart) or dexamethasone (6 mg administered intramuscularly in four doses, 12-hours apart, or 12 mg administered intramuscularly twice, 24-hours apart), may be used (Moderate-quality evidence; Strong recommendation). Administration of two "all" doses is named a "course of corticosteroids".Administration between 22+0 and 23+6 weeks should be considered when preterm birth is anticipated in the next seven days and active newborn life-support is indicated, taking into account parental wishes. Clear survival benefit has been observed in these cases, but the impact on short-term neurological and respiratory function, as well as long-term neurodevelopmental outcome is still unclear (Low/moderate-quality evidence; Weak recommendation).Administration between 34 + 0 and 34 + 6 weeks should only be offered to a few selected cases (Expert opinion). Administration between 35+0 and 36+6 weeks should be restricted to prospective randomized trials. Current evidence suggests that although corticosteroids reduce the incidence of transient tachypnea of the newborn, they do not affect the incidence of respiratory distress syndrome, and they increase neonatal hypoglycemia. Long-term safety data are lacking (Moderate quality evidence; Conditional recommendation).Administration in pregnancies beyond 37+0 weeks is not indicated, even for scheduled cesarean delivery, as current evidence does not suggest benefit and the long-term effects remain unknown (Low-quality evidence; Conditional recommendation).Administration should be given in twin pregnancies, with the same indication and doses as for singletons. However, existing evidence suggests that it should be reserved for pregnancies at high-risk of delivering within a 7-day interval (Low-quality evidence; Conditional recommendation). Maternal diabetes mellitus is not a contraindication to the use of antenatal corticosteroids (Moderate quality evidence; Strong recommendation).A single repeat course of corticosteroids can be considered in pregnancies at less than 34+0 weeks gestation, if the previous course was completed more than seven days earlier, and there is a renewed risk of imminent delivery (Low-quality evidence; Conditional recommendation).
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Affiliation(s)
- George Daskalakis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Pergialiotis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Justus-Liebig-University and Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany.,German Lung Research Center (DZL), Giessen, Germany
| | - Gian Carlo Di Renzo
- Center for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,PREIS International and European School of Perinatal, Neonatal and Reproductive Medicine, Florence, Italy.,Department of Obstetrics and Gynecology, I.M. Sechenov First State University of Moscow, Moscow, Russia
| | - Esin Koç
- Department of Neonatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Ariadne Malamitsi-Puchner
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Králové, Hradec Kralove, Czech Republic
| | - Neena Modi
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.,Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, King's College London, London, UK
| | - Diogo Ayres-de-Campos
- Medical School, Santa Maria University Hospital, Lisbon, Portugal.,European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Elko Gliozheni
- Department of Obstetrics and Gynaecology, Maternity Koco Gliozheni Hospital, Tirana, Albania
| | - Kristiina Rull
- Women's Clinic of Tartu University Hospital, Tartu, Estonia.,Department of Obstetrics and Gynaecology, University of Tartu, Tartu Estonia.,Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Thorsten Braun
- Department of Obstetrics and Division of 'Experimental Obstetrics', Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Artur Beke
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Katarzyna Kosińska-Kaczyńska
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Ana Luisa Areia
- Obstetrics Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Centre of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Coimbra, Portugal
| | - Simona Vladareanu
- Neonatology Clinic, Department of Obstetrics and Gynecology, Faculty of General Medicine, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Tanja Premru Sršen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de gynécologie-obstétrique, hôpital Robert-Debré, Université Paris Cité, Paris, France
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
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2
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Prevalence and Factors Associated with Low Birth Weight and Preterm Delivery in the Ho Municipality of Ghana. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3955869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background. Low birth weight and preterm delivery are birth outcomes that can predict newborns’ survival, development, and long-term health outcomes. This study assessed the prevalence and factors associated with low birth weight and preterm delivery in the Ho Municipality of Ghana. Methods. This retrospective, cross-sectional study analysed data from 680 birth records between October and December 2018. Univariate and multivariate logistic regression models predicted low birth weight and preterm delivery factors. Results. The prevalence of low birth weight and preterm delivery was 12.9% and 14.1%, respectively. Increasing maternal age (AOR: 0.52; 95% CI: 0.28–0.98), multiparity (AOR: 0.54; 95% CI: 0.30–0.94) and increasing doses of sulphadoxine-pyrimethamine (AOR: 0.43; 95% CI: 0.22–0.84) significantly reduced the odds of low birth weight. However, caesarean section (AOR: 1.94; 95% CI: 0.1.16–3.27) and hypertension (AOR: 2.06; 95% CI: 1.27–03.33) significantly increased the likelihood of low birth weight. An increasing number of antenatal care visits (AOR: 0.38; 95% CI: 0.18–0.80) and doses of sulphadoxine-pyrimethamine (AOR: 0.43; 95% CI: 0.19–0.97) were significantly associated with decreased odds of preterm delivery, while caesarean section increased the odds of preterm delivery by two folds (AOR: 2.14; 95% CI: 1.15–3.99). Conclusion. This study shows that maternal age, parity, number of antenatal care visits, hypertension, SP/IPTp, and caesarean section were independently associated with low birth weight and preterm delivery. Education and interventions should be prioritised as vitally important on these factors to reduce the risk and complications associated with these birth outcomes.
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Kim HY, Lee D, Kim J, Noh E, Ahn KH, Hong SC, Kim HJ, Oh MJ, Cho GJ. Secular trends in cesarean sections and risk factors in South Korea (2006-2015). Obstet Gynecol Sci 2020; 63:440-447. [PMID: 32689771 PMCID: PMC7393761 DOI: 10.5468/ogs.19212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE This study aimed to investigate trends in the rate of cesarean sections (CSs) in South Korea from 2006 to 2015 and identify the risk factors associated with these changes. METHODS Using the National Health Insurance Corporation dataset, all women who gave birth between 2006 and 2015 were included in the study. We investigated 1) the mode of delivery, 2) the complication rates during pregnancy (i.e., preeclampsia and placenta previa), and 3) pre-pregnancy factors (body mass index, hypertension [HTN], diabetes mellitus [DM], and other pre-existing medical conditions), and their trends during the study period. RESULTS Over 10 years, the rate of CS increased from 36.3% in 2006 to 40.6% in 2015 (P<0.01). The rate of CS increased in primiparous women, women with multiple pregnancy, and women with preeclampsia. Maternal age and the incidence of placenta previa also increased. In contrast, the rate of vacuum deliveries and vaginal birth after CS decreased during the study period. The rate of women with pre-pregnancy obesity and DM increased, but the rate of women with pre-pregnancy HTN decreased. CONCLUSION The rate of CS in South Korea increased from 2006 to 2015. This trend may reflect changes in the rate of different risk factors. Identifying the causes of the increasing CS trend observed in this study will allow clinicians to monitor these factors and possibly reduce the rate of CS.
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Affiliation(s)
- Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Dokyum Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jinsil Kim
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Korea
| | - Eunjin Noh
- Korea University Guro Hospital Smart Healthcare Center, Seoul, Korea
| | - Ki-Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Tietzmann MR, Teichmann PDV, Vilanova CS, Goldani MZ, Silva CHD. Risk Factors for Neonatal Mortality in Preterm Newborns in The Extreme South of Brazil. Sci Rep 2020; 10:7252. [PMID: 32350375 PMCID: PMC7190611 DOI: 10.1038/s41598-020-64357-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/07/2020] [Indexed: 11/08/2022] Open
Abstract
Neonatal mortality still remains a complex challenge to be addressed. In Brazil, 60% of neonatal deaths occur among preterm infants with a gestational age of 32 weeks or less (≤32w). The aim of this study was to evaluate the factors involved in the high mortality rates among newborns with a gestational age ≤32w in a socioeconomically developed southern city in Brazil. Data on retrospective births and deaths (2000-2014) were analyzed from two official Brazilian national databases. The risk of neonatal death for all independent variables (mother's age and schooling, prenatal visits, birth hospital, delivery method, gestational age, and the newborn's sex, age, and birth year, gemelarity, congenital anomalies and birthplace) was assessed with a univariable and a multivariable model of Cox's semiparametric proportional hazards regression (p < 0.05). Data of 288,904 newborns were included, being 4,514 with a gestational age ≤32w. The proportion of these early newborns remained stable among all births, while the neonatal mortality rate for this group tended to decrease (p < 0.001). The adjusted risk was significantly for lower birthweight infants (mean 659.13 g) born from Caesarean (HR 0.58 [95% CI 0.47-0.71]), but it was significantly higher for heavier birth weight infants (mean 2,087.79) also born via Caesarean section (HR 3.71 [95% CI 1.5-9.15]). Newborns with lower weight seemed to benefit most from Cesarean deliveries. Effort towards reducing unacceptably high surgical deliveries must take into account cases that the operations may be lifesaving for mother and/or the baby.
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Affiliation(s)
- Marcos Roberto Tietzmann
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | - Pedro do Valle Teichmann
- Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil.
| | - Cassia Simeão Vilanova
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | - Marcelo Zubaran Goldani
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
- Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
- Pediatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-007, Brazil
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | - Clécio Homrich da Silva
- Graduate Program in Child and Adolescent Health, Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
- Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
- Pediatric Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, 90035-007, Brazil
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
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5
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Mode of delivery and pregnancy outcomes in preterm birth: a secondary analysis of the WHO Global and Multi-country Surveys. Sci Rep 2019; 9:15556. [PMID: 31664121 PMCID: PMC6820722 DOI: 10.1038/s41598-019-52015-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/12/2019] [Indexed: 11/12/2022] Open
Abstract
Many studies have been conducted to examine whether Caesarean Section (CS) or vaginal birth (VB) was optimal for better maternal and neonatal outcomes in preterm births. However, findings remain unclear. Therefore, this secondary analysis of World Health Organization Global Survey (GS) and Multi-country Survey (MCS) databases was conducted to investigate outcomes of preterm birth by mode of delivery. Our sample were women with singleton neonates (15,471 of 237 facilities from 21 countries in GS; and 15,053 of 239 facilities from 21 countries in MCS) delivered between 22 and <37 weeks of gestation. We assessed association between mode of delivery and pregnancy outcomes in singleton preterm births by multilevel logistic regression adjusted for hierarchical data. The prevalences of women with preterm birth delivered by CS were 31.0% and 36.7% in GS and MCS, respectively. Compared with VB, CS was associated with significantly increased odds of maternal intensive care unit admission, maternal near miss, and neonatal intensive care unit admission but significantly decreased odds of fresh stillbirth, and perinatal death. However, since the information on justification for mode of delivery (MOD) were not available, our results of the potential benefits and harms of CS should be carefully considered when deciding MOD in preterm births.
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6
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Al-Shaer OS, Behiry EG, Elsadek AE, Salama SA. Association between interleukin-10 genetic variant (-1082G>A) with detection and severity of respiratory distress syndrome in preterm neonates. Int J Immunogenet 2019; 47:50-56. [PMID: 31478351 DOI: 10.1111/iji.12455] [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: 05/21/2019] [Revised: 07/19/2019] [Accepted: 07/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Abnormal cytokine production derived from specific polymorphisms can have effect on development of respiratory distress syndrome (RDS). Therefore, the present study aimed to determine whether polymorphisms of IL10 in preterm newborn are associated with RDS. METHODS A total of one hundred and one venous blood samples were collected from preterm neonates, and they were classified as 51 with no RDS and 50 with RDS. Grading of RDS, history of surfactant administration or ventilator was assessed in the diseased group. Genetic variant of IL10-1082G/A (rs1800896) was genotyped by PCR-RFLP. RESULTS The RDS group showed a higher prevalence of IL10-1082 AA and lower prevalence of IL10-1082 GG (p < .001). We found that the incidence of the allele G in the IL10-1082 polymorphism was lower in the RDS group (24%) than the non-RDS group (51%) (p < .001). Allele model (A vs. G): OR = 0.304, 95% CI: 0.166-0.554, p ≤ .001; Dominant model (AA vs. AG + GG): OR = 0 0.470, 95% CI: 0.282-0.783, p = .04. More severe grades of RDS, need for surfactant and mechanical ventilation, were significantly associated with AA genotype when compared to AG + GG genotypes. IL10 (AG + GG) genotypes were considered as an independent predictor for lower risk of RDS within preterm neonates. CONCLUSION IL10-1082 A/A genotype associated with increased susceptibility to RDS. Also, A allele has been associated with increase severity of RDS in preterm neonates. Regression analysis revealed that IL10 AG + GG genotypes were considered as independent predictors for lower risk development of RDS within preterm neonates.
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Affiliation(s)
- Osama S Al-Shaer
- Clinical and Chemical Pathology Department, Benha faculty of medicine, Benha University, Benha, Egypt
| | - Eman G Behiry
- Clinical and Chemical Pathology Department, Benha faculty of medicine, Benha University, Benha, Egypt
| | - Akram E Elsadek
- Pediatric Department, Benha faculty of medicine, Benha University, Benha, Egypt
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Adewuyi EO, Auta A, Khanal V, Tapshak SJ, Zhao Y. Cesarean delivery in Nigeria: prevalence and associated factors-a population-based cross-sectional study. BMJ Open 2019; 9:e027273. [PMID: 31213450 PMCID: PMC6596937 DOI: 10.1136/bmjopen-2018-027273] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the prevalence and factors associated with caesarean delivery in Nigeria. DESIGN This is a secondary analysis of the nationally representative 2013 Nigeria Demographic and Health Survey (NDHS) data. We carried out frequency tabulation, χ2 test, simple logistic regression and multivariable binary logistic regression analyses to achieve the study objective. SETTING Nigeria. PARTICIPANTS A total of 31 171 most recent live deliveries for women aged 15-49 years (mother-child pair) in the 5 years preceding the 2013 NDHS was included in this study. OUTCOME MEASURE Caesarean mode of delivery. RESULTS The prevalence of caesarean section (CS) was 2.1% (95% CI 1.8 to 2.3) in Nigeria. At the region level, the South-West had the highest prevalence of 4.7%. Factors associated with increased odds of CS were urban residence (adjusted OR (AOR): 1.51, 95% CI 1.15 to 1.97), maternal age ≥35 years (AOR: 2.12, 95% CI 1.08 to 4.11), large birth size (AOR: 1.39, 95% CI 1.10 to 1.74) and multiple births (AOR: 4.96, 95% CI 2.84 to 8.62). Greater odds of CS were equally associated with maternal obesity (AOR: 3.16, 95% CI 2.30 to 4.32), Christianity (AOR: 2.06, 95% CI 1.58 to 2.68), birth order of one (AOR: 3.86, 95% CI 2.66 to 5.56), husband's secondary/higher education level (AOR: 2.07, 95% CI 1.29 to 3.33), health insurance coverage (AOR: 2.01, 95% CI 1.37 to 2.95) and ≥4 antenatal visits (AOR: 2.84, 95% CI 1.56 to 5.17). CONCLUSIONS The prevalence of CS was low, indicating unmet needs in the use of caesarean delivery in Nigeria. Rural-urban, regional and socioeconomic differences were observed, suggesting inequitable access to the obstetric surgery. Intervention efforts need to prioritise women living in rural areas, the North-East and the North-West regions, as well as women of the Islamic faith.
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Affiliation(s)
- Emmanuel O Adewuyi
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Pharmacy Department, 2 Division Hospital, Ibadan, Oyo State, Nigeria
| | - Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | | | - Samson J Tapshak
- Department of Obstetrics and Gynaecology, Chivar Specialist Hospital, and Urology Centre Ltd, Abuja, Nigeria
| | - Yun Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Western Australia, Australia
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8
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Jadoon B, Assar TM, Nucier AAAR, Raziq HEA, Abd El-Azym Saad AS, Megahed Amer W. Analysis of the caesarean section rate using the 10-Group Robson classification at Benha University Hospital, Egypt. Women Birth 2019; 33:e105-e110. [PMID: 30987799 DOI: 10.1016/j.wombi.2019.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Egypt has the third highest caesarean section rate (54%) in the world and lacks a standard classification system to analyse caesarean section rates. The World Health Organization (WHO) recommends the Robson classification as an effective caesarean section analysis and monitoring tool. AIM To analyse the caesarean section rate of Benha University Hospital, Egypt using the standard 10-Group Robson classification system. METHOD A prospective, cross-sectional study was conducted at the Benha University Hospital from 1 April to 30 June 2018. All women admitted for childbirth were categorised into Robson groups to determine the absolute and relative contribution made by each group to the overall caesarean section rate. Epi Data V.3.1 software programme was used to analyse the data. FINDINGS 850 women gave birth during the study period, 466 (55%) by caesarean section (CS). Robson Group 5 (multiparous, term, cephalic presentation and previous caesarean section) contributed the most (36%) to the overall CS rate. 175/308 (56%) women in this group had previously undergone one caesarean section. Group 6 (all nulliparous women with single breech pregnancy) and Group10 (cephalic preterm pregnancies) were the second and the third greatest contributors toward the overall CS rate, with 4.6% and 2.8% respectively. CONCLUSIONS In keeping with other studies, Groups 5, 6, and 10 were the main contributors to the overall caesarean section rate. We found Robson classification to be clinically relevant and an effective tool to analyse the caesarean section rate even in settings with limited resources.
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Affiliation(s)
- Bismeen Jadoon
- Research coordinator at the Faculty of Egyptian Society of Royal College of Obstetrics and Gynaecology, (ERC-RCOG), 42 Abdel Monem Road, Mohandseen, Cairo, 11231, Egypt.
| | - Tamer Mahmoud Assar
- Faculty of Medicine-Benha University, El-Shaheed Farid Nada, Qism Banha, Banha, Al Qalyubia Governorate, Egypt.
| | | | - Heba Elsayed Abdel Raziq
- Faculty of Medicine-Benha University, El-Shaheed Farid Nada, Qism Banha, Banha, Al Qalyubia Governorate, Egypt.
| | - Ahmed Samy Abd El-Azym Saad
- Faculty of Medicine-Benha University, El-Shaheed Farid Nada, Qism Banha, Banha, Al Qalyubia Governorate, Egypt.
| | - Wagdy Megahed Amer
- El-Shaheed Farid Nada, Qism Banha, Banha, Al Qalyubia Governorate, Egypt.
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9
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Carrapato MRG, Pereira T, Silva C, Rodrigues J, Monteiro I, Azevedo A, Monteiro J. Late preterms: are they all the same? J Matern Fetal Neonatal Med 2018; 33:1780-1785. [PMID: 30244633 DOI: 10.1080/14767058.2018.1527897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Very preterm infants (VPT) and, especially extreme low gestational age (ELGA) preterms, often on the threshold of viability, make the headlines of both, the scientific as well as the popular press. However, all together they represent between 1 and 2% of all livebirths. Late preterms (LPT) those born between 34/07 and 36/06 weeks, on the other hand, may account for up to 80% of all preterms and for some 5-8% of all births. Although mortality is low they are prone to increasing neonatal morbidities posing a considerable medical, financial and psychosocial burden. In the last years, for many reasons, LPT appear to have increased considerably throughout the western world. But are LPT neonates all the same? In spite of overlapping gestational ages (GA) LPT may behave quite differently depending on circumstances surrounding their pre- and postnatal events. We can identify three different classes of LPT neonates: spontaneous late preterms (SpLPT) born in the absence of previous maternal illnesses and/or pregnancy related disorders; Induced LPT (IdLPT) due to maternal/fetal complications and those babies being born after 34-week gestation from postponed delivery at an earlier GA (PtLPT) - and they are quite different babies, with different behavior, despite a common and same gestational age.
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Affiliation(s)
- Manuel R G Carrapato
- São Sebastião Hospital, Santa Maria Feira, Portugal.,Faculty of Health Sciences, Fernando Pessoa University, Oporto, Portugal
| | | | - Cláudia Silva
- Faculty of Health Sciences, Fernando Pessoa University, Oporto, Portugal.,FP-ENAS (UFP Research Unit on Energy, Environment and Health), CEBIMED (Center for Biomedicine Studies), Oporto, Portugal
| | | | | | - Ana Azevedo
- São Sebastião Hospital, Santa Maria Feira, Portugal
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10
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Bertholdt C, Morel O, Dap M, Choserot M, Minebois H. Labor induction in indicated moderate to late preterm birth. J Matern Fetal Neonatal Med 2018; 33:157-161. [PMID: 29886774 DOI: 10.1080/14767058.2018.1487942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: The primary objective of this study was to evaluate the success of labor induction for indicated moderate and late preterm birth. As secondary objectives, the mode of delivery was assessed.Material and methods: This is an observational study conducted in a tertiary care unit between 2013 and 2015. All patients who underwent labor induction for indicated preterm birth between 32+0 and 36+6 weeks of gestation (as premature rupture of membranes, preeclampsia, intrauterine growth restriction, fetomaternal alloimmunization, or intrahepatic cholestasis) were included. The main outcome was the success of labor induction defined by repeated uterine contractions associated with cervical dilation >3 cm. The secondary outcomes were mode of delivery and neonatal outcomes.Results: Among 824 women who gave birth during the study period, 105 (12.7%) underwent induction of labor for indicated preterm birth. Labor induction was successful in 90.5% of cases (95/105), and 72.4% of the women (76/105) delivered vaginally. The success rate did not differ significantly in cases of moderate (32+0 to 33+6 weeks), compared with late (34+0 to 36+6 weeks) preterm birth (87.5 versus 90.7%, p = .56). The vaginal delivery rate was significantly lower in moderate compared to late preterm birth (37.5 versus 75.3%, p = .03).Conclusion: The success of labor induction and consecutive vaginal delivery were high in case of moderate and late preterm birth. Labor induction can be considered as an effective option for medical indications.
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Affiliation(s)
| | - Olivier Morel
- Obstetric Department, CHRU de Nancy, Nancy, France.,Unité INSERM U1254, Les-Nancy, France
| | - Matthieu Dap
- Obstetric Department, CHRU de Nancy, Nancy, France
| | - Marion Choserot
- Obstetric Department, CHRU de Nancy, Nancy, France.,Clinique Arc en ciel, Service de gynécologie obstétrique, Epinal, France
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Babooa N, Shi WJ, Chen C. Factors relating caesarean section to persistent pulmonary hypertension of the newborn. World J Pediatr 2017; 13:517-527. [PMID: 29058246 DOI: 10.1007/s12519-017-0056-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have clearly demonstrated a significantly higher incidence of persistent pulmonary hypertension of the newborn (PPHN) in neonates delivered by caesarean section (CS) compared to those delivered vaginally. The pathophysiological factors underlying the link between CS and PPHN are still poorly understood. In this review, we describe the mechanisms that could explain the association between CS delivery and subsequent PPHN, as well as potential preventive measures. DATA SOURCES A literature search was conducted by electronic scanning of databases such as PubMed and Web of Science using the key words "persistent pulmonary hypertension of the newborn", "caesarean section", "iatrogenic prematurity", "oxidative stress", "late preterm", "labor" and "vasoactive agents". RESULTS Iatrogenic prematurity, higher rates of late preterm delivery and lack of physiological changes of labor play an important role in the association between CS and PPHN. CS delivery also results in limited endogenous pulmonary vasodilator synthesis and lower levels of protective anti-oxidants in the neonates. In addition, CS delivery exposes infants to a higher risk of respiratory distress syndrome and its concomitant increase in endothelin-1 levels, which might indirectly lead to a higher risk of developing PPHN. We believe that neonates delivered by CS are exposed to a combination of these pathophysiological events, culminating in an endpoint of respiratory distress, hypoxia, acidosis, and delayed transition and thereby increased risks of PPHN. The use of antenatal corticosteroids prior to elective CS in late preterm deliveries, promoting accurate informedconsent process, delaying elective CS to 39 weeks of gestation or beyond and antenatal maternal anti-oxidant supplementation could potentially mitigate the effects of CS delivery and minimize CS-related PPHN. CONCLUSIONS The link between CS delivery and PPHN is complex. In view of the rising rates of CS worldwide, there is an urgent need to further explore the mechanisms linking CS to PPHN and experimentally test therapeutic options in order to allow effective targeted interventions.
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Affiliation(s)
- Niralee Babooa
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Wen-Jing Shi
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China
| | - Chao Chen
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China.
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12
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Norman M. Twin birth - planned vaginal delivery still standard of care. Acta Paediatr 2017; 106:1012. [PMID: 28133785 DOI: 10.1111/apa.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mikael Norman
- Department of Neonatal Medicine, K78; Karolinska Institutet & University Hospital; Stockholm Sweden
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13
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Myocardial Function in Preterm Infants: Every Step Counts. J Am Soc Echocardiogr 2017; 30:98-100. [DOI: 10.1016/j.echo.2016.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Indexed: 11/21/2022]
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14
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Carrapato MRG, Ferreira AM, Wataganara T. Cesarean section: the pediatricians’ views. J Matern Fetal Neonatal Med 2016; 30:2081-2085. [DOI: 10.1080/14767058.2016.1237496] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Manuel R. G. Carrapato
- Pediatrics/Neonatal Department, S. Sebastião Hospital, Santa Maria da Feira, Portugal,
- Fernando Pessoa University, Faculty of Medical Sciences, Oporto, Portugal, and
| | - Ana M. Ferreira
- Pediatrics/Neonatal Department, S. Sebastião Hospital, Santa Maria da Feira, Portugal,
| | - Tuangsit Wataganara
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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15
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Simões R, Cavalli RC, Bernardo WM, Salomão AJ, Baracat EC. Cesarean delivery and prematurity. Rev Assoc Med Bras (1992) 2016; 61:489-94. [PMID: 26841156 DOI: 10.1590/1806-9282.61.06.489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ricardo Simões
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
| | | | | | - Antônio J Salomão
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
| | - Edmund C Baracat
- Federação Brasileira das Associações de Ginecologia e Obstetrícia, Brazil
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16
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Souza RT, Cecatti JG, Passini R, Tedesco RP, Lajos GJ, Nomura ML, Rehder PM, Dias TZ, Haddad SM, Pacagnella RC, Costa ML. The Burden of Provider-Initiated Preterm Birth and Associated Factors: Evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP). PLoS One 2016; 11:e0148244. [PMID: 26849228 PMCID: PMC4743970 DOI: 10.1371/journal.pone.0148244] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/16/2016] [Indexed: 12/22/2022] Open
Abstract
Background About 15 million children are born under 37 weeks of gestation worldwide. Prematurity is the leading cause of neonatal deaths and short/long term morbidities, entailing consequences not only for the individual, but also their family, health agencies, facilities and all community. The provider-initiated preterm birth is currently one of the most important obstetric conditions related to preterm births, particularly in middle and high income countries, thus decreasing the need for therapeutic preterm birth is essential to reduce global prematurity. Therefore detailed knowledge on the factors associated with provider-initiated preterm birth is essential for the efforts to reduce preterm birth rates and its consequences. In this current analysis we aimed to assess the proportion of provider-initiated (pi-PTB) among preterm births in Brazil and identify associated factors. Methods and Findings This is an analysis of a multicenter cross-sectional study with a nested case-control component called Brazilian Multicenter Study on Preterm Birth (EMIP). EMIP was conducted in 20 referral obstetric hospitals located in the three most populated of the five Brazilian regions. We analysed data of women with pi-PTB, defined as childbirth occurring at less than 37 weeks, medically indicated for maternal/fetal compromise or both; and women with term birth, childbirth at or after 37 weeks. Maternal, sociodemographic, obstetric, prenatal care, delivery, and postnatal characteristics were assessed as possible factors associated with pi-PTB, compared to term births. The overall prevalence of preterm births was 12.3%. Of these, approximately one-third of cases were initiated by the provider. Hypertensive disorders, placental abruption, and diabetes were the main maternal conditions leading to pi-PTB. Caesarean section was the most common mode of delivery. Chronic hypertension (OR 7.47; 95%CI 4.02–13.88), preeclampsia/eclampsia/HELLP syndrome (OR 15.35; 6.57–35.88), multiple pregnancy (OR 12.49; 4.86–32.05), and chronic diabetes (OR 5.24; 2.68–10.25) were the most significant factors independently associated with pi-PTB. Conclusions pi-PTB is responsible for about one-third of all preterm births, requiring special attention. The decision-making process relative to the choice of provider-initiated birth is complex, and many factors should be elucidated to improve strategies for its prevention, including evidence-based guidelines on proper management of the corresponding clinical conditions.
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Affiliation(s)
- Renato T. Souza
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Jose G. Cecatti
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
- * E-mail:
| | - Renato Passini
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Ricardo P. Tedesco
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
- Department of Obstetrics and Gynecology, Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Giuliane J. Lajos
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Marcelo L. Nomura
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Patricia M. Rehder
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Tabata Z. Dias
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Samira M. Haddad
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Rodolfo C. Pacagnella
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
| | - Maria L. Costa
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) School of Medicine, Campinas, SP, Brazil
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Turitz AL, Friedman AM, Gyamfi-Bannerman C. Trial of labor after cesarean versus repeat cesarean in women with small-for-gestational age neonates: a secondary analysis. J Matern Fetal Neonatal Med 2015; 29:3051-5. [DOI: 10.3109/14767058.2015.1114084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Amy L. Turitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Alexander M. Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
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18
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Shimokaze T, Akaba K, Banzai M, Kihara K, Saito E, Kanasugi H. Premature rupture of membranes and neonatal respiratory morbidity at 32-41 weeks' gestation: a retrospective single-center cohort study. J Obstet Gynaecol Res 2015; 41:1193-200. [PMID: 25832468 DOI: 10.1111/jog.12689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/18/2014] [Accepted: 01/04/2015] [Indexed: 11/26/2022]
Abstract
AIM To ascertain whether premature rupture of membranes (PROM) independently affects the risk of neonatal respiratory morbidity at 32-41 weeks' gestation because previous reports have given insufficient consideration to the mode of delivery and labor onset. METHODS Data on 4,629 consecutive singleton infants were retrospectively collected. Respiratory morbidity was limited to respiratory distress syndrome and transient tachypnea of the newborn, both of which are related to prematurity. Delivery modes were divided into four groups based on the existence of PROM and of labor onset, and the respiratory morbidity was examined according to the number of weeks of gestational age. Multivariate analysis including PROM and delivery mode was conducted to examine the association of respiratory morbidity. RESULTS Respiratory morbidity or a positive pressure requirement delivered after PROM and intact amniochorionic membranes accompanied by labor were similar at all weeks. Around 37 weeks, the absence of labor onset was associated with a risk of respiratory morbidity or positive pressure requirement. Significant respiratory risk was not associated with the incidence of PROM (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.52-1.83), interval from rupture to delivery (aOR, 1.00; 95% CI, 0.99-1.01), clinical chorioamnionitis, induction management, pregnancy-related complications, or neonatal sex. Delivery by Cesarean section and early gestational age presented a significant risk for respiratory morbidity. CONCLUSIONS Neither PROM nor latency after PROM at 32-41 weeks affected neonatal respiratory morbidity. Avoiding Cesarean section instead of simply increasing the time to delivery may help to reduce respiratory morbidity.
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Affiliation(s)
| | - Kazuhiro Akaba
- Departments of Pediatrics, Saiseikai Yamagata Hospital, Yamagata, Japan
| | - Michio Banzai
- Departments of Obstetrics and Gynecology, Saiseikai Yamagata Hospital, Yamagata, Japan
| | - Kaori Kihara
- Departments of Obstetrics and Gynecology, Saiseikai Yamagata Hospital, Yamagata, Japan
| | - Emi Saito
- Departments of Pediatrics, Saiseikai Yamagata Hospital, Yamagata, Japan
| | - Hiroshi Kanasugi
- Departments of Obstetrics and Gynecology, Saiseikai Yamagata Hospital, Yamagata, Japan
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Suga S, Yasuhi I, Aoki M, Nomiyama M, Kubo N, Kawakami K, Okura N, Okazaki K, Ota A, Kawada K. Risk factors associated with respiratory disorders in late preterm infants. J Matern Fetal Neonatal Med 2015; 29:447-51. [DOI: 10.3109/14767058.2014.1003804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Visser GHA. Women are designed to deliver vaginally and not by cesarean section: an obstetrician's view. Neonatology 2015; 107:8-13. [PMID: 25301178 DOI: 10.1159/000365164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Worldwide, there is a rapid increase in deliveries by cesarean section. The large differences among countries, from about 16% to more than 60%, suggest that the cesarean delivery (CD) rate has little to do with evidence-based medicine. In this review, the background for the increasing CD rate is discussed as well as the limited positive effects on neonatal outcome in both term and preterm neonates. Negative effects of CD, including direct maternal morbidity, complications of subsequent pregnancies and iatrogenic early delivery resulting in increased neonatal morbidity, are discussed in addition to long-term implications for the offspring involving altered development of the immune system. The 'battle' to lower the CD rate will be difficult, but we should not forget that women are designed to deliver vaginally and not by cesarean section.
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Affiliation(s)
- Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
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21
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Yang F, Zubizarreta JR, Small DS, Lorch S, Rosenbaum PR. Dissonant Conclusions When Testing the Validity of an Instrumental Variable. AM STAT 2014. [DOI: 10.1080/00031305.2014.962764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Zou L, Wang X, Ruan Y, Li G, Chen Y, Zhang W. Preterm birth and neonatal mortality in China in 2011. Int J Gynaecol Obstet 2014; 127:243-7. [PMID: 25132529 DOI: 10.1016/j.ijgo.2014.06.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 06/09/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the incidence of preterm birth, its regional distribution, and associated neonatal mortality in mainland China. METHODS In a multicenter, hospital-based investigation of preterm birth, 2011 data were obtained from the seven administrative regions of mainland China. Between one and three subcenters were randomly selected for each administrative region, followed by secondary and tertiary hospitals within the chosen subcenters. Data were obtained from women's medical records, and obstetric and perinatal events were summarized. RESULTS Data for 107,905 deliveries were analyzed, which included 7769 (7.1%) preterm births (occurring between 28 and 37 weeks of pregnancy). The incidence varied among regions. Late preterm birth (between 34 and 37 weeks) accounted for 5495 (70.7%) of preterm births. The neonatal mortality rate was 33 deaths per 1000 live preterm births. Of the 254 neonatal deaths, 147 (57.9%) occurred after very preterm birth (between 28 and 32 weeks). Overall, 4519 (58.2%) preterm births occurred by cesarean. CONCLUSION The distribution of preterm birth across China is unbalanced, and neonatal mortality associated with preterm birth is high.
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Affiliation(s)
- Liying Zou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yan Ruan
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Guanghui Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yi Chen
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Weiyuan Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
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Estimation of preterm birth rate, associated factors and maternal morbidity from a demographic and health survey in Brazil. Matern Child Health J 2014; 17:1638-47. [PMID: 23108739 DOI: 10.1007/s10995-012-1177-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To determine the prevalence of preterm birth from self-reports by Brazilian women, to assess complications, interventions and outcomes, to identify factors associated with preterm birth, and to improve the preterm birth rates estimates. This is a secondary analysis of data from a Demographic Health Survey. It interviewed a sample of 4,743 Brazilian women who had 6,113 live births from 2001 to 2007. Estimates of preterm birth rates were obtained per region and per year according to self-reported gestational age. The prevalence rate and 95 % confidence interval (CI) for preterm was determined according to the characteristics of mothers and offspring. Odds ratios and 95 % CI were estimated for complications such as severe maternal morbidity. The preterm birth rate was 9.9 %, with regional variations. Preterm birth was more likely to be associated with neonatal death, low birth weight, and longer hospital stay. Maternal factors associated with preterm birth were: white ethnicity, living in an urban area, history of hypertension or heart disease, twin gestation, non-elective Cesarean section, medical insurance for delivery, low number of antenatal visits, and severe morbidity. A self-report survey has indicated that the preterm birth rate in Brazil is higher than official data suggest, with an increasing trend in more developed areas, and is associated with poor neonatal and maternal outcomes.
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Corrales Gutiérrez A, Suarez Gonzalez J, Cabrera Delgado M, Benavides Casal M. Resultados perinatales de un protocolo de atención para gestantes con riesgo de prematuridad extrema. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Health outcomes for vaginal compared with cesarean delivery of appropriately grown preterm neonates. Obstet Gynecol 2013; 121:1195-1200. [PMID: 23812452 DOI: 10.1097/aog.0b013e3182918a7e] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between route of delivery and neonatal outcomes in a large, diverse cohort of preterm, appropriate-for-gestational-age neonates. METHODS This is a retrospective cohort study examining New York City birth data for 1995-2003 linked to hospital discharge data. Data were limited to singleton, live-born, cephalic neonates delivered between 24 and 34 weeks of gestation. Exclusion criteria included congenital anomalies, forceps or vacuum assistance, birth weight missing, less than 500 g, or not appropriate for gestational age. Any neonatal diagnosis of intraventricular hemorrhage, seizure, sepsis, subdural hemorrhage, respiratory distress, 5-minute Apgar score less than 7, or neonatal death was considered significant. Associations between method of delivery and neonatal morbidities were estimated using logistic regression. RESULTS Of 20,231 neonates meeting study criteria, 69.3% were delivered vaginally and 30.7% were delivered by cesarean. After controlling for maternal age, ethnicity, education, primary payer, prepregnancy weight, gestational age, diabetes, and hypertension, cesarean delivery compared with vaginal delivery was associated with increased odds of respiratory distress (39.2% compared with 25.6%, adjusted odds ratio [OR] 1.74, 95% confidence interval [CI] 1.61-1.89) and 5-minute Apgar score less than 7 (10.7% compared with 5.8%, adjusted OR 2.04, 95% CI 1.77-2.35). CONCLUSION In this preterm cohort, cesarean delivery was not protective against poor outcomes and in fact was associated with increased risk of respiratory distress and low Apgar score compared with vaginal delivery.
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Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev 2013; 2013:CD000078. [PMID: 24030708 PMCID: PMC7052739 DOI: 10.1002/14651858.cd000078.pub3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Planned caesarean delivery for women thought be in preterm labour may be protective for baby, but could also be quite traumatic for both mother and baby. The optimal mode of delivery of preterm babies for both cephalic and breech presentation remains, therefore, controversial. OBJECTIVES To assess the effects of a policy of planned immediate caesarean delivery versus planned vaginal birth for women in preterm labour. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (5 August 2013). SELECTION CRITERIA Randomised trials comparing a policy of planned immediate caesarean delivery versus planned vaginal delivery for preterm birth. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion. Two review authors independently extracted data and assessed risk of bias. Data were checked for accuracy. MAIN RESULTS We included six studies (involving 122 women) but only four studies (involving only 116 women) contributed data to the analyses. INFANT: There were very little data of relevance to the three main (primary) outcomes considered in this review: There was no significant difference between planned immediate caesarean section and planned vaginal delivery with respect to birth injury to infant (risk ratio (RR) 0.56, 95%, confidence interval (CI) 0.05 to 5.62; one trial, 38 women) or birth asphyxia (RR 1.63, 95% CI 0.84 to 3.14; one trial, 12 women). The only cases of birth trauma were a laceration of the buttock in a baby who was delivered by caesarean section and mild bruising in another allocated to the group delivered vaginally.The difference between the two groups with regard to perinatal deaths was not significant (0.29, 95% CI 0.07 to 1.14; three trials, 89 women) and there were no data specifically relating to neonatal admission to special care and/or intensive care unit.There was also no difference between the caesarean or vaginal delivery groups in terms of markers of possible birth asphyxia (RR 1.63, 95% CI 0.84 to 3.14; one trial, 12 women) or Apgar score less than seven at five minutes (RR 0.83, 95% CI 0.43 to 1.60; four trials, 115 women) and no difference in attempts at breastfeeding (RR 1.40, 95% 0.11 to 17.45; one trial, 12 women). There was also no difference in neonatal fitting/seizures (RR 0.22, 95% CI 0.01 to 4.32; three trials, 77 women), hypoxic ischaemic encephalopathy (RR 4.00, 95% CI 0.20 to 82.01;one trial, 12 women) or respiratory distress syndrome (RR 0.55, 95% CI 0.27 to 1.10; three trials, 103 women). There were no data reported in the trials specifically relating to meconium aspiration. There was also no significant difference between the two groups for abnormal follow-up in childhood (RR 0.65, 95% CI 0.19 to 2.22; one trial, 38 women) or delivery less than seven days after entry (RR 0.95, 95% CI 0.73 to 1.24; two trials, 51 women). MOTHER: There were no data reported on maternal admissions to intensive care. However, there were seven cases of major maternal postpartum complications in the group allocated to planned immediate caesarean section and none in the group randomised to vaginal delivery (RR 7.21, 95% CI 1.37 to 38.08; four trials, 116 women).There were no data reported in the trials specifically relating to maternal satisfaction (postnatal). There was no significant difference between the two groups with regard to postpartum haemorrhage. A number of non-prespecified secondary outcomes were also considered in the analyses. There was a significant advantage for women in the vaginal delivery group with respect to maternal puerperal pyrexia (RR 2.98, 95% CI 1.18 to 7.53; three trials, 89 women) and other maternal infection (RR 2.63, 95% CI 1.02 to 6.78; three trials, 103 women), but no significant differences in wound infection (RR 1.16, 95% CI 0.18 to 7.70; three trials, 103 women), maternal stay more than 10 days (RR 1.27, 95% CI 0.35 to 4.65; three trials, 78 women) or the need for blood transfusion (results not estimable). AUTHORS' CONCLUSIONS There is not enough evidence to evaluate the use of a policy of planned immediate caesarean delivery for preterm babies. Further studies are needed in this area, but recruitment is proving difficult.
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Affiliation(s)
- Zarko Alfirevic
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Stephen J Milan
- St George's University of LondonPopulation Health Sciences and EducationLondonUK
| | - Stefania Livio
- University of Milan, Children's Hospital "V. Buzzi"Department of Obstetrics and GynaecologyVia Castelvetro 32MilanoItaly20154
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Teixeira C, Correia S, Barros H. Risk of caesarean section after induced labour: do hospitals make a difference? BMC Res Notes 2013; 6:214. [PMID: 23714240 PMCID: PMC3668278 DOI: 10.1186/1756-0500-6-214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background There is a well-known relationship between induced labour and caesarean rates. However, it remains unknown whether this relationship reflects the impact of more complex obstetric conditions or the variability in obstetric practices. We sought to quantify the independent role of the hospital as a variable that can influence the occurrence of caesarean section after induced labour. Methods As part of the Portuguese Generation XXI birth cohort, we evaluated 2041 consecutive women who underwent singleton pregnancies with labour induction, at five public level III obstetric units (April 2005-August 2006). The indications for induction were classified according to the guidelines of the American and the Royal Colleges of Obstetricians and Gynaecologists. Poisson regression models were adjusted to estimate the association between the hospital and surgical delivery after induction. Crude and adjusted prevalence ratios (PR) and a 95% confidence interval (95% CI) were computed. Results The proportion of women who were induced without formal clinical indications varied among hospitals from 20.3% to 45.5% (p < 0.001). After adjusting for confounders, the risk of undergoing a caesarean section after induced labour remained significantly different between the hospitals, for the cases in which there was no evident indication for induction [the highest PR reaching 1.86 (95% CI, 1.23–2.82)] and also when at least one such indication was present [1.53 (95% CI, 1.12–2.10)]. This pattern was also observed among the primiparous cephalic term induced women [the highest PR reaching 2.06 (95% CI, 1.23–2.82) when there was no evident indication for induction and 1.61 (95% CI, 1.11–2.34) when at least one such indication was present]. Conclusions Caesarean section after induced labour varied significantly across hospitals where similar outcomes were expected. The effect was more evident when the induction was not based on the unequivocal presence of commonly accepted indications.
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The Brazilian preference: cesarean delivery among immigrants in Portugal. PLoS One 2013; 8:e60168. [PMID: 23555912 PMCID: PMC3608593 DOI: 10.1371/journal.pone.0060168] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 02/25/2013] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate how the country of origin affects the probability of being delivered by cesarean section when giving birth at public Portuguese hospitals. Study Design Women delivered of a singleton birth (n = 8228), recruited from five public level III maternities (April 2005–August 2006) during the procedure of assembling a birth cohort, were classified according to the country of origin and her migration status as Portuguese (n = 7908), non-Portuguese European (n = 84), African (n = 77) and Brazilian (n = 159). A Poisson model was used to evaluate the association between country of birth and cesarean section that was measured by adjusted prevalence ratio (PR) and respective 95% confidence intervals (95%CI). Results The cesarean section rate varied from 32.1% in non-Portuguese European to 48.4% in Brazilian women (p = 0.008). After adjustment for potential confounders and compared to Portuguese women as a reference, Brazilian women presented significantly higher prevalence of cesarean section (PR = 1.26; 95%CI: 1.08–1.47). The effect was more evident among multiparous women (PR = 1.39; 95%CI: 1.12–1.73) and it was observed when cesarean section was performed either before labor (PR = 1.43; 95%CI: 0.99–2.06) or during labor (PR = 1.30; 95%CI: 1.07–1.58). Conclusions The rate of cesarean section was significantly higher among Brazilian women and it was independent of the presence of any known risk factors or usual clinical indications, suggesting that cultural background influences the mode of delivery overcoming the expected standard of care and outcomes in public health services.
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Maharlouei N, Moalaee M, Ajdari S, Zarei M, Lankarani KB. Caesarean delivery in south-western Iran: trends and determinants in a community-based survey. Med Princ Pract 2013; 22:184-8. [PMID: 22922349 PMCID: PMC5586814 DOI: 10.1159/000341762] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 07/05/2012] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess trends in caesarean delivery and its associated factors in south-western Iran. SUBJECTS AND METHODS This cross-sectional study was conducted from January 2007 to January 2010 in Fars province, Iran. All deliveries recorded in public and private hospitals were included. The Mann-Whitney U test, χ2 test and multivariate logistic regression models were used for analysis of data. A p value less than 0.05 was considered significant. RESULTS The rate of caesarean section for the whole sample of 139,159 increased from 51.6% in 2007 to 53.3% in 2009, which was statistically and clinically significant. The rate of caesarean delivery was significantly higher in primiparous compared to multiparous mothers. The rate increased steadily with the mother's age. The most prevalent recorded reason for caesarean delivery was maternal request. Logistic regression analysis showed that maternal age, previous abortions, underlying maternal disease, gestational age and number of living children were key contributing factors to the choice of mode of delivery. CONCLUSION This study showed an increasing rate of caesarean delivery which should draw the attention of policymakers to factors associated with this mode of delivery.
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Affiliation(s)
- Najmeh Maharlouei
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoureh Moalaee
- Clinical Affairs, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Ajdari
- Clinical Affairs, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maasoumeh Zarei
- Clinical Affairs, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran B. Lankarani
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- *Kamran B. Lankarani, MD, Health Policy Research Center, Building No. 2, 8th Floor, School of Medicine, Zand Avenue, PO Box 71345-1877, Shiraz (Iran), Tel. +98 711 230 9615, E-Mail
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Hoa DTP, Börjesson L, Nga NT, Johansson A, Målqvist M. Sex of newborns associated with place and mode of delivery: a population-based study in northern Vietnam. ACTA ACUST UNITED AC 2012; 9:418-23. [PMID: 23153956 DOI: 10.1016/j.genm.2012.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/30/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is increasing evidence of an elevated sex ratio at birth (SRB) in many Asian countries, including Vietnam, and that this prenatal gender inequity is related to sex-selective abortion. However, few studies have investigated the relation between the sex of offspring and delivery care utilization. OBJECTIVE The aim of the present study was to relate sex of newborns to place and mode of delivery in a province in northern Vietnam. METHODS A population-based surveillance system within the Neonatal Health-Knowledge Into Practice (NeoKIP) project (ISRCTN44599712) recorded all births within eight districts of Quang Ninh province in northern Vietnam from July 2008 to June 2011. RESULTS In total, there were 22,377 live births within the study area. SRB was 108 boys per 100 girls. There was a large difference in SRB depending on place of delivery, with 94 boys per 100 girls being delivered at home, whereas 113 boys per 100 girls were delivered at a district-level hospital. Cesarean section (CS) rate was 17%, and within the CS group, the SRB was 135:100. CONCLUSIONS We demonstrated an elevated SRB, especially at district hospital level, and that sex of offspring influenced place and mode of delivery. Although mothers to boys were more likely to receive more qualified delivery care, they were at the same time more likely to undergo unnecessary surgery. Correct information to women and family members about CS and stricter implementation of the medical indications for CS are urgently called for.
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Abstract
OBJECTIVE To compare neonatal outcomes by method of delivery in preterm (34 weeks of gestation or prior), small-for-gestational-age (SGA) newborns in a large diverse cohort. METHODS Birth data for 1995-2003 from New York City were linked to hospital discharge data. Data were limited to singleton, liveborn, vertex neonates delivered between 25 and 34 weeks of gestation. Births complicated by known congenital anomalies and birth weight less than 500 g were excluded. Small for gestational age was used as a surrogate for intrauterine growth restriction. Associations between method of delivery and neonatal morbidities were estimated using logistic regression. RESULTS Two thousand eight hundred eighty-five SGA neonates meeting study criteria were identified; 42.1% were delivered vaginally, and 57.9% were delivered by cesarean. There was no significant difference in intraventricular hemorrhage, subdural hemorrhage, seizure, or sepsis between the cesarean delivery and vaginal delivery groups. Cesarean delivery compared with vaginal delivery was associated with increased odds of respiratory distress syndrome. The increased odds persisted after controlling for maternal age, parity, ethnicity, education, primary payer, prepregnancy weight, gestational age at delivery, diabetes, and hypertension. CONCLUSION Cesarean delivery was not associated with improved neonatal outcomes in preterm SGA newborns and was associated with an increased risk of respiratory distress syndrome.
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Biswas A, Su LL, Mattar C. Caesarean section for preterm birth and, breech presentation and twin pregnancies. Best Pract Res Clin Obstet Gynaecol 2012; 27:209-19. [PMID: 23062593 DOI: 10.1016/j.bpobgyn.2012.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/11/2012] [Indexed: 11/25/2022]
Abstract
Caesarean section incidence is steadily rising worldwide; the major contributor to this rise is pregnancies with previous caesarean section. Hence, it is important to scrutinise carefully the indication of primary caesarean sections. Preterm births, breech presentation and twin pregnancies together complicate 12-18% of all births. The role of caesarean section in these pregnancies is controversial and lacks good evidence-based guidelines. Policy on mode of delivery in these three important obstetric groups is bound to influence overall primary caesarean section rates. In this chapter, we review the evidence on the place of caesarean delivery in these three important groups.
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Affiliation(s)
- Arijit Biswas
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, National University Health Systems and National University of Singapore, Level 12, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore.
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do Carmo Leal M, da Silva AAM, Dias MAB, da Gama SGN, Rattner D, Moreira ME, Filha MMT, Domingues RMSM, Pereira APE, Torres JA, Bittencourt SDA, D'orsi E, Cunha AJ, Leite AJM, Cavalcante RS, Lansky S, Diniz CSG, Szwarcwald CL. Birth in Brazil: national survey into labour and birth. Reprod Health 2012; 9:15. [PMID: 22913663 PMCID: PMC3500713 DOI: 10.1186/1742-4755-9-15] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction. METHODS Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients' medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson's groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design. DISCUSSION This study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it's consequences on postnatal health.
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Affiliation(s)
- Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
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Abstract
BACKGROUND Planned caesarean delivery for women thought be in preterm labour may be protective for baby, but could also be quite traumatic for both mother and baby. The optimal mode of delivery of preterm babies for both cephalic and breech presentation remains, therefore, controversial. OBJECTIVES To assess the effects of a policy of planned immediate caesarean delivery versus planned vaginal birth for women in preterm labour. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (24 April 2012). SELECTION CRITERIA Randomised trials comparing a policy of planned immediate caesarean delivery versus planned vaginal delivery for preterm birth. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion. Two review authors independently extracted data and assessed risk of bias. Data were checked for accuracy. MAIN RESULTS We included six studies (involving 122 women) but only four studies (involving only 116 women) contributed data to the analyses.Infant There were very little data of relevance to the three main (primary) outcomes considered in this review: There was no significant difference between planned immediate caesarean section and planned vaginal delivery with respect to birth injury to infant (risk ratio (RR) 0.56, 95%, confidence interval (CI) 0.05 to 5.62; one trial, 38 women) or birth asphyxia (RR 1.63, 95% CI 0.84 to 3.14; one trial, 12 women). The only cases of birth trauma were a laceration of the buttock in a baby who was delivered by caesarean section and mild bruising in another allocated to the group delivered vaginally.The difference between the two groups with regard to perinatal deaths was not significant (0.29, 95% CI 0.07 to 1.14; three trials, 89 women) and there were no data specifically relating to neonatal admission to special care and/or intensive care unit.There was also no difference between the caesarean or vaginal delivery groups in terms of markers of possible birth asphyxia (RR 1.63, 95% CI 0.84 to 3.14; one trial, 12 women) or Apgar score less than seven at five minutes (RR 0.83, 95% CI 0.43 to 1.60; four trials, 115 women) and no difference in attempts at breastfeeding (RR 1.40, 95% 0.11 to 17.45; one trial, 12 women). There was also no difference in neonatal fitting/seizures (RR 0.22, 95% CI 0.01 to 4.32; three trials, 77 women), hypoxic ischaemic encephalopathy (RR 4.00, 95% CI 0.20 to 82.01;one trial, 12 women) or respiratory distress syndrome (RR 0.55, 95% CI 0.27 to 1.10; three trials, 103 women). There were no data reported in the trials specifically relating to meconium aspiration. There was also no significant difference between the two groups for abnormal follow-up in childhood (RR 0.65, 95% CI 0.19 to 2.22; one trial, 38 women) or delivery less than seven days after entry (RR 0.95, 95% CI 0.73 to 1.24; two trials, 51 women). Mother: There were no data reported on maternal admissions to intensive care. However, there were seven cases of major maternal postpartum complications in the group allocated to planned immediate caesarean section and none in the group randomised to vaginal delivery (RR 7.21, 95% CI 1.37 to 38.08; four trials, 116 women).There were no data reported in the trials specifically relating to maternal satisfaction (postnatal). There was no significant difference between the two groups with regard to postpartum haemorrhage. A number of non-prespecified secondary outcomes were also considered in the analyses. There was a significant advantage for women in the vaginal delivery group with respect to maternal puerperal pyrexia (RR 2.98, 95% CI 1.18 to 7.53; three trials, 89 women) and other maternal infection (RR 2.63, 95% CI 1.02 to 6.78; three trials, 103 women), but no significant differences in wound infection (RR 1.16, 95% CI 0.18 to 7.70; three trials, 103 women), maternal stay more than 10 days (RR 1.27, 95% CI 0.35 to 4.65; three trials, 78 women) or the need for blood transfusion (results not estimable). AUTHORS' CONCLUSIONS There is not enough evidence to evaluate the use of a policy of planned immediate caesarean delivery for preterm babies. Further studies are needed in this area, but recruitment is proving difficult.
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Affiliation(s)
- Zarko Alfirevic
- Department of Women’s and Children’s Health, The University of Liverpool, Liverpool, UK.
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The underestimation of immaturity in late preterm infants. Arch Gynecol Obstet 2012; 286:619-26. [PMID: 22562386 DOI: 10.1007/s00404-012-2366-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Late preterm infants with gestational ages between 34 0/7 and 36 6/7 weeks are known to be at higher risk of mortality and morbidity than term newborns. This study aims to investigate the nature and frequency of neonatological complications in the late preterm population resulting in neonatal intensive care unit admissions as well as to draw obstetrical conclusions from the results. METHODS Neonatological outcomes of 893 consecutively born late preterm infants were evaluated and classified by the frequency of occurrence in relation to potential maternal or fetal risk factors. RESULTS Out of 893 late preterm infants, 528 (59.1 %) required intensive neonatal care. The incidence of apnea and bradycardia, the occurrence of feeding difficulties and the requirement of continuous positive airway pressure (CPAP) were inversely proportional to gestational age (p < 0.001). Gestational diabetes of the mother was more frequently associated with hypoglycemia (p < 0.001), but showed a reduced risk of hypothermia (p < 0.001). Small for gestational age neonates had a significantly lower rate of respiratory disorders (p < 0.001), but were more often affected by feeding difficulties (p < 0.01). Normal vaginal delivery had a significant advantage with regard to the necessity of CPAP (p < 0.01) and the occurrence of feeding difficulties (p < 0.05). Infants born by cesarean section were at higher risk of hypoglycemia (p < 0.001), but at lower risk of hyperbilirubinemia (p < 0.001). CONCLUSIONS The high risk of a problematic neonatological outcome in late preterms requires fundamental reconsideration. All efforts to prolong a pregnancy should be made beyond the 34th week of gestation.
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Mousiolis A, Papantoniou N, Mesogitis S, Baglatzi L, Baroutis G, Antsaklis A. Optimum mode of delivery in gestations complicated by preterm premature rupture of the membranes. J Matern Fetal Neonatal Med 2011; 25:1044-9. [PMID: 21854136 DOI: 10.3109/14767058.2011.614659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To provide evidence about the preferable mode of delivery, vaginal (VD) or caesarean section (CS), in PPROM. METHODS A retrospective study of 190 cases. Survival analysis was used to identify statistically significant differences in mortality rates. RESULTS A total of 126 pregnancies were included in our study. Mean gestational age of rupture was 28(+0) weeks (min = 15, max = 36(+4), sd = 5.796). Mean birth age was 30(+0) weeks (min = 15, max = 37(+2), sd = 5.353). CS was performed in 55 cases (43.7%), VD in 71 cases (56.3%). Data analysis showed that, regardless of presentation, there was a statistically significant benefit on survival in favor of the CS in births below 30 gestational weeks (n = 39, nCS = 18, nND = 21, χ(2) = 7.946, p = 0.005). Hazard ratio estimation set the critical gestational age at 28 weeks. For vaginal deliveries, breech presentation was associated with inferior survival outcome compared to vertex (nTotal = 71; nVertex = 63, nBreech = 8, χ(2) = 13.012, p < 0.001.Also in breech presentation, VD survival outcome was inferior to CS (nTotal = 9; nVD = 6, nCS = 3, χ(2) = 5.145, p < 0.05). CONCLUSIONS According to our results, in cases of PPROM, CS was beneficial below 28 weeks and in breech presentation below 30 weeks.
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Affiliation(s)
- Athanasios Mousiolis
- 1st Obstetrics and Gynecology Clinic, University Hospital Alexandra, Athens, Greece.
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A systematic review of severe morbidity in infants born late preterm. Am J Obstet Gynecol 2011; 205:374.e1-9. [PMID: 21864824 DOI: 10.1016/j.ajog.2011.07.015] [Citation(s) in RCA: 209] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 06/21/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Late-preterm infants (34 weeks 0/7 days-36 weeks 6/7 days' gestation) represent the largest proportion of singleton preterm births. A systematic review was performed to access the short- and/or long-term morbidity of late-preterm infants. STUDY DESIGN An electronic search was conducted for cohort studies published from January 2000 through July 2010. RESULTS We identified 22 studies studying 29,375,675 infants. Compared with infants born at term, infants born late preterm were more likely to suffer poorer short-term outcomes such as respiratory distress syndrome (relative risk [RR], 17.3), intraventricular hemorrhage (RR, 4.9), and death <28 days (RR, 5.9). Beyond the neonatal period, late-preterm infants were more likely to die in the first year (RR, 3.7) and to suffer from cerebral palsy (RR, 3.1). CONCLUSION Although the absolute incidence of neonatal mortality and morbidity in infants born late preterm is low, its incidence is significantly increased as compared with infants born at term.
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Review of the recent literature on the mode of delivery for singleton vertex preterm babies. J Pregnancy 2011; 2011:186560. [PMID: 21811682 PMCID: PMC3147000 DOI: 10.1155/2011/186560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 05/26/2011] [Indexed: 11/17/2022] Open
Abstract
Choosing the safest method of delivery and preventing preterm labour are obstetric challenges in reducing the number of preterm births and improving outcomes for mother and baby. Optimal route of delivery for preterm vertex neonates has been a controversial topic in the obstetric and neonatal community for decades and continues to be debated. We reviewed 22 studies, most of which have been published over the last five years with an aim to find answers to the clinical questions relevant to deciding the mode of delivery. Findings suggested that the neonatal outcome does not depend on the mode of delivery. Though Caesarean section rates are increasing for preterm births, it does not prevent neurodisability and cannot be recommended unless there are other obstetric indications to justify it. Therefore, clinical judgement of the obstetrician depending on the individual case still remains important in deciding the mode of delivery.
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Ye G, Jiang Z, Lu S, Le Y. Premature infants born after preterm premature rupture of membranes with 24-34 weeks of gestation: a study of factors influencing length of neonatal intensive care unit stay. J Matern Fetal Neonatal Med 2011; 24:960-5. [PMID: 21506655 DOI: 10.3109/14767058.2011.572204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the factors influencing length of neonatal intensive care unit (NICU) stay among premature infants born after preterm premature rupture of membranes (PPROM) with 24-34 weeks of gestation. METHODS Characteristic parameters of the pregnant women with PPROM and their premature infants were analyzed retrospectively using univariate and multivariate analysis. RESULTS The overall rate of PPROM was 1.3% (323/24,173), of which 19.2% (62/323) were premature infants with sepsis. Overall, the median NICU stay of the premature infants was 11 days. Multiple factor regression analysis identified factors influencing length of stay in premature infants: gestational age (β = -0.172, P = 0.000), parturition modes (β = -0.115, P = 0.000), infant's birth weight (β = -0.728, P = 0.000), infant's discharge weight (β = 0.443, P = 0.000), bacterial culture of cord blood (β = -0.100, P = 0.011) and sepsis (β = 0.192, P = 0.000). Additionally, latency period of sepsis diagnosis in neonatal sepsis between negative and positive cord blood culture was significantly discrepant, and 98.1% specificity and 84.4% positive predictive value for cord blood culture. CONCLUSION We have identified several predictive factors for length of stay in cases of premature infants after PPROM, of which cord blood culture can be used as an additional diagnostic test to detect newborns at risk of infections, and be valuable in clinical application and generalization among neonate sepsis.
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Affiliation(s)
- Guangyong Ye
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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