Is ultrasound measured fetal biometry predictive of intrapartum caesarean section for failure to progress?

BACKGROUND

There are global concerns regarding excessive caesarean rates, which could be reduced by identification of risk factors leading to preventative measures such as induction of labour.

AIMS

This study aims to describe the association between antenatal ultrasound and emergency caesarean section for: (i) failure to progress; (ii) other indications; and (iii) any indication.

MATERIALS AND METHODS

Women who had an ultrasound in pregnancy between 36^(+0/7) to 38^(+6/7) weeks at Royal Prince Alfred Hospital from January 2005 to June 2009 were included. Ultrasound parameters were linked to clinical parameters from the maternity database. Missing clinical data were imputed and multiple logistic regression performed.

RESULTS

Fetal biometry data were available for 2006 pregnancies. After adjusting for maternal age, height, body mass index, parity, previous caesarean section and diabetes, caesarean section for failure to progress was associated with estimated fetal weight (odds ratio (OR) 2.24 (95% CI: 1.76-2.84) per 500 g increase); or biparietal diameter (OR 1.51 (1.16-1.97) per 5 mm increase) and abdominal circumference (OR for the 4th quartile (>75th centile) compared with the 10-25th centile group was 2.09 (1.13-3.85)).* There were also non-linear associations between components of fetal biometry and caesarean section for fetal distress and for any indication.

CONCLUSIONS

Components of fetal biometry in the third trimester are associated with intrapartum caesarean section for failure to progress. These parameters could be incorporated into models to predict emergency caesarean section which could lead to implementation of preventative strategies. *[Corrections added on 29 January 2018, after first online publication, '(OR for the 4th quartile (>7th centile)' has been changed to '(OR for the 4th quartile (>75th centile)'.].

A prospective longitudinal study of health-related quality of life and psychological wellbeing after an implantable cardioverter defibrillator in patients with genetic heart diseases

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NHMRC Project Grant National Heart Foundation Future Leader Fellowship

OnBehalf

Cardio Genomics Program

Introduction

Genetic heart diseases, often affecting young people, can be clinically heterogeneous and pose an increased risk of sudden cardiac death (SCD). The implantable cardioverter defibrillator (ICD) is a lifesaving therapy. Impact on prospective and long-term psychological and health-related quality of life (HR-QoL) after ICD implant in patients with genetic heart diseases is unknown.

Purpose

We aimed to investigate the psychological functioning and HR-QoL over time in patients with genetic heart diseases who receive an ICD and to identify risk factors for poor psychological functioning and HR-QoL.

Methods

A prospective longitudinal design was used. Patients diagnosed with a genetic heart disease for which they received an ICD, were eligible. Anxiety, depression, health-related quality of life and device acceptance were measured using validated questionnaires. Baseline surveys were completed prior to ICD implantation with five-year follow-up after ICD implant.

Results

Forty patients with an inherited cardiomyopathy or arrhythmia syndrome (mean age 46.3 ± 14.2 years; 65.0% males) were included. Mean psychological and HR-QoL measures were within normative ranges during follow-up. We observed significant overall improvements from baseline to first follow-up with variability increasing after 36 months. The presence of comorbidities predicted worse physical HR-QoL (p = 0.014). Other predictors were not statistically significant, although lower education and female gender seemed to be an interesting predictor for higher anxiety and less mental HR-QoL, and the presence of comorbidities for less physical HR-QoL.

Conclusion

While the majority of patients with a genetic heart disease adjust well to their ICD implant, a subset of patients experiences poor psychological and HR-QoL outcomes.

Attributable factors for the rising cesarean delivery rate over three decades: an observational cohort study

BACKGROUND

Cesarean delivery rates continue to rise globally the reasons for which are incompletely understood.

OBJECTIVES

We aimed to characterize attributable factors for increasing cesarean delivery rates over a 30-year period within our health network.

STUDY DESIGN

This was a planned observational cohort study across two hospitals (a large tertiary referral hospital and a metropolitan hospital) in Sydney, Australia using data from a previously published study. Two time periods were compared: 1989-1999 and 2009-2016, between which the cesarean delivery rate increased from 19% to 30%. Participants were all women who had a cesarean delivery after 24 weeks gestational age. Data were analyzed using multiple imputation and robust Poisson regression to calculate differences in the adjusted and unadjusted relative risk of cesarean delivery and estimate the changes in the cesarean delivery rate attributable to maternal and clinical factors. The primary outcome was cesarean delivery.

RESULTS

After 576 exclusions, 102 589 births were included in the analysis. Fifty-six percent of the increase in the rate of cesarean delivery was attributed to changes in the distribution of maternal age, body mass index, parity and history of previous cesarean delivery. An additional 10% of the increase was attributed to changes in the obstetric management of the following high-risk pregnancies: multiple gestation, malpresentation (mainly breech) and preterm singleton birth. When pre-labor cesarean deliveries for maternal choice, suspected fetal compromise, previous pregnancy issues and suspected large fetus were excluded, 78% of the increase was attributed to either maternal factors or changes in the obstetric management of these high-risk pregnancies.

CONCLUSIONS

Most of the steep rise in the cesarean delivery rate from 19% to 30% was attributed to changes in maternal demographic and clinical factors. This observation is relevant to developing preventative strategies which account for nulliparity, age, body mass index, and the management of high-risk pregnancies.

TWEETABLE ABSTRACT

More than half of the increase in the rate of cesarean delivery is attributable to changes in maternal age, BMI, parity and history of cesarean delivery.