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Wang M, Ji Y, Chen S, Wang M, Lin X, Yang M. Effect of mode of delivery on postpartum weight retention: A systematic review and meta-analysis. Midwifery 2024; 132:103981. [PMID: 38574440 DOI: 10.1016/j.midw.2024.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Retention of weight gained over pregnancy increases the risk of long-term obesity and related health concerns. While many risk factors for this postpartum weight retention have been examined, the role of mode of delivery in this relationship remains controversial. We carried out a systematic review and meta-analysis to determine the effect of mode of delivery on postpartum weight retention. METHODS Ten electronic databases including PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, CINAHL, China National Knowledge Infrastructure (CNKI), Wan-Fang database, the VIP database and China Biology Medicine Database (CBM) were searched from inception through November 2022. Review Manager 5.4 was used to pool the study data and calculate effect sizes. For dichotomous data, the odds ratio and 95 % confidence interval were used to report the results. For continuous data, the mean difference (MD) and 95 % confidence interval were used to report the results. The outcomes were the amount of postpartum weight retention and the number or proportion of women who experienced postpartum weight retention. The Newcastle- Ottawa Scale (NOS) and GRADE Guidelines were used to assess the methodological quality of the included studies. FINDINGS A total of 16 articles were included in the systematic review and 13 articles were included in the meta-analysis. The results showed that the mode of delivery had a significant effect on postpartum weight retention, women who delivered by caesarean section were more likely to experience postpartum weight retention compared to those who delivered vaginally. Sensitivity analysis showed that the results were stable and credible. CONCLUSION Due to the limitations of this study, the findings need to be treated with caution. And, to better prevent the postpartum weight retention, future practice and research need to further focus on upstream modifiable factors.
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Affiliation(s)
- Meiyu Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Yuting Ji
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Shanxia Chen
- Health Management & Biotechnology School, Guangdong Food and Drug Vocational College, No.321, Longdong North Road, Tianhe District, Guangzhou City, Guangdong Province, China
| | - Minyi Wang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Xiaoli Lin
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China
| | - Ming Yang
- School of Nursing, Guangzhou University of Chinese Medicine, No.232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou City, Guangdong Province 510006, China.
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Boie S, Glavind J, Bor P, Steer P, Riis AH, Thiesson B, Uldbjerg N. Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX): individual management based on artificial intelligence - a secondary analysis. BMC Pregnancy Childbirth 2024; 24:291. [PMID: 38641779 PMCID: PMC11027395 DOI: 10.1186/s12884-024-06461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Current guidelines regarding oxytocin stimulation are not tailored to individuals as they are based on randomised controlled trials. The objective of the study was to develop an artificial intelligence (AI) model for individual prediction of the risk of caesarean delivery (CD) in women with a cervical dilatation of 6 cm after oxytocin stimulation for induced labour. The model included not only variables known when labour induction was initiated but also variables describing the course of the labour induction. METHODS Secondary analysis of data from the CONDISOX randomised controlled trial of discontinued vs. continued oxytocin infusion in the active phase of induced labour. Extreme gradient boosting (XGBoost) software was used to build the prediction model. To explain the impact of the predictors, we calculated Shapley additive explanation (SHAP) values and present a summary SHAP plot. A force plot was used to explain specifics about an individual's predictors that result in a change of the individual's risk output value from the population-based risk. RESULTS Among 1060 included women, 160 (15.1%) were delivered by CD. The XGBoost model found women who delivered vaginally were more likely to be parous, taller, to have a lower estimated birth weight, and to be stimulated with a lower amount of oxytocin. In 108 women (10% of 1060) the model favoured either continuation or discontinuation of oxytocin. For the remaining 90% of the women, the model found that continuation or discontinuation of oxytocin stimulation affected the risk difference of CD by less than 5% points. CONCLUSION In women undergoing labour induction, this AI model based on a secondary analysis of data from the CONDISOX trial may help predict the risk of CD and assist the mother and clinician in individual tailored management of oxytocin stimulation after reaching 6 cm of cervical dilation.
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Affiliation(s)
- Sidsel Boie
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.
| | - Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Philip Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | | | | | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Fujita A, Shirozu K, Higashi M, Yamaura K. Anesthetic management in pregnant women with Fontan circulation: a case series. JA Clin Rep 2024; 10:25. [PMID: 38634932 PMCID: PMC11026315 DOI: 10.1186/s40981-024-00706-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Given the advances in medicine, women with Fontan circulation are now reaching childbearing age. However, data on the mode of delivery and anesthetic management of these patients are limited. We report the cases of five pregnant women with Fontan circulation. CASE PRESENTATION The mean age at delivery was 28 ± 3 years, and the mean gestational period was 34 weeks and 3 days. Anticoagulation therapy was switched from warfarin and aspirin to continuous intravenous heparin. The modes of delivery were scheduled cesarean section (C/S) in one, emergency C/S in three, and vaginal delivery with epidural labor analgesia in one patient. Three patients underwent C/S under regional anesthesia; one received general anesthesia. The perinatal complications were heart failure, worsening valve regurgitation, and postoperative hematoma in three, four, and two patients, respectively. CONCLUSIONS For C/S in women with Fontan circulation, regional anesthesia should be considered. Epidural labor analgesia can help prevent the decrease in pulmonary blood flow due to straining. We initiated labor analgesia or C/S with regional anesthesia at the appropriate time in four patients.
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Affiliation(s)
- Ai Fujita
- Operating Rooms, Kyushu University Hospital, Fukuoka, Japan.
- Department of Anesthesiology, Fukuoka Children's Hospital, Kashiiteriha 5-1-1, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Kazuhiro Shirozu
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Midoriko Higashi
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Liu S, Wang L, Gao M, Zhang X, Cui H. Mode of delivery and neonatal outcomes in preterm twins less than 32 weeks of gestation or birthweight under 1500 g: a systematic review and meta-analyses. Arch Gynecol Obstet 2024; 309:1219-1226. [PMID: 38066342 DOI: 10.1007/s00404-023-07307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND The mode of delivery for twins born before 32 weeks of gestation remains controversial. Our purpose is to conduct a meta-analysis of twin pregnancies less than 32 weeks or twin weight less than 1500 g, so as to find a suitable delivery mode. METHODS We searched PubMed database, Cochrane Library database, and EMBASE database through December 2022. This protocol was registered with PROSPERO (CRD42023386946) prior to initiation. Studies that compared vaginal delivery to cesarean section for newborns less than 32 weeks of gestation or birthweight under 1500 g were included. The primary result was neonatal mortality rate. Secondary result was neonatal morbidity. The quality of literatures included in the research was evaluated in accordance with Newcastle-Ottawa Scale (NOS) literature quality evaluation scale. We use odds ratio (OR) as the effect index for binary variables. Point estimates and 95% confidence intervals (95% CI) were calculated. P < 0. 05 indicated statistically significant difference. RESULTS Our search generated 5310 articles, and a total of 8 articles comprising a total of 14,703 newborns were included in the analysis. The odds ratios of neonatal mortality rate were for twins delivered by vaginal delivery compared to cesarean section were 0.84 (95% CI 0.57-1.24, P = 0.38). The 5-min Apgar score < 7 (95% CI 0.44-1.75, P = 0.72), necrotizing enterocolitis (95% CI 0.81-1.19, P = 0.82), intraventricular hemorrhage (95% CI 0.41-1.86, P = 0.71), periventricular leukomalacia (95% CI 0.16-4.52, P = 0.84), bronchopulmonary dysplasia (95% CI 0.88-1.36, P = 0.42), and respiratory distress syndrome (95% CI 0.23-2.01, P = 0.48) were not statistically significant between the two groups. CONCLUSION We have observed that vaginal delivery does not confer an increased risk of neonatal morbidity and mortality in twins born before 32 weeks of gestation. However, the current results are affected by substantial heterogeneity and confounding factors. We still need high-quality randomized-controlled studies require to address this important question.
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Affiliation(s)
- Sishi Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China
| | - Leilei Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China
| | - Man Gao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China
| | - Xue Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China
| | - Hong Cui
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China.
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Yin A, Shi Y, Heinonen S, Räisänen S, Fang W, Jiang H, Chen A. The impact of fear of childbirth on mode of delivery, postpartum mental health and breastfeeding: A prospective cohort study in Shanghai, China. J Affect Disord 2024; 347:183-191. [PMID: 38007102 DOI: 10.1016/j.jad.2023.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The prevalence and impact of fear of childbirth (FOC) has not been sufficiently understood. We aimed to investigate the prevalence of FOC among Chinese population and its impact on mode of delivery, postpartum mental health and breastfeeding. METHODS We conducted a prospective cohort study, wherein pregnant women in their third trimester who underwent antenatal assessments at Shanghai Changning Maternity and Infant Health Hospital between September 2020 and March 2021 were recruited. Sociodemographic data of the participants were gathered by self-administered questionnaire, and their FOC was assessed using the Wijma Delivery Expectancy Questionnaire. Participants were followed up to 42 days postpartum. Information regarding their modes of delivery was retrieved from medical records, and data regarding postpartum mental health symptoms and one-month postpartum breastfeeding were obtained through self-administered questionnaires. RESULTS Among 1287 participants, 461 (35.8 %) had high-level FOC (W-DEQ ≥ 66). Logistic regressions showed that women with high-level of FOC had higher rates of caesarean delivery on maternal request (CDMR) (aOR = 1.55, 95 % CI: 1.00-2.41, p = 0.049), a higher incidence of postpartum mental health symptoms (aOR = 1.68, 95 % CI: 1.09-2.59, p = 0.018), lower rates of one-month postpartum exclusive breastfeeding (aOR = 0.33, 95 % CI: 0.16-0.69, p = 0.003) and mixed feeding (aOR = 0.44, 95 % CI: 0.21-0.91, p = 0.028). LIMITATIONS The long-term implications of FOC beyond the immediate postpartum period were not explored in the study. CONCLUSIONS High-level FOC during the third trimester was associated with increased CDMR and postpartum mental health symptoms and reduced breastfeeding establishment. These results underscore the significance of FOC screening and tailored interventions for affected women.
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Affiliation(s)
- Anxin Yin
- School of Public Health, Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Yunmei Shi
- Shanghai Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Räisänen
- School of Health, Tampere University of Applied Sciences, Tampere, Finland
| | - Wenli Fang
- Shanghai Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Hong Jiang
- School of Public Health, Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai, China.
| | - An Chen
- School of Public Health, Zhejiang Chinese Medical University, Zhejiang, China; Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Hegde A, Huebner M, Ibrahim S, Mastrolia SA, David-Montefiore E, Weintraub AY. Impact of childbirth on pelvic floor dysfunction in women who have undergone previous pelvic floor reconstructive surgery: systematic review and meta-analysis. Int Urogynecol J 2024; 35:3-17. [PMID: 37796329 DOI: 10.1007/s00192-023-05630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/27/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the study was to perform a systematic review and meta-analysis of the impact of pregnancy and childbirth (vaginal delivery [VD]) or cesarean section (CS) on the recurrence of pelvic floor disorders in women who had previously undergone pelvic floor reconstructive surgery for pelvic organ prolapse (POP) or stress urinary incontinence (SUI), to facilitate future evidence-based counseling. METHODS PubMed, Cochrane, Embase, BJOG, Scopus, etc. were screened, from 1990 to date. Inclusion criteria included cohort studies, case-control studies, case series, and case reports that reported on the primary outcome measure of the review. Exclusion criteria included studies on surgical procedures whose outcomes are unlikely to be impacted by pregnancy and childbirth or are obsolete. Meta-analysis was performed using Review Manager 5.3. RESULTS Seven papers on midurethral slings (MUS; 181 women in both VD and CS groups respectively) and three papers on different hysteropexy techniques (47 and 29 women in the VD and CS groups respectively), were included in the meta-analysis. No difference was seen between the two groups regarding the recurrence of SUI in women who had previously undergone MUS surgery (OR: 1.18 [0.66, 2.09]; Z = 0.56; p = 0.58) or the recurrence of POP following hysteropexy using various apical suspension procedures (OR: 1.81 [0.04, 80.65]; Z = 0.31; p = 0.76). There are insufficient data to support meta-analyses for individual MUS sub-types or hysteropexy procedures. CONCLUSION Current literature does not demonstrate a protective effect of CS in preventing recurrent SUI in women who had undergone MUS surgery for SUI. When hysteropexy is considered irrespective of the apical suspension procedure employed, the incidence of recurrent POP appears similar after CS and VD.
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Affiliation(s)
- Aparna Hegde
- Department of Urogynecology, Cama Hospital, Grant Medical College, Mumbai, India.
| | - Markus Huebner
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | | | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Cecchini L, Barmaz C, Cea MJC, Baeschlin H, Etter J, Netzer S, Bregy L, Marchukov D, Trigo NF, Meier R, Hirschi J, Wyss J, Wick A, Zingg J, Christensen S, Radan AP, Etter A, Müller M, Kaess M, Surbek D, Yilmaz B, Macpherson AJ, Sokollik C, Misselwitz B, Ganal-Vonarburg SC. The Bern Birth Cohort (BeBiCo) to study the development of the infant intestinal microbiota in a high-resource setting in Switzerland: rationale, design, and methods. BMC Pediatr 2023; 23:560. [PMID: 37946167 PMCID: PMC10637001 DOI: 10.1186/s12887-023-04198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 07/17/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Microbiota composition is fundamental to human health with the intestinal microbiota undergoing critical changes within the first two years of life. The developing intestinal microbiota is shaped by maternal seeding, breast milk and its complex constituents, other nutrients, and the environment. Understanding microbiota-dependent pathologies requires a profound understanding of the early development of the healthy infant microbiota. METHODS Two hundred and fifty healthy pregnant women (≥20 weeks of gestation) from the greater Bern area will be enrolled at Bern University hospital's maternity department. Participants will be followed as mother-baby pairs at delivery, week(s) 1, 2, 6, 10, 14, 24, 36, 48, 96, and at years 5 and 10 after birth. Clinical parameters describing infant growth and development, morbidity, and allergic conditions as well as socio-economic, nutritional, and epidemiological data will be documented. Neuro-developmental outcomes and behavior will be assessed by child behavior checklists at and beyond 2 years of age. Maternal stool, milk, skin and vaginal swabs, infant stool, and skin swabs will be collected at enrolment and at follow-up visits. For the primary outcome, the trajectory of the infant intestinal microbiota will be characterized by 16S and metagenomic sequencing regarding composition, metabolic potential, and stability during the first 2 years of life. Secondary outcomes will assess the cellular and chemical composition of maternal milk, the impact of nutrition and environment on microbiota development, the maternal microbiome transfer at vaginal or caesarean birth and thereafter on the infant, and correlate parameters of microbiota and maternal milk on infant growth, development, health, and mental well-being. DISCUSSION The Bern birth cohort study will provide a detailed description and normal ranges of the trajectory of microbiota maturation in a high-resource setting. These data will be compared to data from low-resource settings such as from the Zimbabwe-College of Health-Sciences-Birth-Cohort study. Prospective bio-sampling and data collection will allow studying the association of the microbiota with common childhood conditions concerning allergies, obesity, neuro-developmental outcomes , and behaviour. Trial registration The trial has been registered at www. CLINICALTRIALS gov , Identifier: NCT04447742.
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Affiliation(s)
- Luca Cecchini
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Colette Barmaz
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Maria José Coloma Cea
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Hannah Baeschlin
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Julian Etter
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Stefanie Netzer
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Leonie Bregy
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Dmitrij Marchukov
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Nerea Fernandez Trigo
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Rachel Meier
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Jasmin Hirschi
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Jacqueline Wyss
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Andrina Wick
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Joelle Zingg
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Sandro Christensen
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Anda-Petronela Radan
- Department of Obstetrics and Gynaecology, Bern University Hospital, Inselspital, University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
| | - Annina Etter
- Department of Obstetrics and Gynaecology, Bern University Hospital, Inselspital, University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
| | - Martin Müller
- Department of Obstetrics and Gynaecology, Bern University Hospital, Inselspital, University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynaecology, Bern University Hospital, Inselspital, University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
| | - Bahtiyar Yilmaz
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Andrew J Macpherson
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Christiane Sokollik
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital, Inselspital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Benjamin Misselwitz
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland.
| | - Stephanie C Ganal-Vonarburg
- Department for BioMedical Research (DBMR), Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern University Hospital, Freiburgstr. 18, 3010, Bern, Switzerland
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Junior LCM, Pinto CN, Gerencer CS, Pro ECG, de Carvalho HB. Association of maternal, fetal and labor variables with a low Apgar score in the fifth minute in term pregnancy: a case-control study. Arch Gynecol Obstet 2023; 308:1473-1483. [PMID: 36374349 PMCID: PMC9662118 DOI: 10.1007/s00404-022-06832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To search for maternal, labor-related and fetal variables associated with low Apgar in the fifth minute in term pregnancy. METHODS A retrospective case-control study with term births was conducted in a public teaching hospital from 2013 to 2020. Cases were term births with Apgar score less than 7 in the fifth minute, and controls, the next one or two births following a case, with Apgar of 7 or more. Non-cephalic presentations, multiples and malformations were excluded. We accessed 100 cases and 190 controls. We considered significant values of p < 0.05. RESULTS Were accessed 27 variables which could be risk factors, from which 12 were associated with the outcome. We found a protective effect of prelabor cesarean for the outcome, odds ratio (OR) 0.38, p = 0.013. Consequently, we conducted two sets of analyses: in the whole group and in the group of laboring women. The values of OR were in general greater in the group of laboring women, compared with the whole group. We conducted multivariate analysis within the group of women in labor. The variables which fitted best in the model were nulliparity, male sex of the fetus, less than six prenatal visits and abnormal cardiotocography; all remained significant. An association of rupture of membranes more than 360 min with the outcome, even after controlling fpr duration of labor, was found; adjusted OR 2.45, p = 0.023. CONCLUSION Twelve variables were associated with the outcome. Prelabor cesarean had a protective effect. The time of ruptured membranes was associated with low Apgar.
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Affiliation(s)
- Luís Carlos Machado Junior
- Universidade de São Paulo/Faculdade de Medicina/Centro de Saúde Escola Samuel Barnsley Pessoa, São Paulo, Brazil.
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil.
| | - Camila Nazareth Pinto
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil
| | - Caroline Sangalan Gerencer
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil
| | - Elisa Caroline Giacometti Pro
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil
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Yavuz S, İlhan HD, Ersoy M. Factors affecting the need for silicon tube implantation in cases of congenital dacriostenosis: time of delivery, type of delivery and age of operation. Int Ophthalmol 2023; 43:3747-3754. [PMID: 37382816 DOI: 10.1007/s10792-023-02785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To evaluate the delivery time, type of delivery, age at the time of operation, and surgical methods applied in cases of congenital nasolacrimal duct obstruction (CNLDO). METHODS This study retrospectively included a total of 207 eyes of 160 cases who underwent surgery for CNLDO between February 2012 and April 2021. According to their age at the time of operation, the cases were divided into 0-12, 12-24, 24-36, 36-48 and > 48 months groups. The cases were evaluated as term/preterm according to the delivery time and cesarean section/vaginal delivery according to the type of delivery. The surgical methods applied were examined as probing alone and probing plus silicone tube implantation. RESULTS Of the cases, 146 (91.2%) were born at term and 14 (8.7%) were born preterm, and there was no statistically significant difference in the silicone tube implantation rates according to the time of delivery. The rate of silicone tube implantation was statistically significantly higher in the vaginal delivery group than in the cesarean section group (p = 0.001; p < 0.01). The rate of silicone tube implantation was higher in those who were older than the age of the operation. CONCLUSIONS Although the rate of those who were born by cesarean section was higher in probing cases, those who required silicone intubation were more common in those who were born vaginally. This suggests that dacryostenosis in the vaginally born cases resulted from a persistent structural and anatomical obstruction despite the presence of a high intrauterine pressure increase and enzymatic lysis.
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Affiliation(s)
- Sibel Yavuz
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey.
| | | | - Merve Ersoy
- Gaziantep Cengiz Gökçek Obstetrics and Gynecology and Pediatrics Hospital, Gaziantep, Turkey
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10
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Wagaw AC, Sendekie AK, Nigatu SG, Mihretie GS. Preferred mode of delivery and its associated factors in pregnant women with a previous cesarean scar at a tertiary care hospital in Ethiopia: institutional-based cross-sectional study. BMC Pregnancy Childbirth 2023; 23:585. [PMID: 37582715 PMCID: PMC10428546 DOI: 10.1186/s12884-023-05891-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Vaginal births after cesarean or elective repeat cesarean sections (CS) are the options for delivery after one cesarean scar. However, there is a lack of data regarding the preferred next mode of delivery in Ethiopia after a previous cesarean section. Thus, this study assessed the preferred mode of delivery and determinants after one previous CS in the antenatal clinic at the University of Gondar Comprehensive Specialized Hospital (UoGCSH). METHODS An institutional-based cross-sectional study was conducted among pregnant mothers with one previous CS at UoGCSH from March to August 2022. Structured questionnaires were used to collect the data. The collected data were entered, cleaned, and edited using Epi-data 4.6 and exported to SPSS version 26 for analysis. A binary logistic regression was performed to assess the determinants of the preferred mode of delivery. A p-value of < 0.05 at the 95% confidence level (CI) was considered statistically significant. RESULTS The majority, 71.5% (95% CI: 64.7, 77.1), of participants preferred the trial of labor after cesarean (TOLAC) as their mode of delivery. Mothers who were married (AOR = 4.47, 95% CI: 1.19-16.85), had a diploma educational level (AOR = 3.77, 95% CI: 1.84-12.36), had previous post-cesarean complications (AOR = 3.25, 95% CI: 1.08-9.74), and knew about the success of the trial of labor after cesarean (AOR = 13.56, 95% CI: 4.52-37.19) were found to prefer the trial of labor compared with their counterparts. CONCLUSION This study concluded that most pregnant mothers preferred labor trials after one CS, which is a bit lower but comparable with recommended practice guidelines. Providing adequate information and counseling mothers to make informed decisions about their preferred mode of delivery could be substantial.
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Affiliation(s)
- Abebe Chanie Wagaw
- Department of Obstetrics and gynecology, School of Medicine, College of Medicne and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharamcy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemilogy & Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getasew Sisay Mihretie
- Department of Obstetrics and gynecology, School of Medicine, College of Medicne and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Schwarzman P, Sheiner E, Sergienko R, Kessous R. A history of cesarean section and future maternal long-term risk for neoplasms: a population-based cohort study. Arch Gynecol Obstet 2023; 308:499-505. [PMID: 35996034 DOI: 10.1007/s00404-022-06698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/22/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Mode of delivery has long-term implications on the mother, including recent data regarding the level of transmission of fetal microchimeric cells (FMc) and their possible effect on cancer development. We aimed to evaluate the association between cesarean section (CS) and future risk for neoplasms. STUDY DESIGN A population-based cohort analysis comparing the long-term risk for neoplasms between patients that delivered only by CS to those that delivered only vaginally (VD). Neoplasms were pre-defined based on ICD-9 codes. Deliveries occurred between the years 1991-2017 in a tertiary medical center. Kaplan-Meier survival curves were used to compare the cumulative incidence of neoplasms and Cox proportional hazards models were constructed to control for confounders. RESULTS During the study period 105,992 patients met the inclusion criteria; 14150 (13.4%) of patients had only CS and 91842 (86.6%) had VD (comparison group). The CS group had significantly higher incidence of benign and malignant neoplasms (4.73 per 1000 patient-years versus 3.88 per 1000 patient-years, OR = 1.26, 95% CI 1.16-1.37; p = 0.001; 2.19 per 1000 patient-years of follow up versus 1.93 per 1000 patient-years, OR = 1.16, 95% CI 1.03-1.31; p = 0.013). Specifically, the CS group had higher incidence of uterine cancer (1.2 versus 0.06 per 1000 patient-years, OR = 1.97, 95% CI 1.14-3.39; p = 0.013). The cumulative incidence of benign, malignant and uterine neoplasms was significantly higher in the CS group (Log rank test p = 0.001; 0.036 and 0.014; respectively). Importantly, no significant association was found with breast and ovarian malignancies." When performing a Cox regression model controlling for confounders, the risk for malignancy-related hospitalizations remained significant (adjusted HR = 1.22, 95% CI 1.01-1.48; p = 0.031) but not for uterine cancer (adjusted HR = 1.6, 95% CI 0.9-2.8; p = 0.103). CONCLUSION Our findings provide support to linkage between delivery by cesarean section and future maternal malignancy.
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Affiliation(s)
- P Schwarzman
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel.
| | - E Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel
| | - R Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - R Kessous
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel
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12
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Mielewczyk FJ, Boyle EM. Uncharted territory: a narrative review of parental involvement in decision-making about late preterm and early term delivery. BMC Pregnancy Childbirth 2023; 23:526. [PMID: 37464284 DOI: 10.1186/s12884-023-05845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Almost 30% of live births in England and Wales occur late preterm or early term (LPET) and are associated with increased risks of adverse health outcomes throughout the lifespan. However, very little is known about the decision-making processes concerning planned LPET births or the involvement of parents in these. This aim of this paper is to review the evidence on parental involvement in obstetric decision-making in general, to consider what can be extrapolated to decisions about LPET delivery, and to suggest directions for further research.A comprehensive, narrative review of relevant literature was conducted using Medline, MIDIRS, PsycInfo and CINAHL databases. Appropriate search terms were combined with Boolean operators to ensure the following broad areas were included: obstetric decision-making, parental involvement, late preterm and early term birth, and mode of delivery.This review suggests that parents' preferences with respect to their inclusion in decision-making vary. Most mothers prefer sharing decision-making with their clinicians and up to half are dissatisfied with the extent of their involvement. Clinicians' opinions on the limits of parental involvement, especially where the safety of mother or baby is potentially compromised, are highly influential in the obstetric decision-making process. Other important factors include contextual factors (such as the nature of the issue under discussion and the presence or absence of relevant medical indications for a requested intervention), demographic and other individual characteristics (such as ethnicity and parity), the quality of communication; and the information provided to parents.This review highlights the overarching need to explore how decisions about potential LPET delivery may be reached in order to maximise the satisfaction of mothers and fathers with their involvement in the decision-making process whilst simultaneously enabling clinicians both to minimise the number of LPET births and to optimise the wellbeing of women and babies.
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Affiliation(s)
- Frances J Mielewczyk
- Leicester City Football Club (LCFC) Research Programme, Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Elaine M Boyle
- Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
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13
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Piva VMR, Voget V, Nucci LB. Cesarean section rates according to the Robson Classification and its association with adequacy levels of prenatal care: a cross-sectional hospital-based study in Brazil. BMC Pregnancy Childbirth 2023; 23:455. [PMID: 37340447 DOI: 10.1186/s12884-023-05768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU - Adequacy of the prenatal care utilization) index and CS rates. METHODS We conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014-2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth - either public healthcare or private health insurers - and maternal sociodemographic data. RESULTS CS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries. CONCLUSION Access to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.
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Affiliation(s)
- Veridiana Monteiro Ramos Piva
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil.
| | - Verena Voget
- Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
| | - Luciana Bertoldi Nucci
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
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Yoshida T, Matsumura K, Hatakeyama T, Inadera H. Association between Cesarean section and neurodevelopmental disorders in a Japanese birth cohort: the Japan Environment and Children's Study. BMC Pediatr 2023; 23:306. [PMID: 37331958 DOI: 10.1186/s12887-023-04128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND The long-term effects of a Cesarean section (CS) birth on child neurodevelopment are of increasing interest. In this study, we examined the associations between mode of delivery and presence of neurodevelopmental disorders in toddlers. Moreover, given that the prevalence of several neurodevelopmental disorders such as autism spectrum disorder (ASD) is known to differ by sex, we also investigated these associations separately in male and female toddlers. METHODS We investigated 65,701 mother-toddler pairs from the Japan Environment and Children's Study, a nationally representative children's cohort study. To investigate the associations between mode of delivery (CS or vaginal delivery) and neurodevelopmental disorders (motor delay, intellectual disability, and ASD) in 3-year-old toddlers as a whole and stratified by sex, we used logistic regression models to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS The morbidity of ASD at age 3 years was higher for children delivered by CS than those delivered vaginally (aOR 1.38, 95% CI 1.04-1.83). However, no such difference was evident in the case of motor delay or intellectual disability (aOR 1.33, 95% CI 0.94-1.89; aOR 1.18, 95% CI 0.94-1.49, respectively). In the analysis by sex, CS was not associated with increased risk of any of the neurodevelopmental disorders in males, but it was associated with increased risks of motor delay (aOR 1.88, 95% CI 1.02-3.47) and ASD (aOR 1.82, 95% CI 1.04-3.16) in females. CONCLUSIONS This study provides evidence of significant associations between mode of delivery and neurodevelopmental disorders in early childhood. Females may be more sensitive to the effects of CS than males.
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Affiliation(s)
- Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, 2630 Sugitani, Toyama City, 930-0194, Japan.
| | - Kenta Matsumura
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | | | - Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
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Roux L, Chiemlewski MC, Lassel L, Isly H, Enderle I, Beuchée A, Le Lous M. Trial of labor versus elective cesarean delivery for patients with two prior cesarean-sections: A retrospective propensity score analysis. Eur J Obstet Gynecol Reprod Biol 2023; 287:67-74. [PMID: 37295347 DOI: 10.1016/j.ejogrb.2023.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Despite awareness of obstetricians to the constant increase in the number of cesarean sections in recent years, the fear of a uterine scar rupture is still present and influences the choice of the mode of delivery in patients with two previous cesarean sections. However, several clinical studies have suggested that, under certain conditions, vaginal birth after two cesarean sections is usually successful and safe. OBJECTIVE The objective of this study was to compare maternal and neonatal issues according to the planned mode of delivery in patients with two previous cesarean sections. METHODS It was a retrospective observational comparative study at Rennes University Hospital between January 1, 2013, and December 31, 2020. We performed a propensity score for the comparison of neonatal outcomes: cord pH, cord lactates, Apgar scores, transfer to neonatal unit and deaths, according to the planned delivery mode. Secondary outcomes were maternal issues: uterine rupture, post-partum hemorrhage, deaths. RESULTS A total of 410 patients with two previous cesarean section were eligible for our study. Prophylactic cesarean was performed in 358 cases (87.3%). Trial of labor was attempted in the 52 remaining patients (12.7%), 67.3 % of whom were successful. Neonatal weight, APGAR score at 1-5-10 min, and pH on cord blood were comparable in both groups. One case of uterine rupture occurred in the trial of labor group. CONCLUSION Trial of labor seems to be a reasonable option for women with two previous cesarean sections in a selected population.
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Affiliation(s)
- Léa Roux
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | | | - Linda Lassel
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - Hélène Isly
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - Isabelle Enderle
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Alain Beuchée
- University of Rennes 1, INSERM, LTSI - UMR 1099, F35000, Rennes, France; Departement of Pediatrics, University Hospital of Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; University of Rennes 1, INSERM, LTSI - UMR 1099, F35000, Rennes, France.
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Pettersen S, Falk RS, Vangen S, Nyfløt LT. Exploring trends of severe postpartum haemorrhage: a hospital-based study. BMC Pregnancy Childbirth 2023; 23:363. [PMID: 37208647 DOI: 10.1186/s12884-023-05702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Over the past two decades several high-income countries have reported increased rates of postpartum haemorrhage (PPH). Many of the studies are registry studies with limited access to detailed information. We aimed to explore trends of severe PPH in the largest labour ward in Norway during a 10-year period with a hospital based study. Our population constituted all women who gave birth after week 22 at Oslo University Hospital between 2008 and 2017. The main outcome measure was severe PPH, defined as registered blood loss greater than 1500 ml, or transfusion of blood products due to PPH. METHODS We estimated the incidence of severe PPH and blood transfusions, and performed temporal trend analysis. We performed Poisson regression analysis to investigate associations between pregnancy characteristics and severe PPH, presented using crude incidence rate ratios (IRR) with 95% confidence intervals (CI)s. We also estimated annual percentage change of the linear trends. RESULTS Among 96 313 deliveries during the 10-year study period, 2621 (2.7%) were diagnosed with severe PPH. The incidence rate doubled from 17.1/1000 to 2008 to 34.2/1000 in 2017. We also observed an increased rate of women receiving blood transfusion due to PPH, from 12.2/1000 to 2008 to 27.5/1000 in 2017. The rates of invasive procedures to manage severe PPH did not increase, and we did not observe a significant increase in the number of women defined with maternal near miss or massive transfusions. No women died due to PPH during the study period. CONCLUSION We found a significant increasing trend of severe PPH and related blood transfusions during the 10-year study period. We did not find an increase in massive PPH, or in invasive management, and we suspect that the rise can be at least partly explained by increased awareness and early intervention contributing to improved registration of severe PPH.
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Affiliation(s)
- Silje Pettersen
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Box 4959, Nydalen, Oslo, 0424, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Box 4959, Nydalen, Oslo, 0424, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lill Trine Nyfløt
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Box 4959, Nydalen, Oslo, 0424, Norway
- Department of Obstetrics, Drammen Hospital, Drammen, Norway
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Mauri PA, Pilloni E, Stillavato S, Ragusa A, Masturzo B, Trojano G, Piteri G, Pegurri G, Ricci ED, Teodoro MC, Guardalà F, Messina A, Svelato A, Parazzini F, Iurlaro E, Viora E. Role of mode of induction and delivery and women's satisfaction after induction of labour at term: An observational study. Eur J Obstet Gynecol Reprod Biol 2023; 286:47-51. [PMID: 37201318 DOI: 10.1016/j.ejogrb.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
This cross-sectional study aimed at evaluating the impact of different modalities of induction of labour (IOL) and delivery on levels of woman' satisfaction. All women aged 18 years or older, who underwent IOL for at-term pregnancy (≥41 weeks of gestation) in randomly selected days during the study period in 6 participating centres were eligible for the study. The questionnaire investigated women's opinion regarding information about induction, pain control, length of induction, their experience about induction, labour and delivery and their attitude towards induction in a subsequent pregnancy. Women were also asked to fill in the Italian version of the Birth Satisfaction Scale-Revised (BSS-R). A total of 300 women entered the study. The answer to the question about a "positive attitude towards induction in a subsequent pregnancy was "absolutely yes" or "yes" respectively in the 77.8%, 52.8% and 48.6% of women who were induced with oral drugs, vaginal drugs and Cook balloon (heterogeneity chi-square p = 0.05). The corresponding values for women who delivered vaginally or by caesarean section (CS) were 63.3% and 36.4% (chi-square p = 0.0009). The mean BSS-R total score was higher among women who underwent IOL with oral drugs than with vaginal drugs (p < 0.0001) or Cook Balloon (p < 0.0001), and among women who delivered vaginally than in those who delivered by CS (p < 0.0001). Women were asked "What do you think is important for a method of induction?": 47.3% (95% CI 41.7%-53.0%) of women answered that "should make the induction as painless as possible", 47.0% (95% CI 41.4%-52.7%) "should induce labour quickly", 44.3% (95% CI 38.8%-50.0%) "should be safe for baby". This study showed that vaginal delivery was associated with a higher rate of satisfaction among induced women. Considering mode of induction, oral drugs were associated with a higher level of satisfaction. Control of pain and quick induction were the most appreciated characteristics.
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Affiliation(s)
- Paola Agnese Mauri
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy; SITRA Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy.
| | - Eleonora Pilloni
- Obstetrics and Gynecology Department 3, Sant' Anna Hospital, Corso Spezia 60, 10126 Turin, Italy.
| | - Silvia Stillavato
- Obstetrics and Gynecology Department 3, Sant' Anna Hospital, Corso Spezia 60, 10126 Turin, Italy.
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, Università Campus Bio Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy.
| | - Bianca Masturzo
- Obstetrics and Gynecology Department, General Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Biella- University of Turin, Italy.
| | - Giuseppe Trojano
- Department of Maternal and Child Health "Madonna delle Grazie" Hospital ASM, Contrada Cattedra Ambulante, 75100 Matera, Italy.
| | - Giulia Piteri
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Giorgia Pegurri
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Elena Delfina Ricci
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Maria Cristina Teodoro
- Department Maternal and Child Health, Obstetrics and Gynecology Unit, Hospital AO for Emergency Cannizzaro, via Messina 829, 95126 Catania, Italy.
| | - Fabio Guardalà
- Department Maternal and Child Health, Obstetrics and Gynecology Unit, Hospital AO for Emergency Cannizzaro, via Messina 829, 95126 Catania, Italy.
| | - Alessandro Messina
- Obstetrics and Gynecology Department, General Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Biella- University of Turin, Italy.
| | - Alessandro Svelato
- Obstetric Pathology Unit Ospedale Fatebenefratelli Hospital, Gemelli-Isola Tiberina, via di Ponte Quattro capi 39, 00186 Rome, Italy.
| | - Fabio Parazzini
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Enrico Iurlaro
- Obstetric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, 20122 Milan, Italy.
| | - Elsa Viora
- Associazione Ostetrici e Ginecologi Italiani, via Abamonti 1, 20129 Milan, Italy.
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Döblin S, Seefeld L, Weise V, Kopp M, Knappe S, Asselmann E, Martini J, Garthus-Niegel S. The impact of mode of delivery on parent-infant-bonding and the mediating role of birth experience: a comparison of mothers and fathers within the longitudinal cohort study DREAM. BMC Pregnancy Childbirth 2023; 23:285. [PMID: 37098555 PMCID: PMC10127505 DOI: 10.1186/s12884-023-05611-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 04/14/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The association between mode of delivery (MOD) and parent-infant-bonding has only been studied in mothers and findings have been inconclusive. The aim of this study was to prospectively investigate how MOD relates to postpartum parent-infant-bonding in both mothers and fathers and whether these associations are mediated by birth experience. METHODS This study is part of the prospective cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Our sample comprised N = 1,780 participants who completed quantitative questionnaires during pregnancy as well as 8 weeks and 14 months postpartum. MOD was dummy coded, contrasting spontaneous vaginal delivery against vaginal delivery induced by drugs, operative vaginal delivery, planned, and unplanned cesarean section. Parent-infant bonding and birth experience were assessed using validated scales. A moderated mediation analysis based on ordinary least square (OLS) regression and bootstrapped estimates was conducted, considering relevant confounding variables. RESULTS Compared to spontaneous vaginal delivery, all categories of MOD predicted more negative birth experiences in both parents. A more positive birth experience predicted stronger parent-infant-bonding at 8 weeks, but not at 14 months postpartum. Mothers who delivered via cesarean section (planned or unplanned) reported stronger parent-infant-bonding at 8 weeks and 14 months postpartum. In fathers, only unplanned cesarean section was associated with stronger parent-infant-bonding at 8 weeks postpartum. At 8 weeks postpartum, birth experience mediated the association between a vaginal delivery induced by drugs and a planned cesarean section and mother-infant-bonding and between a vaginal delivery induced by drugs, an operative vaginal delivery, and planned cesarean section and father-infant-bonding. At 14 months postpartum, birth experience mediated the association between a vaginal delivery induced by drugs, operative vaginal delivery, and planned cesarean section and parent-infant-bonding in both parents. CONCLUSIONS The results emphasize the importance of the birth experience for parent-infant-bonding in both mothers and fathers. Further research should address the mechanisms by which parents with an unplanned cesarean section establish stronger parent-infant-bonding compared to parents whose baby was delivered via spontaneous vaginal delivery, despite their overall more negative birth experiences.
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Affiliation(s)
- Svenja Döblin
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lara Seefeld
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine TU Dresden, Dresden, Germany
| | - Victoria Weise
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Marie Kopp
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susanne Knappe
- Evangelische Hochschule Dresden (Ehs), University of Applied Sciences for Social Work, Education and Nursing, Dresden, Germany
| | - Eva Asselmann
- Faculty of Health, HMU Health and Medical University, Potsdam, Germany
| | - Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway.
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine of the Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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Wada S, Matsubara K, Miyakoshi C, Iwata A, Isome K, Hori M, Kawasaki Y, Naito A, Kim K, Iio K, Yamaguchi Y. Effect of delivery mode on postnatal platelet count dynamics in neonates born to mothers with immune thrombocytopenia. Int J Hematol 2023:10.1007/s12185-023-03582-2. [PMID: 36947369 DOI: 10.1007/s12185-023-03582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
We aimed to determine the effect of delivery mode on postnatal platelet count dynamics in neonates born to mothers with immune thrombocytopenia (ITP). This single-center, retrospective study included 41 mothers with ITP and their 65 infants born by vaginal delivery (VD, n = 30) and cesarean section (CS, n = 35) between January 1997 and March 2022. The median difference in platelet counts from day 0 to day 2 (ΔPlt [D 0-2]) was significantly lower in the VD group (- 39 × 109/L, interquartile range [IQR]: - 47 to - 24 × 109/L) than the CS group (15 × 109/L, IQR: - 6.5 to 33 × 109/L) (p < 0.001). The median ΔPlt (D 0-5) was significantly lower in the VD group (- 55 × 109/L, IQR: - 85 to - 31 × 109/L) than the CS group (33 × 109/L, IQR: 1-69 × 109/L) (p < 0.001). Multivariate analysis also showed a significant association of delivery mode with ΔPlt (D 0-2) and ΔPlt (D 0-5) (both p < 0.001). VD neonates with platelet counts ≥ 100 × 109/L at birth were significantly more likely than CS neonates to develop thrombocytopenia < 100 × 109/L at nadir (1/26 vs. 6/25) (p = 0.0496). Our findings indicate that mode of delivery is a useful predictor of postnatal platelet count dynamics in neonates born to mothers with ITP.
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Affiliation(s)
- Shoichiro Wada
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Kousaku Matsubara
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan.
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Aya Iwata
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Kenichi Isome
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Masayuki Hori
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Yu Kawasaki
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Akiyoshi Naito
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Kaya Kim
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Kyohei Iio
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Yoshimichi Yamaguchi
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
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Katzir T, Brezinov Y, Khairish E, Hadad S, Vaisbuch E, Levy R. Intrapartum ultrasound use in clinical practice as a predictor of delivery mode during prolonged second stage of labor. Arch Gynecol Obstet 2023; 307:763-70. [PMID: 35576076 DOI: 10.1007/s00404-022-06469-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 02/15/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To determine the validity of intrapartum ultrasound (IPUS), and particularly the angle of progression (AOP), in predicting delivery mode when measured in real-life clinical practice among women with protracted second stages of labor. METHODS Using electronic medical records, nulliparous women with a second stage of labor of ≥ 3 h ("prolonged") and a documented AOP measurement during the second stage were identified. The ability of a single AOP measurement in "prolonged" second stage to predict a vaginal delivery (VD) was assessed. Fetal head descent, measured by AOP change/h (calculated from serial measurements), was compared between women who delivered vaginally and those who had a cesarean delivery (CD) for arrest of descent. RESULTS Of the 191 women who met the inclusion criteria, 62 (32.5%) delivered spontaneously, 96 (50.2%) had a vacuum extraction (VE) and 33 (17.3%) had a CD. The mean AOP was wider among women who had VD (spontaneous or VE) compared to those who had CD (153° ± 19 vs. 133° ± 17, p < 0.001). Wider AOPs were associated with higher rates of VD and an AOP ≥ 127° was associated with a VD rate of 88.6% (148/167). Among the 87 women who had more than one AOP measurement, the mean AOP change per hour was higher in the VD group than in the CD group (15.1° ± 11.4° vs. 6.2° ± 6.3°, p < 0.001). CONCLUSION Ultrasound-assessed fetal head station in nulliparous women with a protracted second stage of labor can be an accurate and objective additive tool in predicting the mode and interval time to delivery in real-life clinical practice.
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21
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de Waal AC, van Amstel T, Dekker JJML, Ket JCF, Kuijper CF, Salvatore CM, de Jong JR, Gorter RR. Outcome after vaginal delivery of women with a previous medical history of surgically corrected anorectal malformations: a systematic review. BMC Pregnancy Childbirth 2023; 23:94. [PMID: 36739371 PMCID: PMC9898899 DOI: 10.1186/s12884-023-05389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Discussion remains on how to advise women with a past medical history of surgically corrected anorectal malformations (ARMs) regarding vaginal delivery. The aim of this review is to evaluate and review the reported obstetrical complications and outcomes after vaginal delivery for these women. DATA SOURCES A systematic search was performed from inception up to 25 July 2022 in PubMed, Embase.com and Clarivate Analytics/Web of Science Core Collection, with backward citation tracking. STUDY ELIGIBILITY CRITERIA/APPRAISAL All articles reported on the outcomes of interest in women with a past medical history of surgically corrected anorectal malformation and had a vaginal delivery were included with the exception of editorial comments or invitational commentaries. Screening, data extraction and risk of bias assessment was done by two authors independently with a third and fourth reviewer in case of disagreement. Tool for Quality assessment depended on the type of article. As low quality evidence was expected no meta-analysis was performed. RESULTS Only five of the 2377 articles screened were eligible for inclusion with a total of 13 attempted vaginal deliveries in eight women. In three patients complications were reported: failed vaginal delivery requiring urgent cesarean section in two patients, and vaginal tearing in one patient. CONCLUSION High quality evidence regarding outcomes and complications after vaginal delivery in women with a history of surgically corrected anorectal malformation is lacking. Therefore, based upon this systematic review no formal recommendation can be formulated regarding its safety. Future studies are essential to address this problem. TRIAL REGISTRATION CRD42020201390. Date: 28-07-2020s.
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Affiliation(s)
- Ayla C. de Waal
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
| | - Tim van Amstel
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
| | - Judith J. M. L. Dekker
- grid.7177.60000000084992262Department of Obstetrics and Gynecology Division of Reproductive Medicine, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes C. F. Ket
- grid.12380.380000 0004 1754 9227Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Caroline F. Kuijper
- grid.7177.60000000084992262Department of Paediatric Urology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Concetta M. Salvatore
- grid.7177.60000000084992262Department of Obstetrics and Gynecology Division of Reproductive Medicine, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Justin R. de Jong
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
| | - Ramon R. Gorter
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
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22
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Narice BF, Marks K, Jha S. Factors that influence pregnant women's decision on mode of delivery after previous obstetric anal sphincter injury. Eur J Obstet Gynecol Reprod Biol 2023; 281:32-35. [PMID: 36529064 DOI: 10.1016/j.ejogrb.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/09/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Maternal request for caesarean section (CS) is increasing. One common reason is following a previous obstetric anal sphincter injury (OASI). We aim to understand which factors bear the greatest influence in driving this women's decision-making process once they are pregnant after having sustained an OASI. METHODS Pregnant women with a previous OASIS who were attending their first antenatal appointment were deemed eligible and were asked to complete two questionnaires on their preferred mode of delivery (MoD) and ongoing pelvic floor symptomatology. Data were analysed with descriptive and inferential statistics using SPSS, and results were presented both quanti- and qualitatively. RESULTS Data from 63 participants was included in the final analysis. Most women had experienced 3A/3B OASIS (n = 49, 77.78 %), and they were more likely to report bladder pain and difficulties with voiding than those with major tears (p < 0.05). The type of tear did not impact directly on the preferred MoD. However, women still experiencing bladder pain were more likely to request a CS (p < 0.05). Even though all participants who attended a perineal trauma clinic postpartum found it helpful, they reported that ultimately the decision on how to deliver was theirs, and their ideas and concerns played the greatest influence. CONCLUSION Pregnant women with ongoing urinary symptoms rather than sexual or bowel dysfunction seem to favour a planned CS, regardless of the severity of their previous tear. Postpartum follow-up in a perineal trauma clinic is extremely valuable but even more is the need to understand women's motivations to support them make an informed decision.
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Affiliation(s)
- Brenda F Narice
- Academic Unit of Reproductive and Developmental Medicine, the University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK; Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
| | - Kylie Marks
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
| | - Swati Jha
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK; Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK.
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23
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Stuebs FA, Mergel F, Koch MC, Dietl AK, Schulmeyer CE, Adler W, Geppert C, Hartman A, Knöll A, Beckmann MW, Gass P, Mehlhorn G. Cervical intraepithelial neoplasia grade 3: development during pregnancy and postpartum. Arch Gynecol Obstet 2022; 307:1567-1572. [PMID: 36271921 PMCID: PMC10110634 DOI: 10.1007/s00404-022-06815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aims of the present study were to evaluate the development of untreated cervical intraepithelial neoplasia (CIN) 3 during pregnancy and to assess persistence, progression, and regression rates postpartum to identify factors associated with regression. METHODS In a tertiary gynecology and obstetrics department, a total of 154 pregnant women with CIN 3 were treated in the dysplasia unit. The follow-up findings were analyzed retrospectively on the basis of histological, cytological, and human papillomavirus (HPV) testing of 154 pregnant women confirmed as having CIN 3 in colposcopically guided biopsies. RESULTS The rates of persistence, regression, and progression of CIN 3 in these women were 76.1%, 20% and 3.2%, respectively. Data for the delivery mode was available for 126 women. The rate of regression was almost twice as high with vaginal delivery as with cesarean section, at 27.4 vs. 15.2%, whereas the rate of progression was lower with vaginal delivery, at 2.7 vs. 6.5%. CONCLUSION The rate of persistence of CIN observed in this study is comparable to that reported in other studies. The study provides strong evidence for greater regression among women who have vaginal deliveries. Careful work-up is recommended postpartum for this group of women in order to rule out persistent CIN 3 or invasive disease.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Franziska Mergel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
- Department of Gynecology and Obstetrics, Ulm University Hospital, Comprehensive Cancer Center Ulm (CCCU), Ulm, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carol Geppert
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartman
- Institute of Pathology, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Grit Mehlhorn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
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Dachew BA, Tessema GA, Alati R. Association between obstetric mode of delivery and emotional and behavioural problems in children and adolescents: the children of the 90s health study. Soc Psychiatry Psychiatr Epidemiol 2022:10.1007/s00127-022-02374-z. [PMID: 36239743 DOI: 10.1007/s00127-022-02374-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Existing evidence on the relationship between mode of delivery and offspring emotional and behavioural problems, especially in older age groups, is limited and inconsistent. This study aimed to examine the association between obstetric mode of delivery and emotional and behavioural problems in offspring aged 3-16 years. METHODS The sample for this study comprised participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom. The study cohort ranged from 7074 (at 3 years of age) to 4071 (at 16 years of age) mother-offspring pairs. Data on obstetric mode of delivery were abstracted from obstetric records by trained research midwives and classified as spontaneous vaginal delivery, assisted vaginal delivery and caesarean delivery (elective and emergency). Offspring emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ) when the child was 3, 7, 9, 11, and 16 years. Logistic regression analyses were used to examine associations. RESULTS Assisted vaginal delivery was associated with an increased risk of emotional problems at age 11 years (OR = 1.42; 95% CI 1.11-1.81). No significant associations were observed at ages 3, 7, 9 and 16. We found no evidence of associations between caesarean delivery (elective or emergency) and emotional and behavioural measures in offspring across all age groups. CONCLUSION Mode of delivery does not appear to be associated with emotional and behavioural problems in children and adolescents. Further research is needed to understand the potential longer-term effects of assisted vaginal deliveries on offspring emotional development.
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Affiliation(s)
| | - Gizachew A Tessema
- School of Population Health, Curtin University, Perth, Australia.,School of Public Health, University of Adelaide, Adelaide, Australia
| | - Rosa Alati
- School of Population Health, Curtin University, Perth, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, Australia
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Pappa C, Gkrozou F, Dimitriou E, Tsonis O, Kitsouli A, Varvarousis D, Xydis V, Paschopoulos M, Kitsoulis P. Can maternal hormones play a significant role in delivery mode? J OBSTET GYNAECOL 2022; 42:2779-2786. [PMID: 35962554 DOI: 10.1080/01443615.2022.2109139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was primarily to evaluate the levels of progesterone, oestradiol and relaxin during different delivery modes and secondarily to assess specific traits and changes in maternal pelvic dimensions during pregnancy and childbirth, in correlation with foetal size and maternal hormonal profile. Nulliparous women (n = 448) were evaluated at three different stages, during first trimester, at the time of admission for childbirth and finally just before childbirth. Each examination included clinical internal pelvimetry, blood sample collection for defining the hormones levels in peripheral maternal circulation and ultrasonographic measurements of specific variables of the pubic symphysis and the foetus. We included 304 nulliparous women divided in three groups. According to our results, there was statistically significant difference at the mean progesterone, oestradiol and relaxin range during different modes of childbirth (p-value < .01). We also found significant correlation between the newborn's weight and the changes in pubic symphysis dimensions. However, no significant association was noted between maternal hormones studied and the changes in pelvic dimensions.IMPACT STATEMENTWhat is already known on this subject? Mode of childbirth can be affected by various aspects, like maternal pelvic anatomy, foetal size and hormonal status at the time of labour. Hormonal fluctuations along with mechanical forces caused by the foetus are believed to lead to morphological alterations to promote natural vaginal childbirth.What do the results of this study add? Our results clearly showed that successful vaginal delivery is characterised by the prevalence of a hyperoestrogenic environment with higher values of intrapartum oestradiol range and significant increase in maternal serum relaxin levels. We also proved that progesterone levels do not decrease during vaginal childbirth, and we concluded that foetal size seems to be the most crucial factor causing alterations in maternal pelvis during parturition.What are the implications of these findings for clinical practice and further research? Our findings could form part of a set of key factors included in future algorithms or computerised biomechanical models for predicting potential childbirth mode. Larger multicenter studies should confirm our results and evaluate their clinical significance in the decision making to ensure safe childbirth and optimal maternal and perinatal outcomes.
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Affiliation(s)
- Christina Pappa
- Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Fani Gkrozou
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Orestis Tsonis
- St. Bartholomew's Hospital, Barts Health NHS, City of London, UK
| | - Aikaterini Kitsouli
- Anatomy-Histology-Embryology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Vasileios Xydis
- Department of Radiology, University Hospital of Ioannina, Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | - Panagiotis Kitsoulis
- Anatomy-Histology-Embryology, University Hospital of Ioannina, Ioannina, Greece.,Orthopedic Surgeon, Medical School, University of Ioannina, Ioannina, Greece
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Gao L, Chen CR, Wang F, Ji Q, Chen KN, Yang Y, Liu HW. Relationship between age of pregnant women with gestational diabetes mellitus and mode of delivery and neonatal Apgar score. World J Diabetes 2022; 13:776-785. [PMID: 36188149 PMCID: PMC9521439 DOI: 10.4239/wjd.v13.i9.776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/01/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) refers to abnormal glucose tolerance during pregnancy, and it is often accompanied by obvious changes in glucose and lipid metabolism, and associated with adverse pregnancy outcomes. The incidence of fetal distress, polyhydramnios, puerperal infection, premature delivery, and macrosomia in pregnant women with GDM are higher than in those without GDM.
AIM To analyze the relationship between age of pregnant women with GDM and mode of delivery and neonatal Apgar score.
METHODS A total of 583 pregnant women with GDM who delivered in the Department of Obstetrics at our hospital between March 2019 and March 2022 were selected. Among them, 377 aged < 35 years were selected as the right age group and 206 aged > 35 years were selected as the older group. The clinical data of the two groups were collected, and the relationship between age of the pregnant women with GDM and mode of delivery, maternal and neonatal outcomes, and neonatal Apgar score were compared. In the older group, 159 women were classed as the adverse outcome group and 47 as the good outcome group according to whether they had adverse maternal and infant outcomes. The related factors of adverse maternal and infant outcomes were analyzed through logistic regression.
RESULTS The number of women with assisted pregnancy, ≤ 37 wk gestation, ≥ 2 pregnancies, one or more deliveries, and no pre-pregnancy blood glucose screening in the older group were all higher than those in the right age group (P < 0.05). The natural delivery rate in the right age group was 40.85%, which was higher than 22.33% in the older group (P < 0.05). The cesarean section rate in the older group was 77.67%, which was higher than 59.15% in the right age group (P < 0.05). The older group had a higher incidence of polyhydramnios and postpartum hemorrhage, and lower incidence of fetal distress than the right age group had (P < 0.05). There was no significant difference in neonatal weight between the two groups (P > 0.05). The right age group had higher Apgar scores at 1 and 5 min than the older group had (P < 0.05). Significant differences existed between the poor and good outcome groups in age, education level, pregnancy mode, ≤ 37 wk gestation, number of pregnancies, and premature rupture of membranes (P < 0.05). Logistic regression showed that age, education level and premature rupture of membranes were all risk factors affecting the adverse outcomes of mothers and infants (P < 0.05).
CONCLUSION Delivery mode and Apgar score of pregnant women with GDM are related to age. Older age increases the adverse outcome of mothers and infants.
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Affiliation(s)
- Lan Gao
- Department of Endocrinology, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Cun-Ren Chen
- Department of Endocrinology, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Fei Wang
- Department of Endocrinology, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Qun Ji
- Department of Endocrinology, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Kai-Ning Chen
- Department of Endocrinology, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Yang Yang
- Department of Obstetrics and Gynecology, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Hai-Wei Liu
- Department of Endocrinology, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
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Okten SB, Gunduz A, Sencelikel T, Desteli G, Usta Gunduz EB, Bildaci TB. The role of personality traits on mode of delivery. J Psychosom Obstet Gynaecol 2022; 43:292-297. [PMID: 33541178 DOI: 10.1080/0167482x.2021.1879045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The aim of this study is to understand the motives behind CS requests in nulliparous women in their late pregnancy better and to investigate if specific personality traits affect the maternal decision on mode of delivery. MATERIAL AND METHOD This prospective study was conducted with 70 healthy, nulliparous parturient with singleton pregnancies. Women at their 28-32. weeks of gestation were asked to fill a socio-demographic data form and the questionnaires; Personality Belief Questionnaire - Short Form (PBQ-SF) and The Childbirth Attitudes Questionnaire (CAQ). After delivery, all the results of pre-filled questionnaires and women's mode of delivery were analyzed and compared. RESULTS There were significant differences in personality types; dependent (p = 0.033), passive-aggressive (p = 0.031), obsessive-compulsive (p = 0.001), antisocial (p = 0.014), narcissistic (p = 0.014) and borderline (p = 0.014) between vaginal delivery and CS groups. The CAQ scores of the mothers who requested CS were significantly higher (p:0.007). Weak but significant positive relation was found between total CAQ scores and avoidant (p = 0.022), dependent (p = 0.034), passive-aggressive (p = 0.040), narcissistic (p = 0,006), schizoid (p = 0.007), paranoid (p = 0.007) and borderline (p = 0.007) personality types. CONCLUSION This is the first study that investigates the relationship between mode of delivery and personality traits according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and cognitive behavioral perspective in the literature. These personality traits can be carried at a level that is not clinically significant to create an obvious pathology, yet they might play a role as the motives behind the apparent reasons for women who request CS. Understanding women's motives and attitudes for childbirth during their pregnancy may help healthcare providers to tailor women's approach to childbirth to avoid unnecessary CS.
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Affiliation(s)
- Sabri Berkem Okten
- Department of Obstetrics and Gynecology, Baskent University Istanbul Health Practice and Research Center, Istanbul, Turkey
| | - Anil Gunduz
- Department of Psychology, Istanbul Kent University, Istanbul, Turkey
| | - Tugce Sencelikel
- Department of Biostatistics, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Guldeniz Desteli
- Department of Obstetrics and Gynecology, Baskent University Istanbul Health Practice and Research Center, Istanbul, Turkey
| | - Elvan Basak Usta Gunduz
- Department of Child Psychiatry, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Tevfik Berk Bildaci
- Department of Obstetrics and Gynecology, Baskent University Istanbul Health Practice and Research Center, Istanbul, Turkey
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Potnuru PP, Ganduglia C, Schaefer CM, Suresh M, Eltzschig HK, Jiang Y. Impact of cesarean versus vaginal delivery on the risk of postpartum acute kidney injury: A retrospective database controlled study in 116,876 parturients. J Clin Anesth 2022; 82:110915. [PMID: 35969987 DOI: 10.1016/j.jclinane.2022.110915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 10/31/2022]
Abstract
STUDY OBJECTIVE The rate of cesarean delivery is increasing globally but the risk of perioperative organ injury associated with cesarean delivery is not well defined. The objective of this study was to determine the risk of postpartum acute kidney injury, a peripartum complication defined by an acute decrease in kidney function, associated with cesarean delivery compared to vaginal delivery. SETTING Population-based discharge database. PATIENTS The Optum Clinformatics® Data Mart was queried for parturients that underwent cesarean or vaginal delivery between January 2016 to January 2018. Using a propensity score model based on 27 antepartum characteristics, we generated a final matched cohort of 116,876 parturients. INTERVENTION/EXPOSURE Cesarean delivery as the mode of delivery. MEASUREMENTS The risk of acute kidney injury associated with each delivery mode and the effect of acute kidney injury on the length of hospital stay for parturients. MAIN RESULTS The matched cohort consisted of 116,876 deliveries, with 58,438 cases in each group. In the cesarean delivery group, the incidence of postpartum acute kidney injury was 24.5 vs. 7.9 per 10,000 deliveries in the vaginal delivery group (adjusted odds ratio = 3; 95% CI, 2.13-4.22; P < .001). The median of the length of hospital stay [interquartile range] was longer by 50% in parturients who developed postpartum acute kidney injury after vaginal delivery (3 [2-4] days vs. those who did not, 2 [2, 3] days; P < .001) and by 67% after cesarean delivery (5 [4-7] days vs. 3 [3, 4] days; P < .001). CONCLUSIONS Cesarean delivery is associated with a significantly increased risk of postpartum acute kidney injury as compared to vaginal delivery. The development of postpartum acute kidney injury is associated with prolonged length of hospital stay.
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Affiliation(s)
- Paul P Potnuru
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Cecilia Ganduglia
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Caroline M Schaefer
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Maya Suresh
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Holger K Eltzschig
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Yandong Jiang
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA.
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Bracic T, Reich O, Taumberger N, Tamussino K, Trutnovsky G. Does mode of delivery impact the course of cervical dysplasia in pregnancy? A review of 219 cases. Eur J Obstet Gynecol Reprod Biol 2022; 274:13-18. [PMID: 35561565 DOI: 10.1016/j.ejogrb.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The prevalence of cervical intraepithelial neoplasia (CIN) in pregnancy is about 1%. The aim of this study was to analyze the regression, persistence and progression rates of cervical dysplasia in pregnancy and the impact of delivery mode. STUDY DESIGN In this retrospective study, data from pregnant patients with abnormal cytology findings, who presented to a colposcopic outpatient clinic of a university hospital within the last 10 years, were analyzed. Information on cytology, histology and Human Papillomavirus (HPV) status during pregnancy and postpartum and mode of delivery was collected. RESULTS 219 women, who were assessed with cytology and /or biopsy antepartum and postpartum between January 2010 and July 2020, were included in the study. Antepartum patients presented with low grade squamous intraepithelial lesions (LSIL) in 37% and high grade squamous intraepithelial lesions (HSIL) in 53%. During pregnancy biopsy was performed in 78 patients (36%). Postpartum evaluation revealed an overall regression rate of 39%. Persistence rates were especially high in the HSIL group with 70 %. HSIL regressed in 28 %. Progression to invasive disease was rare and seen in two patients postpartum only. 141 women delivered vaginally (VD) and 51 received a cesarean section (CS). Regression rates were similar: 36 % and 47 %. There was no significant difference in progression or persistence rates. CONCLUSION Our study demonstrates that mode of delivery does not influence the course of SIL. SIL show high rates of regression and persistence, progression to invasive disease is rare.
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Affiliation(s)
- Taja Bracic
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria.
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Nadja Taumberger
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Gerda Trutnovsky
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
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Sutopa TS, Bari W. How does mode of delivery associate with double burden of malnutrition among mother-child dyads?: a trend analysis using Bangladesh demographic health surveys. BMC Public Health 2022; 22:1243. [PMID: 35733171 PMCID: PMC9219174 DOI: 10.1186/s12889-022-13660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The simultaneity of undernourishment among child and overweight/obesity among mothers in lower-and-middle-income-countries (LMICs) introduces a new nutrition dilemma, known as double burden of malnutrition (DBM). Amidst of such paradox, the hike of caesarean section (CS) delivery is also triggering child undernutrition and maternal obesity. A gap of knowledge regarding the effect of mode of delivery on DBM still persists. The study aims to explore the association between DBM at household level and mode of delivery over time in LMICs. METHOD The study used data from recent four consecutive waves of Bangladesh Demographic and Health Survey (BDHS) ranging from BDHS 2007 to BDHS 2017. It considered the mother-child pairs from data where mothers were non-pregnant women aged 15-49 years having children born in last 3 years preceding the survey. Bivariate analysis and Logistic Regression were performed to explore the unadjusted and adjusted effect of covariates on DBM. An interaction term of mode of delivery and survey year was considered in regression model. RESULTS The study evinces a sharp increase of DBM rate in Bangladesh from 2007 to 2017 (2.4% vs. 6.4%). The prevalence of DBM in household level among the children delivered by CS is more than two times of those born by normal delivery (8.2% vs. 3.5%). The multivariate analysis also indicates that the children born by CS delivery are more likely to be affected by DBM at household level significantly than those born by normal delivery in each waves. Moreover, the odds ratio (OR) of DBM at household is increased by 43% for one unit change in time for normal delivery whereas CS delivery births have 12% higher odds of DBM at household level with one unit change in time. CONCLUSION The study discloses a drastic increase of rate of DBM among mother-child pairs over the time. It stipulates inflated risk of DBM at household with time for both mode of delivery but the children with CS delivery are at more risk to the vulnerability of DBM at household level. The study recommends a provision of special care to the mothers with CS delivery to reduce DBM at household.
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Affiliation(s)
| | - Wasimul Bari
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
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Xiong Z, Zhou L, Chen Y, Wang J, Zhao L, Li M, Chen I, Krewski D, Wen SW, Xie RH. Prevalence of eczema between cesarean-born and vaginal-born infants within 1 year of age: a systematic review and meta-analysis. Eur J Pediatr 2022; 181:2237-2247. [PMID: 35303168 DOI: 10.1007/s00431-022-04436-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 02/21/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
Abstract
UNLABELLED This study aims to quantify the difference in prevalence of eczema between cesarean-born and vaginal-born infants within 1 year of age through a systematic review and meta-analysis. Six electronic databases were searched from inception to August 31, 2021. Studies were included if they reported the prevalence of eczema in infants within 1 year of age with specified mode of delivery. The quality of included studies was assessed using the Joanna Briggs Instrument Critical Appraisal Checklist. Pooled prevalence and odds ratio (OR) were estimated by meta-analyses of included studies. Meta-regression was conducted to explore factors affecting heterogeneity of the prevalence of eczema. Nine studies were included with 3,758 cesarean-born infants and 9,631 vaginal-born infants. The prevalence of eczema in cesarean-born infants [27.8%; 95% confidence interval (CI): 17.7-39.2] was higher than in vaginal-born infants (20.1%; 95% CI: 13.9-28.1), with a pooled OR of 1.31 (95% CI: 1.04-1.65). Subgroup analyses showed that the prevalence of eczema in cesarean-born infants varied according to country, study design, and method of ascertainment. Additionally, the pooled prevalence of eczema in vaginal-born infants differed by age at which eczema was identified. Meta-regression analysis showed that study design and eczema ascertainment method were significant sources of heterogeneity. CONCLUSION About 28% of cesarean-born infants within 1 year of age developed eczema, significantly higher than the 20% rate or occurrence seen in vaginal-born infants. PROTOCOL REGISTRATION CRD 42,020,152,437. WHAT IS KNOWN • Eczema, a complex inflammatory cutaneous disorder characterized by immune mediated inflammation and epidermal barrier dysfunction, is one of the most common allergic disorders in infants. • Eczema may increase the risk of immune-mediated inflammatory disease such as food allergy, asthma, and allergic rhinitis, leading to psychological and social burdens on affected individuals and their families. • Mode of delivery may be associated with the risk of developing eczema, although further studies are needed to clarify such differences. WHAT IS NEW • This is the first systematic review designed to estimate the prevalence of eczema in cesarean- and vaginal-born infants within 1 year of age. • Cesarean delivery may increase the risk of developing eczema in infants within the first year of life.
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Affiliation(s)
- Ziyu Xiong
- Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, 28 Liguan Rd, Lishui, Foshan, Guangdong, 528244, China
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Lepeng Zhou
- Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, 28 Liguan Rd, Lishui, Foshan, Guangdong, 528244, China
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Yanfang Chen
- Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, 28 Liguan Rd, Lishui, Foshan, Guangdong, 528244, China
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Jie Wang
- Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, 28 Liguan Rd, Lishui, Foshan, Guangdong, 528244, China
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Liuhong Zhao
- Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, 28 Liguan Rd, Lishui, Foshan, Guangdong, 528244, China
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Meng Li
- Department of Obstetrics, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Innie Chen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Krewski
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Risk Science International, Ottawa, ON, Canada
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ri-Hua Xie
- Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, 28 Liguan Rd, Lishui, Foshan, Guangdong, 528244, China.
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong, China.
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Yang J, Armson BA, Attenborough R, Carson GD, da Silva O, Heaman M, Janssen P, Murphy PA, Pasquier JC, Sauve R, von Dadelszen P, Walker M, Lee SK; Canadian Mode of Delivery Study Group. Survey of mode of delivery and maternal and perinatal outcomes in Canada. J Obstet Gynaecol Can 2022:S1701-2163(22)00361-9. [PMID: 35595024 DOI: 10.1016/j.jogc.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify determinants of cesarean delivery (CD) and examine associations between mode of delivery (MOD) and maternal and perinatal outcomes. METHODS We conducted a retrospective analysis of a Canadian multicentre birth cohort derived from provincial data collected in 2008/2009. Maternal and perinatal characteristics and outcomes were compared between vaginal and cesarean birth and between the following MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery (CD), and intrapartum CD. Multivariate regression identified determinants of CD and the effects of MOD and previous CD on maternal and perinatal outcomes. RESULTS The cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions. Determinants of CD included maternal age, parity, previous CD, chronic hypertension, diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal bleeding, labour induction, preterm gestational age, low birth weight, large for gestational age, malpresentation, and male sex. CD was associated with greater risk of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal mortality but increased maternal and neonatal morbidity. Previous CD increased the risk of maternal and neonatal morbidity among multiparous women. CONCLUSIONS The CD rate in Canada is consistent with global trends reflecting demographic and obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants evaluation of interventions to safely prevent nonessential cesarean birth.
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Wandel L, Abele H, Pauluschke-Fröhlich J, Kagan KO, Brucker S, Rall K. Mode of birth in monochorionic versus dichorionic twin pregnancies: a retrospective study from a large tertiary centre in Germany. BMC Pregnancy Childbirth 2022; 22:214. [PMID: 35300616 PMCID: PMC8932227 DOI: 10.1186/s12884-022-04531-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Optimal mode of birth for twins, in particular monochorionic twins, has been the subject of much debate. This retrospective study compared maternal and newborn outcomes after vaginal birth in monochorionic and dichorionic twins, utilizing a large institutional database. Methods Retrospective analysis focusing on 98 monochorionic-diamniotic (MC-DA) and 540 dichorionic-diamniotic (DC-DA) twin births extracted from the perinatal database of a large German hospital. Pregnancies ≥36 weeks of gestation with two viable foetuses born between 2004 and 2014 divided into planned vaginal and planned caesarean delivery were included. Descriptive analysis was performed for maternal characteristics. Odds ratios (OR) with 95% confidences intervals (CI) tested the predictive effect of vaginal birth on neonatal and maternal outcomes. Results 51.0% MC-DA and 46.7% DC-DA twin pregnancies were planned vaginal births and 44.0% MC-DA mothers and 43.7% DC-DA mothers actually gave birth vaginally. The overall rate of caesarean section (CS) during the years under observation was 79.6% for MC-DA and 77.0% for DC-DA pregnancies. There were no significant differences in neonatal outcome between the subsamples, although acidosis was observed more often in the second DC-DA twin and Apgar scores < 7 were observed more often in MC-DA twins. Conclusion Vaginal birth may be recommended as an option to women with monochorionic twins as no significant differences in outcomes were found between MC-DA and DC-DA twins. However, over half of planned vaginal twin births resulted in CS.
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Affiliation(s)
- Lena Wandel
- Department for Women's Health, Women's University Hospital, Calwerstraße 7, 72076, Tübingen, Germany.
| | - Harald Abele
- Department for Women's Health, Women's University Hospital, Calwerstraße 7, 72076, Tübingen, Germany
| | - Jan Pauluschke-Fröhlich
- Department for Women's Health, Women's University Hospital, Calwerstraße 7, 72076, Tübingen, Germany
| | - Karl Oliver Kagan
- Department for Women's Health, Women's University Hospital, Calwerstraße 7, 72076, Tübingen, Germany
| | - Sara Brucker
- Department for Women's Health, Women's University Hospital, Calwerstraße 7, 72076, Tübingen, Germany
| | - Katharina Rall
- Department for Women's Health, Women's University Hospital, Calwerstraße 7, 72076, Tübingen, Germany
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Steetskamp J, Treiber L, Roedel A, Thimmel V, Hasenburg A, Skala C. Post-traumatic stress disorder following childbirth: prevalence and associated factors-a prospective cohort study. Arch Gynecol Obstet 2022. [PMID: 35230501 DOI: 10.1007/s00404-022-06460-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
Objective Traumatic experiences during or after childbirth are subject of intense discussions in mainstream and social media as well as in scientific literature. Aim of this evaluation is to estimate the prevalence of post-traumatic stress disorder (PTSD) following childbirth in postpartum women and to evaluate the influence of maternal, obstetrical and neonatal characteristics on the degree of PTSD symptoms measured by the Impact of Events Scale questionnaire (IES-R). Methods In total, 589 women who gave birth in the University Medical Center Mainz, Germany in 2016, participated in a survey within the first days after birth. Of these, 278 also participated 6 months later. All participants received the validated Impact of Events Scale questionnaire (IES-R). The influence of maternal, obstetric and fetal parameters on PTSD score was evaluated. Results PTSD overall prevalence was 2.9%. Patients with PTSD had significantly less often personal support during labor (p < 0.001). Maternal age (p < 0.001), parity (p < 0.001), migration background (p < 0.001), mode of delivery (p < 0.001) and assistance during labor (p < 0.001) were parameters significantly influential on the PTSD symptom level measured by the IES-R. Conclusions Maternal PTSD prevalence after childbirth seems to be quite rare with 2.9%. Nevertheless, recent findings assume that this prevalence may only represent the “tip of the iceberg”. PTSD after childbirth should not be underestimated. As PTSD depends on personal vulnerability and existing risk factors, patients at risk have to be detected before childbirth, which appears to be challenging especially for obstetric and family care professionals.
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Evans K, Fraser H, Uthman O, Osokogu O, Johnson S, Al-Khudairy L. The effect of mode of delivery on health-related quality-of-life in mothers: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2022; 22:149. [PMID: 35193505 PMCID: PMC8864819 DOI: 10.1186/s12884-022-04473-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Previous research is inconclusive on the effects of mode of delivery on maternal health-related quality-of-life (HRQoL). We conducted a systematic review and meta-analysis to assess the current evidence for associations between mode of delivery and postpartum health-related quality-of-life. Methods Electronic databases MEDLINE ALL (OVID), Web of Science, The Cochrane Library, CINAHL and EMBASE (OVID) were searched for English written articles investigating the relationship between mode of delivery and quality-of-life published form inception to 15th October 2020. Two reviewers independently screened titles and abstracts, assessed full texts, and extracted data. Meta-analysis was conducted where possible. Results Twenty-one studies, including 19,879 women, met the inclusion criteria. A meta-analysis of 18 studies found HRQoL scores were significantly higher for women after vaginal delivery in comparison to caesarean (emergency and elective combined) (Effect Size (ES) 0.17, 95% CI 0.01–0.25, n = 7665) with highest scores after assisted vaginal delivery (ES 0.21, 95% CI 0.13–0.30, n = 2547). Physical functioning (ES 11.18, 95% CI = 2.29–20.06, n = 1746), physical role (ES 13.10, 95% CI = 1.16–25.05, n = 1471), vitality (ES 6.31, 95% CI = 1.14–10.29, n = 1746) and social functioning (ES 5.69, 95% CI = 1.26–10.11, n = 1746) were significantly higher after vaginal delivery compared to caesarean. Conclusions Health-related quality-of-life scores were higher for women after vaginal delivery in comparison to caesarean section. Consequently, women should be encouraged to deliver vaginally where possible. The findings of this research should be available to the relevant population to help support informed choice. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04473-w.
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Affiliation(s)
- Kate Evans
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England.
| | - Hannah Fraser
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Olalekan Uthman
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Osemeke Osokogu
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Samantha Johnson
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Lena Al-Khudairy
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
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Chimenea A, García-Díaz L, Antiñolo G. Mode of delivery, perinatal outcome and neurodevelopment in uncomplicated monochorionic diamniotic twins: a single-center retrospective cohort study. BMC Pregnancy Childbirth 2022; 22:89. [PMID: 35105319 PMCID: PMC8805339 DOI: 10.1186/s12884-022-04425-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is no agreement on the effect of planned mode of delivery in the perinatal morbidity and neurodevelopment in uncomplicated monochorionic diamniotic as well as regarding the safest mode of delivery. In this paper we have aimed to analyze the impact of the mode of delivery in uncomplicated monochorionic diamniotic twins ≥ 32 weeks of gestation. MATERIAL AND METHODS This study included 72 women, followed and attended at our department, with uncomplicated monochorionic diamniotic pregnancies who had a birth between 32.0 and 37.6 weeks of gestation from January 2012 to December 2018. Outcomes were recorded in women who underwent planned vaginal delivery (induced or spontaneous onset of labor), and women who underwent a planned cesarean section for any reason that excluded vaginal delivery. Primary outcomes included: (1) A composite of any of the following: neonatal death, 5-min Apgar score < 4, respiratory distress syndrome, bronchopulmonary dysplasia, sepsis, periventricular leukomalacia, intraventricular hemorrhage, and necrotizing enterocolitis. (2) Neurodevelopmental status at 2 years of corrected age. RESULTS In this period, 42 women (58.3%) had a planned vaginal delivery, and 30 women (41.7%) had a planned cesarean section. In the first group, 64.3% had a vaginal delivery. The rate of successful vaginal delivery was similar regardless the onset of labor. We did not find a higher composite perinatal morbidity in the planned vaginal delivery group (planned vaginal delivery: 3.6% vs. planned cesarean section: 8.3%, aOR 1.36, 95% CI 0.24-7.81). Considering the onset of labor, it was more frequent in the spontaneous subgroup (8.3% vs. 0%). The rate of neurodevelopmental impairment was higher in the planned cesarean section group, without reaching statistical significance [10.2% vs. 4.9%, aOR 1.53 (95% CI 0.37-6.29)]. CONCLUSIONS In uncomplicated monochorionic diamniotic twins at ≥ 32 weeks of gestation, when the first twin is in vertex presentation, our results suggest that planned vaginal delivery is safe, with a successful outcome as well as high vaginal delivery rate.
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Affiliation(s)
- Angel Chimenea
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
- Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain
| | - Lutgardo García-Díaz
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
- Department of Surgery, University of Seville, Seville, Spain
| | - Guillermo Antiñolo
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain.
- Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain.
- Department of Surgery, University of Seville, Seville, Spain.
- Centre for Biomedical Network Research On Rare Diseases (CIBERER), Seville, Spain.
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Ehrhardt H, Desplanches T, van Heijst AFJ, Toome L, Fenton A, Torchin H, Nuytten A, Mazela J, Zeitlin J, Maier RF. Mode of Delivery and Incidence of Bronchopulmonary Dysplasia: Results from the Population-Based EPICE Cohort. Neonatology 2022; 119:464-473. [PMID: 35526524 DOI: 10.1159/000524337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/24/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Bronchopulmonary dysplasia (BPD) represents a tremendous disease burden following preterm birth. The strong association between compromised gas exchange after birth and BPD demands particular focus on the perinatal period. The mode of delivery can impact on lung fluid clearance and microbial colonization, but its impact on BPD and potential trade-off effects between death and BPD are not established. METHODS A total of 7,435 live births (24+0 to 31+6 weeks postmenstrual age) in 19 regions of 11 European countries were included. Principal outcomes were death and BPD at 36 weeks. We estimated unadjusted and adjusted associations with mode of delivery using multilevel logistic regression to account for clustering within units and regions. Sensitivity analyses examined effects, taking into consideration regional variations in C-section rates. RESULTS Compared to vaginal delivery, delivery by C-section was not associated with the incidence of BPD (OR 0.92, 95% CI: 0.68-1.25) or the composite outcome of death or BPD (OR 0.94, 95% CI: 0.74-1.19) after adjustment for perinatal and neonatal risk factors in the total cohort and in pregnancies for whom a vaginal delivery could be considered. Sensitivity analyses among singletons, infants in cephalic presentation, and infants of ≥26+0 weeks of gestation did not alter the results for BPD, severe BPD, and death or BPD, even in regions with a high C-section rate. CONCLUSIONS In our population-based cohort study, the mode of delivery was not associated with the incidence of BPD. The intention to reduce BPD does not justify a C-section in pregnancies where a vaginal delivery can be considered.
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Affiliation(s)
- Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Thomas Desplanches
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), INSERM, Université de Paris, Paris, France.,Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon University Hospital, Dijon, France
| | - Arno F J van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Estonia University, Tallinn, Estonia.,Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Alan Fenton
- Newcastle Neonatal Service, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Héloïse Torchin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), INSERM, Université de Paris, Paris, France.,Department of Neonatal Pediatrics, Cochin Port Royal Hospital, APHP, Paris, France
| | - Alexandra Nuytten
- Department of Neonatology, Jeanne de Flandre Hospital, CHU Lille, University of Lille, Lille, France.,ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, CHU Lille, University of Lille, Lille, France
| | - Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), INSERM, Université de Paris, Paris, France
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
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Maher GM, Khashan AS, McCarthy FP. Obstetrical mode of delivery and behavioural outcomes in childhood and adolescence: findings from the Millennium Cohort Study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1697-1709. [PMID: 35032173 PMCID: PMC9288955 DOI: 10.1007/s00127-022-02233-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine the association between mode of delivery (in particular caesarean section) and behavioural outcomes in offspring at six time-points between age 3 and 17 years. METHODS Similar to previous work examining the association between mode of delivery and behavioural outcomes in offspring at age 7, we used maternal-reported data from the Millennium Cohort Study. Data on mode of delivery were collected when children were 9 months and categorised as spontaneous vaginal delivery, assisted vaginal delivery, induced vaginal delivery, emergency caesarean section, planned caesarean section and caesarean section after induction of labor. Data on behavioural outcomes were collected at ages 3, 5, 7, 11, 14 and 17 years using the Strengths and Difficulties Questionnaire (SDQ). Crude and adjusted logistic regression examined mode of delivery-behavioural difficulties relationship, using validated SDQ cut-off points (total SDQ ≥ 17, emotional ≥ 5, conduct ≥ 4, hyperactivity ≥ 7, peer problems ≥ 4 and prosocial behaviour ≤ 4). Multilevel models with linear splines examined the association between mode of delivery and repeated measures of SDQ. RESULTS There were 18,213 singleton mother-child pairs included at baseline, 13,600 at age 3; 13,831 at age 5; 12,687 at age 7; 11,055 at age 11; 10,745 at age 14 and 8839 at age 17. Adjusted logistic regression suggested few associations between mode of delivery and behavioural outcomes at ages 3, 5, 11, 14 and 17 years using validated SDQ cut-off points. After correction for multiple testing, only the protective association between planned caesarean section-Conduct difficulties at age 5 years (OR 0.63, 95% CI 0.46, 0.85) and positive association between caesarean section after induction-Emotional difficulties at age 11 years (OR 1.57, 95% CI 1.19, 2.07) remained statistically significant. Multilevel modelling suggested mean SDQ scores were similar in each mode of delivery group at each time point. CONCLUSIONS Results of this study indicate that mode of delivery is unlikely to have a major impact on behavioural outcomes.
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Affiliation(s)
- Gillian M Maher
- INFANT Research Centre, Cork, Ireland.
- School of Public Health, University College Cork, Cork, Ireland.
| | - Ali S Khashan
- INFANT Research Centre, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Huang P, Shi X, Xiao F, Wang L, Liu W, Zeng J, Lin M, Li X. Relationship between Obstetric Mode of Delivery and Risk of Overweight/Obesity in 1- to 4-Year-Old Children. Obes Facts 2022; 15:366-372. [PMID: 35144262 PMCID: PMC9210009 DOI: 10.1159/000521854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Childhood obesity is an important public health problem, which may lead to increased risk of obesity in adulthood. The relationship between the incidence of obesity and the mode of delivery is not clear. Cesarean section (CS) may be one of the risk factors of obesity in children. We investigated the relationship between the mode of delivery of pregnant women and the risk of overweight/obesity in children of all ages from 1 to 4 years. METHODS Registered in the maternal and child registration system of Xiamen city, newborns born between January 2011 and December 2012 were followed up to 4 years old. RESULTS 9,964 cases were included in the study, of which 3,462 cases (34.7%) were cesarean deliveries. From 1 to 4 years of age, BMI Z-scores and the risk for overweight/obesity of children delivered by CS were higher than by the vagina. Longitudinal analysis of anthropometric outcomes assessed during study visits in 1- to 4-year-old offspring exposed to CS showed that after adjustment for kinds of effect factors, the changes in BMI Z-scores were 0.04 (95% CI: 0.01-0.09, p = 0.003), significantly higher than vaginal delivery, and the risk incidence of overweight/obesity by increased 8% in CS offspring; OR = 1.08 (1.01-1.21, p< 0.05). CONCLUSION The mode of cesarean delivery is related to the risk of overweight and obesity in children aged 1-4 years. When pregnant women choose cesarean delivery without medical indications, they should be concerned that their offspring may have a higher risk of obesity.
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Affiliation(s)
- Peiying Huang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China,
- Xiamen Diabetes Institute, Xiamen, China,
| | - Xiulin Shi
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Diabetes Institute, Xiamen, China
| | - Fangsen Xiao
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Diabetes Institute, Xiamen, China
| | - Liying Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Diabetes Institute, Xiamen, China
| | - Wei Liu
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Diabetes Institute, Xiamen, China
| | - Jinyang Zeng
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Diabetes Institute, Xiamen, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Diabetes Institute, Xiamen, China
| | - Xuejun Li
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Diabetes Institute, Xiamen, China
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Robin A, Eyraud JL, Catalan C, Aubard Y, Coste Mazeau P. [Impact of a service protocol on the practice of vaginal delivery of breech presentations at term]. Gynecol Obstet Fertil Senol 2022; 50:45-52. [PMID: 34530145 DOI: 10.1016/j.gofs.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The delivery of breech presentations remains controversial. Our study analysed the impact of a service protocol on the proportion of planned vaginal delivery and its success. Immediate neonatal morbidity and factors that may influence the success of vaginal delivery were studied. METHODS Retrospective study, between 2009 and 2020 at the CHRU of Limoges, type 3 maternity hospital, on patients with a breech foetus at term. The proportion of planned vaginal delivery and the rate of effective vaginal delivery were compared before/after 2015. Neonatal morbidity was compared for planned vaginal delivery and planned cesarean delivery groups. RESULTS We included 923 patients. The rate of planned vaginal delivery was significantly higher after 2015 from 5.2% to 19% (P<0.001), with a success rate increasing from 60% to 82.1% (P=0.06). The rate of vaginal breech deliveries significantly increased from 3.8% to 17% (P<0.001). We found significantly more newborns with moderate acidosis when a vaginal delivery was attempted (P<0.001). The success of vaginal delivery was correlated to the Magnin index (P=0.044), to gestational age (P=0.037), and to multiparity (OR 3.78 95% CI [1.42-10.03] P=0.006). CONCLUSION Our study demonstrates the benefits of setting up a service protocol for the practice of breech vaginal delivery.
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Affiliation(s)
- A Robin
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - J-L Eyraud
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - C Catalan
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Aubard
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - P Coste Mazeau
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France; Inserm U1092, centre de biologie et de recherche en santé, université de Limoges, CHRU de Limoges, 2, rue du Pr Bernard Descottes, 87000 Limoges, France.
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Sunarno I, Riu DS, Mappaware NA. Factors associated with and mode of delivery in prelabour rupture of membrane at secondary health care. Gac Sanit 2021; 35 Suppl 2:S498-S500. [PMID: 34929885 DOI: 10.1016/j.gaceta.2021.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The study aimed to explore factors associated with prelabor rupture of membrane (PROM) and mode of delivery of PROM at secondary health care. METHODS It was a retrospective case-control study within a year observational period. Data were collected from medical records at St. Khadijah I Mother and Child Hospital Makassar. RESULTS There were 4003 samples with 259 cases with PROM. Parity and body mass index (BMI) were factors associated with PROM with p=0.000 and .032 consecutively; among them, BMI was more prominent than parity with OR=2.392, and 95% CI=1.052-5.442. Cesarean section is not associated with PROM, p=.000. CONCLUSION Primigravidae and obesity were factors associated with PROM, and BMI was more strongly associated with PROM than parity. PROM is not an indication for cesarean section.
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Affiliation(s)
- Isharyah Sunarno
- Department of Obstetrics & Gynecology, Faculty of Medicine, Hasanuddin University, Indonesia.
| | - Deviana Soraya Riu
- Department of Obstetrics & Gynecology, Faculty of Medicine, Hasanuddin University, Indonesia
| | - Nasrudin Andi Mappaware
- Department of Obstetrics & Gynecology, Faculty of Medicine, Hasanuddin University, Indonesia
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Gjærum R, Johansen IH, Øian P, Bernitz S, Dalbye R. Associations between cervical dilatation on admission and mode of delivery, a cohort study of Norwegian nulliparous women. Sex Reprod Healthc 2021; 31:100691. [PMID: 34952402 DOI: 10.1016/j.srhc.2021.100691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/30/2021] [Accepted: 12/11/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate associations between cervical dilatation at hospital admission and mode of delivery. METHODS A cohort study with data from a cluster-randomised controlled trial, the Labour Progression Study. The study population of 6511 nulliparous women with a singleton fetus in cephalic presentation with spontaneous onset of labour at term, was divided into two groups: <4 cm and ≥ 4 cm cervical dilatation on admission. Binary logistic regression comparing mode of delivery was used to estimate crude and adjusted OR with associated 95% CI. RESULTS Of the total study population, 56.7% were admitted with < 4 cm cervical dilatation and 43.3% with ≥ 4 cm. Women admitted with ≥ 4 cm had a significantly higher chance of spontaneous delivery, with adjusted OR of 1.28 (95% CI: 1.14-1.44), and a significantly lower risk of caesarean sections, with an adjusted OR of 0.51 (95% CI: 0.41-0.64). For operative vaginal delivery, there were no significant difference between the study groups. Intrapartum interventions as epidural analgesia and augmentation with oxytocin were lower among women admitted with ≥ 4 cm cervical dilatation. CONCLUSION The study found a significantly higher chance of spontaneous delivery among women admitted with ≥ 4 cm. More research is needed to investigate why so many women are admitted early in labour, and how these women can be better cared for to increase their chances of a spontaneous delivery.
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Affiliation(s)
- Ragnhild Gjærum
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO-box 4, St. Olavs plass, 0130 Oslo, Norway.
| | - Ingvild Haarklau Johansen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO-box 4, St. Olavs plass, 0130 Oslo, Norway
| | - Pål Øian
- Department of Obstetrics and Gynaecology, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Stine Bernitz
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO-box 4, St. Olavs plass, 0130 Oslo, Norway; Department of Obstetrics and Gynaecology, Østfold Hospital Trust, PO-box 300, 1714 Grålum, Norway
| | - Rebecka Dalbye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, PO-box 4, St. Olavs plass, 0130 Oslo, Norway; Department of Obstetrics and Gynaecology, Østfold Hospital Trust, PO-box 300, 1714 Grålum, Norway
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Rottenstreich M, Rotem R, Glick I, Reichman O, Rottenstreich A, Grisaru-Granovsky S, Sela HY. Maternal and Neonatal Outcomes in Twin Deliveries with Prolonged Second-Stage Duration of the Presenting Twin: a Retrospective Cohort Study. Reprod Sci 2021; 29:143-153. [PMID: 34782987 DOI: 10.1007/s43032-021-00798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 11/06/2021] [Indexed: 11/30/2022]
Abstract
To assess the risk of adverse maternal and neonatal outcomes as a function of the presenting twin second-stage duration. A retrospective cohort study of deliveries taking place in an academic medical center between 2005 and 2019. The study group included women with twin pregnancies with the first fetus in vertex presentation, who attempted vaginal delivery with epidural analgesia and attained the second stage of labor. Prolonged second stage (PSS) was defined as when exceeding the 95th percentile of presenting twin second-stage duration recorded among all parturients who achieved spontaneous vaginal deliveries in our center during the study period, stratified by parity: 3 h in nulliparas and 1 h in multiparas. Women with and without PSS were compared. The primary outcome was a composite of adverse maternal outcomes. A univariate analysis was conducted and followed by multivariate analysis. During the study period, 1,337 parturients (36% of twin deliveries) met study criteria, of these 22% (298) were nulliparous and 78% (1,039) were multiparous. The second stage of labor of the presenting twin was prolonged in 41 (13.8%) of the nulliparas and 64 (6.2%) multiparas. Prolonged second stage was associated with episiotomy, chorioamnionitis, endometritis, and blood product transfusion, as well as vacuum deliveries of the first and second twin, second-stage cesarean, and a higher rate of composite adverse maternal outcome in nulliparous (41.5% vs. 20.2%, p<0.01) and with higher rates of episiotomy, postpartum hemorrhage, and vacuum deliveries of the first and second twin, but a similar rate of composite adverse maternal outcome in multiparous women (7.8% vs. 9.3%, p=0.68); moreover, the composite adverse neonatal outcome was not increased in nulliparous (36.6% vs. 38.5%, p=0.81) nor in multiparous women (21.9% vs. 23.6%, p=0.75). Prolonged second stage of labor of the presenting twin was associated with an adverse composite maternal outcome in nulliparous and with postpartum hemorrhage in multiparous. Further larger studies are warranted to reinforce our findings.
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Affiliation(s)
- Misgav Rottenstreich
- Department of Obstetrics and Gynecology, 12 Bayit Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem, 91031, Jerusalem, Israel.,Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, 12 Bayit Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem, 91031, Jerusalem, Israel.
| | - Itamar Glick
- Department of Obstetrics and Gynecology, 12 Bayit Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem, 91031, Jerusalem, Israel
| | - Orna Reichman
- Department of Obstetrics and Gynecology, 12 Bayit Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem, 91031, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, 12 Bayit Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem, 91031, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, 12 Bayit Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem, 91031, Jerusalem, Israel
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Haahr T, Clausen TD, Thorsen J, Rasmussen MA, Mortensen MS, Lehtimäki J, Shah SA, Hjelmsø MH, Bønnelykke K, Chawes BL, Vestergaard G, Jacobsson B, Larsson PG, Brix S, Sørensen SJ, Bisgaard H, Stokholm J. Vaginal dysbiosis in pregnancy associates with risk of emergency caesarean section: a prospective cohort study. Clin Microbiol Infect 2021; 28:588-595. [PMID: 34500080 DOI: 10.1016/j.cmi.2021.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate changes in vaginal microbiota during pregnancy, and the association between vaginal dysbiosis and reproductive outcomes. METHODS A total of 730 (week 24) and 666 (week 36) vaginal samples from 738 unselected pregnant women were studied by microscopy (Nugent score) and characterized by 16S rRNA gene sequencing. A novel continuous vaginal dysbiosis score was developed based on these methods using a supervised partial least squares model. RESULTS Among women with bacterial vaginosis in week 24 (n = 53), 47% (n = 25) also had bacterial vaginosis in week 36. In contrast, among women without bacterial vaginosis in week 24, only 3% (n = 18) developed bacterial vaginosis in week 36. Vaginal samples dominated by Lactobacillus crispatus (OR 0.35, 95% CI 0.20-0.60) and Lactobacillus iners (OR 0.40, 95% CI 0.23-0.68) in week 24 were significantly more stable by week 36 when compared with other vaginal community state types. Vaginal dysbiosis score at week 24 was associated with a significant increased risk of emergency, but not elective, caesarean section (OR 1.37, 955 CI 1.15-1.64, p < 0.001), suggesting a 37% increased risk per standard deviation increase in vaginal dysbiosis score. CONCLUSIONS Changes in vaginal microbiota from week 24 to week 36 of pregnancy correlated with bacterial vaginosis status and vaginal community state type. A novel vaginal dysbiosis score was associated with a significantly increased risk of emergency, but not elective, caesarean section. This was not found for bacterial vaginosis or any vaginal community state type and could point to the importance of investigating vaginal dysbiosis as a nuanced continuum instead of crude clusters.
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Affiliation(s)
- Thor Haahr
- Department of Clinical Medicine, Aarhus University, Denmark and the Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - Tine Dalsgaard Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Jonathan Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten A Rasmussen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Section of Chemometrics and Analytical Technologies, Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark
| | - Martin S Mortensen
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Jenni Lehtimäki
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Shiraz A Shah
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mathis H Hjelmsø
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo L Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gisle Vestergaard
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Per-Göran Larsson
- Department of Obstetrics and Gynecology, Skaraborg Hospital Skövde, Skövde, Sweden; Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Søren J Sørensen
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Section of Microbiology and Fermentation, Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark.
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Paixao ES, Bottomley C, Smeeth L, da Costa MCN, Teixeira MG, Ichihara MY, Gabrielli L, Barreto ML, Campbell OMR. Using the Robson classification to assess caesarean section rates in Brazil: an observational study of more than 24 million births from 2011 to 2017. BMC Pregnancy Childbirth 2021; 21:589. [PMID: 34461851 PMCID: PMC8406968 DOI: 10.1186/s12884-021-04060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Applying the Robson classification to all births in Brazil, the objectives of our study were to estimate the rates of caesarean section delivery, assess the extent to which caesarean sections were clinically indicated, and identify variation across socioeconomic groups. METHODS We conducted a population-based study using routine records of the Live Births Information System in Brazil from January 1, 2011, to December 31, 2017. We calculated the relative size of each Robson group; the caesarean section rate; and the contribution to the overall caesarean section rate. We categorised Brazilian municipalities using the Human Development Index to explore caesarean section rates further. We estimated the time trend in caesarean section rates. RESULTS The rate of caesarean sections was higher in older and more educated women. Prelabour caesarean sections accounted for more than 54 % of all caesarean deliveries. Women with a previous caesarean section (Group 5) made up the largest group (21.7 %). Groups 6-9, for whom caesarean sections would be indicated in most cases, all had caesarean section rates above 82 %, as did Group 5. The caesarean section rates were higher in municipalities with a higher HDI. The general Brazilian caesarean section rate remained stable during the study period. CONCLUSIONS Brazil is a country with one of the world's highest caesarean section rates. This nationwide population-based study provides the evidence needed to inform efforts to improve the provision of clinically indicated caesarean sections. Our results showed that caesarean section rates were lower among lower socioeconomic groups even when clinically indicated, suggesting sub-optimal access to surgical care.
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Affiliation(s)
- Enny S Paixao
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil.
| | - Christian Bottomley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Conceicao N da Costa
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia - Salvador (BA), Salvador, Brazil
| | - Maria Gloria Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia - Salvador (BA), Salvador, Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Ligia Gabrielli
- Institute of Collective Health, Federal University of Bahia - Salvador (BA), Salvador, Brazil
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Heida FH, Kooi EMW, Wagner J, Nguyen TY, Hulscher JBF, van Zoonen AGJF, Bos AF, Harmsen HJM, de Goffau MC. Weight shapes the intestinal microbiome in preterm infants: results of a prospective observational study. BMC Microbiol 2021; 21:219. [PMID: 34289818 PMCID: PMC8293572 DOI: 10.1186/s12866-021-02279-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/28/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The intestinal microbiome in preterm infants differs markedly from term infants. It is unclear whether the microbiome develops over time according to infant specific factors. METHODS We analysed (clinical) metadata - to identify the main factors influencing the microbiome composition development - and the first meconium and faecal samples til the 4th week via 16 S rRNA amplican sequencing. RESULTS We included 41 infants (gestational age 25-30 weeks; birth weight 430-990 g. Birth via Caesarean section (CS) was associated with placental insufficiency during pregnancy and lower BW. In meconium samples and in samples from weeks 2 and 3 the abundance of Escherichia and Bacteroides (maternal faecal representatives) were associated with vaginal delivery while Staphylococcus (skin microbiome representative) was associated with CS. Secondly, irrespective of the week of sampling or the mode of birth, a transition was observed as children children gradually increased in weight from a microbiome dominated by Staphylococcus (Bacilli) towards a microbiome dominated by Enterobacteriaceae (Gammaproteobacteria). CONCLUSIONS Our data show that the mode of delivery affects the meconium microbiome composition. They also suggest that the weight of the infant at the time of sampling is a better predictor for the stage of progression of the intestinal microbiome development/maturation than postconceptional age as it less confounded by various infant-specific factors.
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Affiliation(s)
- Fardou H Heida
- Division of Obstetrics & Gynecology, Isala Klinieken, University of Groningen, Zwolle, the Netherlands. .,Division of Pediatric Surgery Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Elisabeth M W Kooi
- Division of Neonatology Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Josef Wagner
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital, Melbourne, Australia
| | - Thi-Yen Nguyen
- Division of Pediatric Surgery Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan B F Hulscher
- Division of Pediatric Surgery Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anne G J F van Zoonen
- Division of Pediatric Surgery Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arend F Bos
- Division of Neonatology Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hermie J M Harmsen
- Division of Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcus C de Goffau
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Parasites and Microboes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, United Kingdom
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Irene K, Amubuomombe PP, Mogeni R, Andrew C, Mwangi A, Omenge OE. Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley mother baby hospital: a longitudinal case-series study. BMC Pregnancy Childbirth 2021; 21:439. [PMID: 34167502 PMCID: PMC8228929 DOI: 10.1186/s12884-021-03875-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/13/2021] [Indexed: 12/18/2022] Open
Abstract
Background Eclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0–40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1–2.0). Conclusion There is no benefit of emergency caesarean section for women with eclampsia. This study showed that induction of labour and vaginal delivery can be successfully achieved in pregnant women with eclampsia. Maternal and perinatal mortality from eclampsia can be prevented through prompt and effective care. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03875-6.
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Affiliation(s)
- Koech Irene
- Reproductive Health, Moi Teaching& Referral Hospital, PO Box 3-30100, Nandi road, Eldoret, Kenya
| | - Poli Philippe Amubuomombe
- Reproductive Health, Moi Teaching& Referral Hospital, PO Box 3-30100, Nandi road, Eldoret, Kenya. .,Department of Reproductive Health, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya.
| | - Richard Mogeni
- Reproductive Health, Moi Teaching& Referral Hospital, PO Box 3-30100, Nandi road, Eldoret, Kenya
| | - Cheruiyot Andrew
- Department of Reproductive Health, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya
| | - Ann Mwangi
- Department of Behavioural Sciences, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Orang'o Elkanah Omenge
- Reproductive Health, Moi Teaching& Referral Hospital, PO Box 3-30100, Nandi road, Eldoret, Kenya.,Department of Reproductive Health, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya
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Salman L, Shmueli A, Aharony S, Pardo A, Chen R, Wiznitzer A, Gabbay-Benziv R. Postpartum voiding dysfunction following vaginal versus caesarean delivery. J OBSTET GYNAECOL 2021; 42:256-260. [PMID: 34027805 DOI: 10.1080/01443615.2021.1907553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this prospective study, we evaluated postpartum voiding dysfunction stratified by mode of delivery - vaginal delivery versus elective caesarean delivery (CD). We recruited nulliparous women carrying singleton gestation at term admitted to delivery room or elective CD. Pre-labour voiding function was assessed by recording the post-voiding residual volume (PVRV) using a bladder scan. PVRV evaluation was repeated at least 12 hours following delivery and before discharge. PVRVs were considered abnormal if ≥150 mL. PVRVs were compared between vaginal and CD. Overall, 54 women were included. Of them, 34 (63%) delivered vaginally and 20 (37%) had an elective CD. Postpartum mean PVRVs were significantly higher compared to pre-labour PVRVs (215 vs. 133 mL, p<.001). Abnormal postpartum PVRV was significantly higher in vaginal delivery compared to CD (73.5% vs. 45%, p<.05). In conclusion, delivery adversely affects voiding function. Vaginal delivery is associated with more severe voiding dysfunction compared to elective CD.Impact StatementWhat is already known on this subject? Delivery is associated with voiding dysfunction. While most studies on postpartum voiding dysfunction were related to vaginal delivery, little is known on the effect of mode of delivery (vaginal versus caesarean delivery (CD)) on voiding dysfunction.What the results of this study add? In this study, we found that postpartum post-voiding residual volume is significantly higher than the pre-labour PVRV in women delivered vaginally. In addition, postpartum PVRV was significantly higher in women delivered vaginally compared to elective CD.What the implications are of these findings for clinical practice and/or further research? This study implicates that women with vaginal delivery are more prone to voiding dysfunction compared to elective CD. However, larger observational studies are warranted to confirm these results and evaluate whether this difference still exists beyond the post-partum period.
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Affiliation(s)
- Lina Salman
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shmueli
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Aharony
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Urology Service, Rabin Medical Center, Petah Tikva, Israel
| | - Anat Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rony Chen
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Gabbay-Benziv
- Hillel Yaffe Medical Center, Hadera, Israel.,The Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Oelhafen S, Trachsel M, Monteverde S, Raio L, Cignacco E. Informal coercion during childbirth: risk factors and prevalence estimates from a nationwide survey of women in Switzerland. BMC Pregnancy Childbirth 2021; 21:369. [PMID: 33971841 PMCID: PMC8112037 DOI: 10.1186/s12884-021-03826-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background In many countries, the increase in facility births is accompanied by a high rate of obstetric interventions. Lower birthrates or elevated risk factors such as women’s higher age at childbirth and an increased need for control and security cannot entirely explain this rise in obstetric interventions. Another possible factor is that women are coerced to agree to interventions, but the prevalence of coercive interventions in Switzerland is unknown. Methods In a nationwide cross-sectional online survey, we assessed the prevalence of informal coercion during childbirth, women’s satisfaction with childbirth, and the prevalence of women at risk of postpartum depression. Women aged 18 years or older who had given birth in Switzerland within the previous 12 months were recruited online through Facebook ads or through various offline channels. We used multivariable logistic regression to estimate the risk ratios associated with multiple individual and contextual factors. Results In total, 6054 women completed the questionnaire (a dropout rate of 16.2%). An estimated 26.7% of women experienced some form of informal coercion during childbirth. As compared to vaginal delivery, cesarean section (CS) and instrumental vaginal birth were associated with an increased risk of informal coercion (planned CS risk ratio [RR]: 1.52, 95% confidence interval [1.18,1.96]; unplanned CS RR: 1.92 [1.61,2.28]; emergency CS RR: 2.10 [1.71,2.58]; instrumental vaginal birth RR: 2.17 [1.85,2.55]). Additionally, migrant women (RR: 1.45 [1.26,1.66]) and women for whom a self-determined vaginal birth was more important (RR: 1.15 [1.06,1.24]) more often reported informal coercion. Emergency cesarean section (RR: 1.32 [1.08,1.62]), being transferred to hospital (RR: 1.33 [1.11,1.60]), and experiencing informal coercion (RR: 1.35 [1.19,1.54]) were all associated with a higher risk of postpartum depression. Finally, women who had a non-instrumental vaginal birth reported higher satisfaction with childbirth while women who experienced informal coercion reported lower satisfaction. Conclusions One in four women experience informal coercion during childbirth, and this experience is associated with a higher risk of postpartum depression and lower satisfaction with childbirth. To prevent traumatic after-effects, health care professionals should make every effort to prevent informal coercion and to ensure sensitive aftercare for all new mothers. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03826-1.
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Affiliation(s)
- Stephan Oelhafen
- Department of Health Professions, Applied Research & Development in Midwifery, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
| | - Manuel Trachsel
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Clinical Ethics Unit, University Hospital of Basel and Psychiatric University Clinics Basel, Basel, Switzerland
| | - Settimio Monteverde
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Department of Health Professions, School of Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - Eva Cignacco
- Department of Health Professions, Applied Research & Development in Midwifery, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
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50
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Soni S, Moldenhauer JS, Kallan MJ, Rintoul N, Adzick NS, Hedrick HL, Khalek N. Influence of Gestational Age and Mode of Delivery on Neonatal Outcomes in Prenatally Diagnosed Isolated Congenital Diaphragmatic Hernia. Fetal Diagn Ther 2021; 48:372-380. [PMID: 33951652 DOI: 10.1159/000515252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 02/15/2021] [Indexed: 11/19/2022]
Abstract
AIM The optimal gestational age (GA) at delivery and mode of delivery (MoD) for pregnancies with fetal congenital diaphragmatic hernia (CDH) is undetermined. The impact of early term (37-38 weeks 6 days) versus full term (39-40 weeks 6 days) and MoD on immediate neonatal outcomes in prenatally diagnosed isolated CDH cases was evaluated. MATERIAL AND METHODS A retrospective chart review of pregnancies evaluated and delivered with the prenatal diagnosis of CDH between July 1, 2008, and December 31, 2018. The primary outcome was survival to hospital discharge. Secondary outcomes included neonatal intensive care unit (NICU) length of stay (LOS), extracorporeal membrane oxygenation (ECMO) requirement and need for supplemental oxygen at day 30 of life. RESULTS A total of 296 patients were prenatally evaluated for CDH and delivered in a single center during the study period. After applying exclusion criteria, data were available on 113 women who delivered early term and 72 women who delivered full term. Survival to hospital discharge was comparable between the 2 groups - 83.2% in the early term versus 93.1% in the full term (p = 0.07; 95% CI of 0.13-1.04). No difference was observed in any other secondary outcomes. MoD was stratified into spontaneous vaginal, induced vaginal, unplanned cesarean and scheduled cesarean delivery with associated neonatal survival rates of 74.2, 90.6, 89.7 and 88.2%, respectively, p = 0.13. The 5-min Apgar score was higher in the elective cesarean group (7.94) followed by the induced vaginal delivery group (7.8) compared to 7.17 and 7.18 in the spontaneous vaginal and unplanned cesarean groups, respectively (p = 0.03). The GA and MoD did not influence survival to hospital discharge nor NICU LOS in multivariate analysis. CONCLUSIONS Though there were no significant differences in neonatal outcomes for early term compared to full term deliveries of CDH neonates, a trend toward improved survival rates and lower ECMO requirements in the full term group may suggest an underlying importance GA at delivery. Further studies are warranted to validate these findings.
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Affiliation(s)
- Shelly Soni
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julie S Moldenhauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael J Kallan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Natalie Rintoul
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N Scott Adzick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Holly L Hedrick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nahla Khalek
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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