Early postpartum breast-feeding outcomes and breast-feeding self-efficacy in Turkish mothers undergoing vaginal birth or cesarean birth with different types of anesthesia.

PubMed

Alus Tokat, Merlinda; Serçekuş, Pinar; Yenal, Kerziban; Okumuş, Hülya

2015-04-01

To compare the breast-feeding outcomes and breast-feeding self-efficacy, in the first 24 postpartum hours, of mothers who underwent vaginal birth, cesarean birth with epidural anesthesia, and cesarean birth with general anesthesia. A comparative study was conducted in Turkey. A total of 334 mothers participated. Data were evaluated through descriptive data form, breast-feeding outcomes form, and the Breastfeeding Self-Efficacy Scale. It was observed that the mothers who had cesarean birth with general anesthesia experienced more breast-feeding problems. With regard to breast-feeding self-efficacy, all the groups were similar. For reducing breast-feeding problems, nurses should provide more care and support to mothers undergoing cesarean birth. Therefore, the fact that the breast-feeding self-efficacy was similar among the groups might be related to culture. © 2014 NANDA International, Inc.

Labor patterns in women attempting vaginal birth after cesarean with normal neonatal outcomes.

PubMed

Grantz, Katherine L; Gonzalez-Quintero, Victor; Troendle, James; Reddy, Uma M; Hinkle, Stefanie N; Kominiarek, Michelle A; Lu, Zhaohui; Zhang, Jun

2015-08-01

We sought to describe labor patterns in women with a trial of labor after cesarean (TOLAC) with normal neonatal outcomes. In a retrospective observational study at 12 US centers (2002 through 2008), we examined time interval for each centimeter of cervical dilation and compared labor progression stratified by spontaneous or induced labor in 2892 multiparous women with TOLAC (second delivery) and 56,301 nulliparous women at 37 0/7 to 41 6/7 weeks of gestation. Analyses were performed including women with intrapartum cesarean delivery, and also limiting only to women who delivered vaginally. Labor was induced in 23.4% of TOLAC and 44.1% of nulliparous women (P < .001). Cesarean delivery rates were 57.7% in TOLAC vs 19.0% in nulliparous women (P < .001). Oxytocin was used in 52.4% of TOLAC vs 64.3% of nulliparous women with spontaneous labor (P < .001) and 89.8% of TOLAC vs 91.6% of nulliparous women with induced labor (P = .099); however, TOLAC had lower maximum doses of oxytocin compared to nulliparous women: median (90th percentile): 6 (18) mU/min vs 12 (28) mU/min, respectively (P < .001). Median (95th percentile) labor duration for TOLAC vs nulliparous women with spontaneous labor from 4-10 cm was 0.9 (2.2) hours longer (P = .007). For women who entered labor spontaneously and achieved vaginal delivery, labor patterns for TOLAC were similar to nulliparous women. For induced labor, labor duration for TOLAC vs nulliparous women from 4-10 cm was 1.5 (4.6) hours longer (P < .001). For women who achieved vaginal delivery, labor patterns were slower for induced TOLAC compared to nulliparous women. Labor duration for TOLAC was slower compared to nulliparous labor, particularly for induced labor. By improved understanding of the rates of progress at different points in labor, this new information on labor curves in women undergoing TOLAC, particularly for induction, should help physicians when managing labor. Published by Elsevier Inc.

Labor Patterns in Women Attempting Vaginal Birth After Cesarean With Normal Neonatal Outcomes

PubMed Central

GRANTZ, Katherine L.; GONZALEZ-QUINTERO, Victor; TROENDLE, James; REDDY, Uma M.; HINKLE, Stefanie N.; KOMINIAREK, Michelle A.; LU, Zhaohui; ZHANG, Jun

2015-01-01

Objective To describe labor patterns in women with a trial of labor after cesarean (TOLAC) with normal neonatal outcomes. Study Design In a retrospective observational study at 12 U.S. centers (2002–2008), we examined time interval for each centimeter of cervical dilation and compared labor progression stratified by spontaneous or induced labor in 2,892 multiparous women with TOLAC (second delivery) and 56,301 nulliparous women at 37 0/7 to 41 6/7 weeks of gestation. Analyses were performed including women with intrapartum cesarean delivery, and then repeated limiting only to women who delivered vaginally. Results Labor was induced in 23.4% of TOLAC and 44.1% of nulliparous women (P<.001). Cesarean delivery rates were 57.7% in TOLAC versus 19.0% in nulliparous women (P<.001). Oxytocin was used in 52.4% of TOLAC versus 64.3% of nulliparous women with spontaneous labor (P<.001) and 89.8% of TOLAC versus 91.6% of nulliparous women with induced labor (P=.099); however, TOLAC had lower maximum doses of oxytocin compared to nulliparous women: median (90th percentile): 6 (18) mU/min versus 12 (28) mU/min, respectively (P<.001). Median (95th percentile) labor duration for TOLAC versus nulliparous women with spontaneous labor from 4–10cm was 0.9 (2.2) hours longer (P=.007). For women who entered labor spontaneously and achieved vaginal delivery, labor patterns for TOLAC were similar to nulliparous women. For induced labor, labor duration for TOLAC versus nulliparous women from 4–10cm was 1.5 (4.6) hours longer (P<.001). For women who achieved vaginal delivery, labor patterns were slower for induced TOLAC compared to nulliparous women. Conclusions Labor duration for TOLAC was slower compared to nulliparous labor, particularly for induced labor. By improved understanding of the rates of progress at different points in labor, this new information on labor curves in women undergoing TOLAC, particularly for induction, should help physicians when managing labor. PMID

Simple, validated vaginal birth after cesarean delivery prediction model for use at the time of admission.

PubMed

Metz, Torri D; Stoddard, Gregory J; Henry, Erick; Jackson, Marc; Holmgren, Calla; Esplin, Sean

2013-09-01

To create a simple tool for predicting the likelihood of successful trial of labor after cesarean delivery (TOLAC) during the pregnancy after a primary cesarean delivery using variables available at the time of admission. Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with one cesarean delivery and one subsequent delivery were included. Variables associated with successful VBAC were identified using multivariable logistic regression. Points were assigned to these characteristics, with weighting based on the coefficients in the regression model to calculate an integer VBAC score. The VBAC score was correlated with TOLAC success rate and was externally validated in an independent cohort using a logistic regression model. A total of 5,445 women met inclusion criteria. Of those women, 1,170 (21.5%) underwent TOLAC. Of the women who underwent trial of labor, 938 (80%) had a successful VBAC. A VBAC score was generated based on the Bishop score (cervical examination) at the time of admission, with points added for history of vaginal birth, age younger than 35 years, absence of recurrent indication, and body mass index less than 30. Women with a VBAC score less than 10 had a likelihood of TOLAC success less than 50%. Women with a VBAC score more than 16 had a TOLAC success rate more than 85%. The model performed well in an independent cohort with an area under the curve of 0.80 (95% confidence interval 0.76-0.84). Prediction of TOLAC success at the time of admission is highly dependent on the initial cervical examination. This simple VBAC score can be utilized when counseling women considering TOLAC. II.

Cesarean Birth

MedlinePlus

... after the procedure? • What should I expect during recovery? • Glossary What is cesarean birth? Cesarean birth is ... right away. You will be taken to a recovery room or directly to your room. Your blood ...

Postpartum fatigue, baby-care activities, and maternal-infant attachment of vaginal and cesarean births following rooming-in.

PubMed

Lai, Ya-Ling; Hung, Chich-Hsiu; Stocker, Joel; Chan, Te-Fu; Liu, Yi

2015-05-01

This study compares women's postpartum fatigue, baby-care activities, and maternal-infant attachment following vaginal and cesarean births in rooming-in settings. Postpartum women admitted to baby-friendly hospitals are asked to stay with their babies 24 hours a day and to breastfeed on demand regardless of the type of childbirth. The study used a descriptive cross-sectional study design. A total of 120 postpartum women were recruited from two accredited baby-friendly hospitals in southern Taiwan. Three structured questionnaires were used to collect data, on which an analysis of covariance was conducted. Women who experienced a cesarean birth had higher postpartum fatigue scores than women who had given birth vaginally. Higher postpartum fatigue scores were correlated with greater difficulty in baby-care activities, which in turn resulted in weaker maternal-infant attachment as measured in the first 2 to 3 days postpartum. Hospitals should implement rooming-in in a more flexible way by taking women's postpartum fatigue and physical functioning into consideration. Copyright © 2014 Elsevier Inc. All rights reserved.

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy.

PubMed

Barrett, Jon F R; Hannah, Mary E; Hutton, Eileen K; Willan, Andrew R; Allen, Alexander C; Armson, B Anthony; Gafni, Amiram; Joseph, K S; Mason, Dalah; Ohlsson, Arne; Ross, Susan; Sanchez, J Johanna; Asztalos, Elizabeth V

2013-10-03

Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy. We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison. A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P=0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P=0.49). In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00187369; Current Controlled Trials number, ISRCTN74420086.).

VBAC (Vaginal Birth After C-Section)

MedlinePlus

Vaginal birth after C-section (VBAC) Overview If you've delivered a baby by C-section and you're pregnant again, you might be able to choose between scheduling a repeat C-section or attempting vaginal birth after C-section ( ...

Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer.

PubMed

Dominguez-Bello, Maria G; De Jesus-Laboy, Kassandra M; Shen, Nan; Cox, Laura M; Amir, Amnon; Gonzalez, Antonio; Bokulich, Nicholas A; Song, Se Jin; Hoashi, Marina; Rivera-Vinas, Juana I; Mendez, Keimari; Knight, Rob; Clemente, Jose C

2016-03-01

Exposure of newborns to the maternal vaginal microbiota is interrupted with cesarean birthing. Babies delivered by cesarean section (C-section) acquire a microbiota that differs from that of vaginally delivered infants, and C-section delivery has been associated with increased risk for immune and metabolic disorders. Here we conducted a pilot study in which infants delivered by C-section were exposed to maternal vaginal fluids at birth. Similarly to vaginally delivered babies, the gut, oral and skin bacterial communities of these newborns during the first 30 d of life was enriched in vaginal bacteria--which were underrepresented in unexposed C-section-delivered infants--and the microbiome similarity to those of vaginally delivered infants was greater in oral and skin samples than in anal samples. Although the long-term health consequences of restoring the microbiota of C-section-delivered infants remain unclear, our results demonstrate that vaginal microbes can be partially restored at birth in C-section-delivered babies.

Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy.

PubMed

Asztalos, Elizabeth V; Hannah, Mary E; Hutton, Eileen K; Willan, Andrew R; Allen, Alexander C; Armson, B Anthony; Gafni, Amiram; Joseph, K S; Ohlsson, Arne; Ross, Susan; Sanchez, J Johanna; Mangoff, Kathryn; Barrett, Jon F R

2016-03-01

The Twin Birth Study randomized women with uncomplicated pregnancies, between 32(0/7)-38(6/7) weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery. This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age. A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births. Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77-1.41; P = .79). A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32(0/7)-38(6/7)weeks' gestation where the first twin is in cephalic presentation. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of Breast Crawl Between Infants Delivered by Vaginal Delivery and Cesarean Section.

PubMed

Heidarzadeh, Mohammad; Hakimi, Sevil; Habibelahi, Abbas; Mohammadi, Marzieh; Shahrak, Shakiba Pourasad

2016-05-12

Exclusive breastfeeding is the single most cost-effective intervention to reduce infant mortality. Breast crawl (BC) is deemed a natural way for the baby to behave immediately after delivery. BC is the method that may help initiation of breastfeeding in the most natural way. The aim of this study is to compare successful BC between neonates born through vaginal delivery and those born through cesarean section (CS) and factors associated with a positive outcome. Participants were mothers who delivered their babies during the period of October 2012 to December 2013 in Alzahra Hospital in Tabriz, through cesarean or vaginal delivery. Infants were placed prone on their mothers' abdomen after delivery. Data show that babies delivered through vaginal delivery had significantly more success in BC than babies born through the cesarean delivery (88.01% versus 11.21%). Moreover, babies in the CS group used significantly less time to achieve BC (45 versus 28 minutes). There is a remarkable difference in completion and length of time used to achieve BC between infants with regard to the delivery mode. Encouraging BC in all dyads, especially in cesarean births, may unduly delay the infant's first breastfeed.

Vaginal breech birth: can we move beyond the Term Breech Trial?

PubMed

Hunter, Linda A

2014-01-01

Since the publication of the Term Breech Trial in 2000, planned cesarean has become the preferred mode of birth for women whose fetus is in a breech presentation. Over the past 20 years, however, subsequent evidence has not shown conclusively that cesarean birth is safer than vaginal birth for a fetus in a breech presentation when certain criteria are met. Many obstetric organizations support the option of planned vaginal birth for women with a breech presentation under strict prelabor selection criteria and intrapartum management guidelines. The growing trend toward cesarean unfortunately has left midwives and other intrapartum care providers in training with dwindling opportunities to competently master skills for vaginal breech birth. Although simulation training offers opportunities to practice infrequently encountered skills such as vaginal breech birth, it is unknown if this alternative will provide sufficient experience for future generations of clinicians. As a result, women with a breech presentation at term who desire a trial of labor often have limited choices. This article reviews the controversies surrounding the ideal mode of birth created by the Term Breech Trial. Criteria for vaginal breech birth are summarized and the role of simulation explored. Implications for midwifery practice when a breech presentation is diagnosed are also included. © 2014 by the American College of Nurse-Midwives.

Obstetric outcome associated with trial of labor in women with three prior cesarean delivery and at least one prior vaginal birth in an area with a particularly high rate of cesarean delivery.

PubMed

Vigorito, Roberto; Montemagno, Rodolfo; Saccone, Gabriele; De Stefano, Renato

2016-11-01

The objective of this study is to evaluate maternal and neonatal outcomes associated with trial of labor after cesarean (TOLAC) in women with three prior cesarean delivery (CD) and at least one prior vaginal delivery. This is a retrospective study using data collected from clinical records of women three prior CD and at least one prior vaginal delivery who were referred to our unit. Maternal and perinatal outcomes were compared between women with three prior CD who underwent TOLAC and those who underwent planned repeated CD (i.e. control group). The primary outcome was a composite of maternal complications including at least one of the followings: need for blood transfusion, uterine rupture, hysterectomy, and admission to intensive care unit. Fifty singleton gestations with three prior CD at with at least one prior vaginal birth were analyzed. Of them, 10 accepted to undergo TOLAC. Of the 10 women who underwent TOLAC, nine had vaginal birth and one had CD for non-reassuring pattern. We found no significant differences in the primary outcome, in need for blood transfusion, in the incidence of uterine rupture, hysterectomy, and admission to intensive care unit comparing TOLAC group with controls. TOLAC in women with three prior CD and at least one prior vaginal delivery is a viable option and is not associated with higher risk of adverse maternal or fetal outcomes.

Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?

PubMed

Grobman, William A; Lai, Yinglei; Landon, Mark B; Spong, Catherine Y; Leveno, Kenneth J; Rouse, Dwight J; Varner, Michael W; Moawad, Atef H; Caritis, Steve N; Harper, Margaret; Wapner, Ronald J; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; O'Sullivan, Mary J; Sibai, Baha M; Langer, Oded; Thorp, John M; Ramin, Susan M; Mercer, Brian M

2009-01-01

The objective of the study was to determine whether a model for predicting vaginal birth after cesarean (VBAC) can also predict the probabilty of morbidity associated with a trial of labor (TOL). Using a previously published prediction model, we categorized women with 1 prior cesarean by chance of VBAC. Prevalence of maternal and neonatal morbidity was stratfied by probability of VBAC success and delivery approach. Morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOL (P < .001) but not elective repeat cesarean section (ERCS) (P > .05). When the predicted chance of VBAC was less than 70%, women undergoing a TOL were more likely to have maternal morbidity (relative risk [RR], 2.2; 95% confidence interval [CI], 1.5-3.1) than those who underwent an ERCS; when the predicted chance of VBAC was at least 70%, total maternal morbidity was not different between the 2 groups (RR, 0.8; 95% CI, 0.5-1.2). The results were similar for neonatal morbidity. A prediction model for VBAC provides information regarding the chance of TOL-related morbidity and suggests that maternal morbidity is not greater for those women who undergo TOL than those who undergo ERCS if the chance of VBAC is at least 70%.

Do They Stand a Chance? Vaginal Birth after Cesarean Section in Adolescents Compared to Adult Women.

PubMed

Damle, Lauren F; Wilson, Kathy; Huang, Chun-Chih; Landy, Helain J; Gomez-Lobo, Veronica

2015-08-01

To determine the rate of elective repeat cesarean delivery (CD), vaginal birth after cesarean (VBAC) attempt, and VBAC success in adolescent mothers presenting for delivery of a second child after a prior CD compared to their adult counterparts. Retrospective cohort study analyzing data from the Consortium on Safe Labor Database which includes data for 228,668 deliveries from 2002 to 2008. 19 hospitals within 12 institutions in the United States. 10,791 women age ≤ 35 (428 adolescents, age ≤ 19 and 10,363 adults age 20-35) with history of prior CD presenting for delivery of a second child. The database was accessed for information on patient characteristics, prenatal comorbidities, and delivery data. Rates of repeat CD, VBAC attempt, and VBAC success were calculated. Multiple logistic regression was applied to identify predictors of VBAC success. Adolescents had a lower overall repeat CD rate and higher VBAC attempt rate compared to adults (80.61% vs 85.32%, P = .0072; 40.42% vs 30.09%, P < .0001 respectively). VBAC success was similar between adolescents and adults (47.98% vs 48.78% P = .8368). Delivery at a teaching hospital and greater gestational age were predictive of VBAC success. Gestational diabetes mellitus, induction of labor, and higher maternal body mass index were predictive of VBAC failure. Adolescence was not an independent predictor of VBAC outcome. Adolescents are more likely to attempt VBAC and are likely to be as successful as their adult counterparts. Adolescents should be encouraged to attempt a trial of labor after prior CD when appropriate to lower the risks of lifelong maternal morbidity from numerous repeat CDs. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Influences on vaginal birth after caesarean section: A qualitative study of Taiwanese women.

PubMed

Chen, Mei-Man; McKellar, Lois; Pincombe, Jan

2017-04-01

Vaginal birth is a safe mode of birth for most women who have had a prior caesarean with a transverse incision. Despite the evidence, most Taiwanese women who have had a previous caesarean are rarely offered the opportunity to consider any possibility other than a repeat caesarean. This study explored factors affecting Taiwanese women's decisionmaking regarding vaginal birth after cesarean. Ajzen's Theory of Planned Behaviour provided the theoretical framework to underpin the study, which adopted an interpretive descriptive methodology. Sequential semi-structured interviews were conducted with 29 women who had a previous caesarean and were pregnant between 34 and 38 weeks gestation, ten women who attempted vaginal birth in the third to fifth day postpartum, and 25 women in the fourth week postpartum. Boyatzis' method of thematic analysis was used to identify themes and codes. This paper reports the findings of the prenatal interviews with 29 participants. The major factor influencing women's decision-making was to avoid negative outcomes for themselves and their babies. Three thematic codes describe influences on the women's decisions: 'past experience of childbirth', 'anticipating the next experience of normal birth' and 'contemplation on the process of childbirth'. Women who have had a previous caesarean section are prepared to have a vaginal birth but are not always supported to carry out this decision. Changing the models of antenatal care is recommended as a strategy to overcome this difficulty therefore empowering women to make a meaningful choice about VBAC after a CS. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery.

PubMed

Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Chervenak, Frank A

2017-01-01

The United States is with 37,451 home births in 2014 the country with the largest absolute number of home births among all developed countries. The purpose of this study was to examine the occurrence and risks of a 5-minute Apgar score of zero and neonatal seizures or serious neurologic dysfunction in women with a history of prior cesarean delivery for planned home vaginal birth after cesarean (VBAC), compared to hospital VBAC and hospital birth cesarean deliveries for term normal weight infants in the United States from 2007-2014. We report in this study outcomes of women who had one or more prior cesarean deliveries and included women who had a successful vaginal birth after a trial of labor after cesarean (TOLAC) at home and in the hospital, and a repeat cesarean delivery in the hospital. We excluded preterm births (<37 weeks) and infants weighing under 2500 g. Hospital VBACS were the reference. Women with a planned home birth VBAC had an approximately 10-fold and higher increase in adverse neonatal outcomes when compared to hospital VBACS and hospital repeat cesarean deliveries, a significantly higher incidence and risk of a 5-minute Apgar score of 0 of 1 in 890 (11.24/10,000, relative risk 9.04, 95% confidence interval 4-20.39, p<.0001) and an incidence of neonatal seizures or severe neurologic dysfunction of 1 in 814 (Incidence: 12.27/10,000, relative risk 11.19, 95% confidence interval 5.13-24.29, p<.0001). Because of the significantly increased neonatal risks, obstetric providers should therefore not offer or perform planned home TOLACs and for those desiring a VBAC should strongly recommend a planned TOLAC in the appropriate hospital setting. We emphasize that this stance should be accompanied by effective efforts to make TOLAC available in the appropriate hospital setting.

Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood.

PubMed

Yuan, Changzheng; Gaskins, Audrey J; Blaine, Arianna I; Zhang, Cuilin; Gillman, Matthew W; Missmer, Stacey A; Field, Alison E; Chavarro, Jorge E

2016-11-07

Cesarean birth has been associated with higher risk of obesity in offspring, but previous studies have focused primarily on childhood obesity and have been hampered by limited control for confounders. To investigate the association between cesarean birth and risk of obesity in offspring. A prospective cohort study was conducted from September 1, 1996, to December 31, 2012, among participants of the Growing Up Today Study, including 22 068 offspring born to 15 271 women, followed up via questionnaire from ages 9 to 14 through ages 20 to 28 years. Data analysis was conducted from October 10, 2015, to June 14, 2016. Birth by cesarean delivery. Risk of obesity based on International Obesity Task Force or World Health Organization body mass index cutoffs, depending on age. Secondary outcomes included risks of obesity associated with changes in mode of delivery and differences in risk between siblings whose modes of birth were discordant. Of the 22 068 offspring (20 950 white; 9359 male and 12 709 female), 4921 individuals (22.3%) were born by cesarean delivery. The cumulative risk of obesity through the end of follow-up was 13% among all participants. The adjusted risk ratio for obesity among offspring delivered via cesarean birth vs those delivered via vaginal birth was 1.15 (95% CI, 1.06-1.26; P = .002). This association was stronger among women without known indications for cesarean delivery (adjusted risk ratio, 1.30; 95% CI, 1.09-1.54; P = .004). Offspring delivered via vaginal birth among women who had undergone a previous cesarean delivery had a 31% (95% CI, 17%-47%) lower risk of obesity compared with those born to women with repeated cesarean deliveries. In within-family analysis, individuals born by cesarean delivery had 64% (8%-148%) higher odds of obesity than did their siblings born via vaginal delivery. Cesarean birth was associated with offspring obesity after accounting for major confounding factors. Although additional research is

Validation of the close-to-delivery prediction model for vaginal birth after cesarean delivery in a Middle Eastern cohort.

PubMed

Abdel Aziz, Ahmed; Abd Rabbo, Amal; Sayed Ahmed, Waleed A; Khamees, Rasha E; Atwa, Khaled A

2016-07-01

To validate a prediction model for vaginal birth after cesarean (VBAC) that incorporates variables available at admission for delivery among Middle Eastern women. The present prospective cohort study enrolled women at 37weeks of pregnancy or more with cephalic presentation who were willing to attempt a trial of labor (TOL) after a single prior low transverse cesarean delivery at Al-Jahra Hospital, Kuwait, between June 2013 and June 2014. The predicted success rate of VBAC determined via the close-to-delivery prediction model of Grobman et al. was compared between participants whose TOL was and was not successful. Among 203 enrolled women, 140 (69.0%) had successful VBAC. The predicted VBAC success rate was higher among women with successful TOL (82.4%±13.1%) than among those with failed TOL (67.7%±18.3%; P<0.001). There was a high positive correlation between actual and predicted success rates. For deciles of predicted success rate increasing from >30%-40% to >90%-100%, the actual success rate was 20%, 30.7%, 38.5%, 59.1%, 71.4%, 76%, and 84.5%, respectively (r=0.98, P=0.013). The close-to-delivery prediction model was found to be applicable to Middle Eastern women and might predict VBAC success rates, thereby decreasing morbidities associated with failed TOL. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Reducing the Primary Cesarean Birth Rate: A Quality Improvement Project.

PubMed

Javernick, Julie A; Dempsey, Amy

2017-07-01

Research continues to support vaginal birth as the safest mode of childbirth, but despite this, cesarean birth has become the most common surgical procedure performed on women. The rate has increased 500% since the 1970s without a corresponding improvement in maternal or neonatal outcomes. A Colorado community hospital recognized that its primary cesarean birth rate was higher than national and state benchmark levels. To reduce this rate, the hospital collaborated with its largest maternity care provider group to implement a select number of physiologic birth practices and measure improvement in outcomes. Using a pre- and postprocess measure study design, the quality improvement project team identified and implemented 3 physiologic birth parameters over a 12-month period that have been shown to promote vaginal birth. These included reducing elective induction of labor in women less than 41 weeks' gestation; standardizing triage to admit women at greater than or equal to 4 cm dilation; and increasing the use of intermittent auscultation as opposed to continuous fetal monitoring for fetal surveillance. The team also calculated each obstetrician-gynecologist's primary cesarean birth rate monthly and delivered these rates to the providers. Outcomes showed that the provider group decreased its primary cesarean birth rate from 28.9% to 12.2% in the 12-month postprocess measure period. The 57.8% decrease is statistically significant (odds ratio [OR], 0.345; z = 6.52, P < .001; 95% confidence interval [CI], 0.249-0.479). While this quality improvement project cannot be translated to other settings, promotion of physiologic birth practices, along with audit and feedback, had a statistically significant impact on the primary cesarean birth rate for this provider group and, consequently, on the community hospital where they attend births. © 2017 by the American College of Nurse-Midwives.

Perspectives on Promoting Hospital Primary Vaginal Birth: A Qualitative Study.

PubMed

Kennedy, Holly P; Doig, Eleanor; Tillman, Stephanie; Strauss, Amanda; Williams, Beth; Pettker, Christian; Illuzzi, Jessica

2016-12-01

One in three women will deliver by cesarean, a procedure that can be life saving, but which also carries short- and long-term risks. There is growing interest in preventing primary cesarean deliveries, while optimizing the health of the mother and infant. The primary aim of this study was to use participatory action strategies and ethnographic interview data collected from diverse stakeholders in birth (caregivers, women, policymakers) about facilitators and barriers to the achievement of primary vaginal birth in first-time mothers in hospital settings. The secondary aim was to use the findings to identify strategies to promote primary vaginal birth and future areas of research. Individual and small group interviews were conducted with caregivers and policymakers (N = 79) and first-time mothers (N = 24) at a northeastern hospital. All interviews were audio-recorded, transcribed, and analyzed using Atlas.ti. Four broad themes were identified: 1) preparation for childbirth, 2) early labor management, 3) caregiver knowledge and practice style, and 4) birth environment (physical, cultural/emotional). The first two were closely linked from caregivers' perspectives. If the woman was not prepared for childbirth, it was perceived she would be more likely to present to the hospital in early labor. Once there, it was hard to prevent admission and interventions. A woman's knowledge and confidence were perceived as powerful mediators for vaginal birth. Caregivers and first-time mothers identified early labor management and childbirth preparation as important factors to promote primary vaginal birth in hospital settings. Both deserve further inquiry as potential strategies to decrease rising cesarean delivery rates. © 2016 Wiley Periodicals, Inc.

Dinoprostone vaginal insert versus intravenous oxytocin to reduce postpartum blood loss following vaginal or cesarean delivery.

PubMed

Ozalp, E; Tanir, H M; Sener, T

2010-01-01

To compare the impact of a dinoprostone vaginal insert and intravenous oxytocin in reducing blood loss of women undergoing vaginal or cesarean delivery. This study was conducted among term singleton pregnancies delivered vaginally or by elective cesarean section. In the vaginally delivered cases, active management of the third stage of labor was conducted. During cesarean delivery, 20 IU of intravenous oxytocin was administered. Women, who either delivered via the vaginal or abdominal route, were then randomly allocated to receive 10 mg vaginal dinoprostone insert for 12 hours (group I, n: 100) or intravenous oxytocin (group II, n: 100), respectively. Mean blood loss and need for additional uterotonics and postpartum hemoglobin and hematocrit levels at 24 and 36 hours after delivery did not differ between the two groups. Women allocated to the dinoprostone vaginal insert arm experienced more nausea and vomiting. Dinoprostone vaginal insert was as effective as intravenous oxytocin in the prevention of postpartum blood loss.

Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis

PubMed Central

2011-01-01

Background Objective: To compare the risk of placenta previa at second birth among women who had a cesarean section (CS) at first birth with women who delivered vaginally. Methods Retrospective cohort study of 399,674 women who gave birth to a singleton first and second baby between April 2000 and February 2009 in England. Multiple logistic regression was used to adjust the estimates for maternal age, ethnicity, deprivation, placenta previa at first birth, inter-birth interval and pregnancy complications. In addition, we conducted a meta-analysis of the reported results in peer-reviewed articles since 1980. Results The rate of placenta previa at second birth for women with vaginal first births was 4.4 per 1000 births, compared to 8.7 per 1000 births for women with CS at first birth. After adjustment, CS at first birth remained associated with an increased risk of placenta previa (odds ratio = 1.60; 95% CI 1.44 to 1.76). In the meta-analysis of 37 previously published studies from 21 countries, the overall pooled random effects odds ratio was 2.20 (95% CI 1.96-2.46). Our results from the current study is consistent with those of the meta-analysis as the pooled odds ratio for the six population-based cohort studies that analyzed second births only was 1.51 (95% CI 1.39-1.65). Conclusions There is an increased risk of placenta previa in the subsequent pregnancy after CS delivery at first birth, but the risk is lower than previously estimated. Given the placenta previa rate in England and the adjusted effect of previous CS, 359 deliveries by CS at first birth would result in one additional case of placenta previa in the next pregnancy. PMID:22103697

Cesarean Birth Regret and Dissatisfaction: A Qualitative Approach.

PubMed

Burcher, Paul; Cheyney, Melissa J; Li, Kalie N; Hushmendy, Shazeen; Kiley, Kevin C

2016-12-01

The most consistently noted difference between unplanned cesarean and vaginal births is patient dissatisfaction or regret. This has been explored in multiple quantitative studies. However, the causes of this dissatisfaction remain elusive as a result of the limitations of survey instruments that restrict possible choices. Using open-ended, semi-structured interviews (n = 14), the purpose of this study was to identify potentially alterable factors that contribute to cesarean section regret when the surgery is performed during labor. In interviews that took place between 2 and 6 weeks postpartum, patients who had undergone an unscheduled cesarean birth during labor and had volunteered for the study were asked to share the story of their birth. Each participant was prompted to describe her understanding of the indication for her cesarean, and reflect on what felt positive and negative about her experience. Using consensus coding, three investigators independently evaluated the transcribed interviews, identifying recurring themes that were then discussed until consensus on the major themes was achieved. Four key themes emerged from patients' unplanned cesarean narratives: poor communication, fear of the operating room, distrust of the medical team, and loss of control. Lack of or incomplete trust in care providers was a new factor not previously recognized as a cause of distress or dissatisfaction in the literature to date. The four factors identified in this study are all potentially ameliorable, suggesting that changes in physician behavior may reduce patient dissatisfaction with unplanned cesarean birth. © 2016 Wiley Periodicals, Inc.

Simulation to Improve Trainee Knowledge and Comfort About Twin Vaginal Birth.

PubMed

Easter, Sarah Rae; Gardner, Roxane; Barrett, Jon; Robinson, Julian N; Carusi, Daniela

2016-10-01

To describe a simulation-based curriculum on twin vaginal delivery and evaluate its effects on trainee knowledge and comfort about twin vaginal birth. Trainees participated in a three-part simulation consisting of a patient counseling session, a twin delivery scenario, and a breech extraction skills station. Consenting trainees completed a 21-item presimulation survey and a 22-item postsimulation survey assessing knowledge, experience, attitudes, and comfort surrounding twin vaginal birth. Presimulation and postsimulation results were compared using univariate analysis. Our primary outcomes were change in knowledge and comfort before and after the simulation. Twenty-four obstetrics and gynecology residents consented to participation with 18 postsimulation surveys available for comparison (75%). Trainees estimated their participation in 445 twin deliveries (median 19, range 0-52) with only 20.4% of these as vaginal births. Participants reported a need for more didactic or simulated training on this topic (64% and 88%, respectively). Knowledge about twin delivery improved after the simulation (33.3% compared with 58.3% questions correct, P<.01). Before training, 33.3% of participants reported they would strongly counsel a patient to attempt vaginal birth instead of elective cesarean delivery for twins compared with 50% after training (P=.52). Personal comfort with performing a breech extraction of a nonvertex second twin improved from 5.5% to 66.7% after the simulation (P<.01). Resident exposure to twin vaginal birth is infrequent and variable with a demonstrable need for more training. Our contemporary obstetric climate is prioritizing vaginal birth despite less frequent operative obstetric interventions. We describe a reproducible twin delivery simulation associated with a favorable effect on resident knowledge and comfort levels.

Labor Nurses' Views of Their Influence on Cesarean Birth.

PubMed

Simpson, Kathleen Rice; Lyndon, Audrey

As part of an ongoing study about nurse staffing during labor and birth sponsored by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), outcomes that may be linked to aspects of labor nursing were considered. The purpose of this study was to see if labor nurses felt they influenced whether a woman has a cesarean birth. These data were used to determine if cesarean birth should be included as an outcome measure in the multistate labor nurse staffing study. Focus groups were used to explore the role of labor nurses and cesarean birth. Participants were attending the AWHONN national convention in 2015. Two open-ended questions were asked: 1) Do labor nurses influence whether a woman has a cesarean? 2) What specific things do you do as a labor nurse to help a woman avoid a cesarean? Two focus groups were held (n = 15 and n = 9). Nurses overwhelmingly agreed nursing care can influence mode of birth. They described multiple strategies routinely used to help a woman avoid a cesarean, which were categorized into three main themes: support, advocacy, and interactions with physicians. Support was emotional, informational, and physical. Advocacy involved advocating for women and helping women advocate for themselves. Nurses tried to focus on positive aspects of labor progress when communicating with physicians. Descriptions of interactions with some physicians implied less than optimal teamwork and lack of collaboration. Labor nurses are likely influential in whether some women have a cesarean. They reported consistently taking an active role to help women avoid a cesarean. Promoting vaginal birth as appropriate to the clinical situation was a high priority. Trust, partnership, and respect for roles and responsibilities of each discipline were not evident in some of the clinical situations nurses described.

Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.

PubMed

Haas, David M; Morgan, Sarah; Contreras, Karenrose

2014-09-09

Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (21 July 2014). We included randomized and quasi-randomized trials assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. We independently assessed eligibility and quality of the studies. Five trials randomizing 1946 women (1766 analyzed) evaluated the effects of vaginal cleansing (all with povidone-iodine) on post-cesarean infectious morbidity. The risk of bias was generally low, with the quality of most of the studies being high. Vaginal preparation immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 7.2% in control groups to 3.6% in vaginal cleansing groups (average risk ratio (RR) 0.39, 95% confidence interval (CI) 0.16 to 0.97, five trials, 1766 women). The risk reduction was particularly strong for women with ruptured membranes (1.4% in the vaginal cleansing group versus 15.4% in the control group; RR 0.13, 95% CI 0.02 to 0.66, two trials, 148 women). No other outcomes realized statistically significant differences between the vaginal cleansing and control groups. No adverse effects were reported with the povidone-iodine vaginal cleansing.The quality of the evidence using GRADE was low for post-cesarean endometritis

Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.

PubMed

Haas, David M; Morgan, Sarah; Contreras, Karenrose

2014-12-21

Cesarean delivery is one of the most common surgical procedures performed by obstetricians. Infectious morbidity after cesarean delivery can have a tremendous impact on the postpartum woman's return to normal function and her ability to care for her baby. Despite the widespread use of prophylactic antibiotics, postoperative infectious morbidity still complicates cesarean deliveries. To determine if cleansing the vagina with an antiseptic solution before a cesarean delivery decreases the risk of maternal infectious morbidities, including endometritis and wound complications. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 December 2014). We included randomized and quasi-randomized trials assessing the impact of vaginal cleansing immediately before cesarean delivery with any type of antiseptic solution versus a placebo solution/standard of care on post-cesarean infectious morbidity. We independently assessed eligibility and quality of the studies. Seven trials randomizing 2816 women (2635 analyzed) evaluated the effects of vaginal cleansing (all with povidone-iodine) on post-cesarean infectious morbidity. The risk of bias was generally low, with the quality of most of the studies being high. Vaginal preparation immediately before cesarean delivery significantly reduced the incidence of post-cesarean endometritis from 8.3% in control groups to 4.3% in vaginal cleansing groups (average risk ratio (RR) 0.45, 95% confidence interval (CI) 0.25 to 0.81, seven trials, 2635 women). The risk reduction was particularly strong for women who were already in labor at the time of the cesarean delivery (7.4% in the vaginal cleansing group versus 13.0% in the control group; RR 0.56, 95% CI 0.34 to 0.95, three trials, 523 women) and for women with ruptured membranes (4.3% in the vaginal cleansing group versus 17.9% in the control group; RR 0.24, 95% CI 0.10 to 0.55, three trials, 272 women). No other outcomes realized statistically significant

Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section.

PubMed

Kayman-Kose, Seda; Arioz, Dagistan Tolga; Toktas, Hasan; Koken, Gulengul; Kanat-Pektas, Mine; Kose, Mesut; Yilmazer, Mehmet

2014-10-01

The present study aims to determine the efficiency and reliability of transcutaneous electrical nerve stimulation (TENS) in the management of pain related with uterine contractions after vaginal delivery and the pain related with both abdominal incision uterine contractions after cesarean section. A hundred healthy women who underwent cesarean section under general anesthesia were randomly assigned to the placebo group (Group 1) or the TENS group (Group 2), while 100 women who delivered by vaginal route without episiotomy were randomized into the placebo group (Group 3) or the TENS group (Group 4). The patients in Group 2 had statistically lower visual analog scale (VAS) and verbal numerical scale (VNS) scores than the patients in Group 1 (p < 0.001 for both). The patients in Group 4 had statistically lower VAS and VNS scores than the patients in Group 3 (p = 0.022 and p = 0.005, respectively). The analgesic requirement at the eighth hour of cesarean section was significantly lower in the patients who were treated with TENS (p = 0.006). The need for analgesics at the eighth hour of vaginal delivery was statistically similar in the patients who were treated with TENS and the patients who received placebo (p = 0.830). TENS is an effective, reliable, practical and easily available modality of treatment for postpartum pain.

Circulating maternal cortisol levels during vaginal delivery and elective cesarean section.

PubMed

Stjernholm, Ylva Vladic; Nyberg, Annie; Cardell, Monica; Höybye, Charlotte

2016-08-01

Maternal S-cortisol levels increase throughout pregnancy and peak in the third trimester. Even higher levels are seen during the physical stress of delivery. Since analgesia for women in labor has improved, it is possible that maternal stress during labor is reduced. The aim of this study was to compare maternal S-cortisol during vaginal delivery and elective cesarean section. Twenty healthy women with spontaneous vaginal delivery and healthy women (n = 20) undergoing elective cesarean section were included in the study. S-cortisol was measured during three stages of spontaneous vaginal delivery (tvd1, tvd2 and tvd3), as well as before and after elective cesarean section (tcs1 and tcs2). In the vaginal delivery group, mean S-cortisol at tvd1 was 1325 ± 521 nmol/L, at tvd2 1559 ± 591 nmol/L and at tvd3 1368 ± 479 nmol/L. In the cesarean section group, mean S-cortisol at tcs1 was 906 ± 243 nmol/L and at tcs2 831 ± 257 nmol/L. S-cortisol was higher in the vaginal delivery group at the onset of labor as compared to the cesarean section preoperative group (p = 0.006). There were also significant differences between S-cortisol levels postpartum as compared to postoperatively (p < 0.001). Maternal S-cortisol was higher during vaginal delivery compared to elective cesarean section, indicating higher stress levels. A reduction in the hydrocortisone dose at childbirth in women with adrenal insufficiency should be considered, particularly in women undergoing an elective cesarean section.

Cervical dilation at the time of cesarean section for dystocia -- effect on subsequent trial of labor.

PubMed

Abildgaard, Helle; Ingerslev, Marie Diness; Nickelsen, Carsten; Secher, Niels Joergen

2013-02-01

To investigate the effect of cervical dilation at the time of cesarean section due to dystocia and success in a subsequent pregnancy of attempted vaginal delivery. Retrospective study. University hospital in Copenhagen capital area. All women with a prior cesarean section due to dystocia who had undergone a subsequent pregnancy with a singleton delivery during 2006-2010. Medical records were reviewed for prior vaginal birth, cervical dilation reached before cesarean section and induction of labor, gestational age, use of oxytocin, epidural anesthesia and mode of birth was collected. A total of 889 women were included; 373 had had a trial of labor. The success rate for vaginal birth among women with prior cesarean section for dystocia at 4-8 cm dilation was 39%, but 59% for women in whom prior cesarean section had been done at a fully or almost fully dilated cervix (9-10 cm) (p < 0.001). Among the women with a previous vaginal delivery prior to their cesarean section, the success rate for vaginal birth was 76.2%, in contrast to 48.9% in the group without a previous vaginal delivery (p < 0.01). Women who had a trial of labor after a prior cesarean section for dystocia done late in labor and women with a vaginal delivery prior to their cesarean section had a greater chance of a successful vaginal birth during a subsequent delivery. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Birth by Cesarean Section, Allergic Rhinitis, and Allergic Sensitization among Children with Parental History of Atopy

PubMed Central

Pistiner, Michael; Gold, Diane R.; Abdulkerim, Hassen; Hoffman, Ellaine; Celedón, Juan C.

2016-01-01

Background Cesarean delivery may alter neonatal immune responses and increase the risk of atopy. Studies of the relation between cesarean delivery and allergic diseases in children not selected on the basis of a family history of atopy have yielded inconsistent findings. Objective To examine the relation between birth by cesarean delivery and atopy and allergic diseases in children at risk for atopy. Methods We examined the relation between mode of delivery and the development of atopy and allergic diseases among 432 children with parental history of atopy followed from birth to age 9 years. Asthma was defined as physician-diagnosed asthma and wheeze in the previous year and allergic rhinitis as physician-diagnosed allergic rhinitis and naso-ocular symptoms apart from colds in the previous year. Atopy was considered present at school age if there was >=1 positive skin test or specific IgE to common allergens. Stepwise logistic regression was used to study the relation between cesarean delivery and the outcomes of interest. Results After adjustment for other covariates, children born by cesarean section had twofold higher odds of atopy than those born by vaginal delivery (OR=2.1, 95% CI=1.1–3.9). In multivariate analyses, birth by cesarean section was significantly associated with increased odds of allergic rhinitis (OR=1.8, 95% CI=1.0–3.1) but not with asthma. Conclusions Our findings suggest that cesarean delivery is associated with allergic rhinitis and atopy among children with parental history of asthma or allergies. This could be explained by lack of contact with the maternal vaginal/fecal flora or reduced/absent labor during cesarean delivery. Clinical Implications Potential development of allergic diseases should be considered as a potential risk of cesarean delivery among children with parental history of atopy. Capsule Summary Cesarean delivery may lead to an increased risk of allergic rhinitis and atopy in children with parental history of atopy. PMID

The Green Bay cesarean section study. III. Falling cesarean birth rates without a formal curtailment program.

PubMed

Sandmire, H F; DeMott, R K

1994-06-01

We observed decreases in cesarean birth rates at two Green Bay hospitals after the 1990 publication of our first cesarean section study. The purpose of this study was to determine the causes of those decreases and to see whether any outcome changes occurred with lower rates. An additional objective was to determine the perceptions of the 10 physicians regarding the determinants of cesarean birth rates. We compared recent cesarean birth rates (1990 to 1992) to former rates (1986 to 1988) for 10 of the 11 physicians analyzed in our previous studies. Newborn outcomes were analyzed to determine whether variations occur in comparing low to high cesarean rate physician groups. The total, primary, and repeat cesarean birth rates declined from 13.3% to 10.2%, 8.6% to 6.8%, and 4.7% to 3.4%, respectively, between 1986 to 1988 and 1990 to 1992. Variations in cesarean rates occurred among physicians and groups of physicians. Higher cesarean rates did not result in better perinatal outcome. Literature reports, residency training, continuing medical education attendance, and liability risks were the major determinants of cesarean birth as perceived by the 10 physicians in the study. The least important determinant, rated fifteenth of 15, was the national cesarean birth rate.

Arterial oxygen saturation and heart rate after birth in newborns with and without maternal bonding.

PubMed

Bancalari, Aldo; Araneda, Heriberto; Echeverría, Patricia; Alvear, Marina; Romero, Luzmira

2016-10-01

The aim of this study was to determine and compare changes in arterial oxygen saturation (SpO 2 ) and heart rate (HR) in healthy term infants with and without maternal bonding. This was a prospective observational study in healthy term infants. SpO 2 and HR were recorded from 1 to 10 min after birth. After this, SpO 2 and HR were registered at 15, 30 and 60 min and then at 12 and 24 h after birth. SpO 2 and HR were measured with a pulse oximeter. A total of 216 healthy term infants were divided into three different groups: 136 (63%) born by vaginal delivery, 56 (26%) born by cesarean section with bonding, and 24 (11%) born by cesarean section without bonding. No difference in SpO 2 was found in babies born by cesarean section with or without maternal bonding. In neonates delivered vaginally, SpO 2 was significantly higher during the first 10 min after birth than in neonates born by cesarean section with bonding (P < 0.05). Compared with infants born by cesarean section without bonding, this tendency was not significant. In general, HR was similar across groups, although, for infants born by cesarean section, neonates who received bonding had lower HR from 6 to 8 min (P < 0.05). In healthy term newborns, maternal bonding in infants born by cesarean section did not have effects on SpO 2 . Some differences were observed in HR between infants born by cesarean section with and without bonding. © 2016 Japan Pediatric Society.

Modeling the Cost-Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery.

PubMed

Kozhimannil, Katy B; Hardeman, Rachel R; Alarid-Escudero, Fernando; Vogelsang, Carrie A; Blauer-Peterson, Cori; Howell, Elizabeth A

2016-03-01

One in nine US infants is born before 37 weeks' gestation, incurring medical costs 10 times higher than full-term infants. One in three infants is born by cesarean; cesarean births cost twice as much as vaginal births. We compared rates of preterm and cesarean birth among Medicaid recipients with prenatal access to doula care (nonmedical maternal support) with similar women regionally. We used data on this association to mathematically model the potential cost-effectiveness of Medicaid coverage of doula services. Data came from two sources: all Medicaid-funded, singleton births at hospitals in the West North Central and East North Central US (n = 65,147) in the 2012 Nationwide Inpatient Sample, and all Medicaid-funded singleton births (n = 1,935) supported by a community-based doula organization in the Upper Midwest from 2010 to 2014. We analyzed routinely collected, de-identified administrative data. Multivariable regression analysis was used to estimate associations between doula care and outcomes. A probabilistic decision-analytic model was used for cost-effectiveness estimates. Women who received doula support had lower preterm and cesarean birth rates than Medicaid beneficiaries regionally (4.7 vs 6.3%, and 20.4 vs 34.2%). After adjustment for covariates, women with doula care had 22 percent lower odds of preterm birth (AOR 0.77 [95% CI 0.61-0.96]). Cost-effectiveness analyses indicate potential savings associated with doula support reimbursed at an average of $986 (ranging from $929 to $1,047 across states). Based on associations between doula care and preterm and cesarean birth, coverage reimbursement for doula services would likely be cost saving or cost-effective for state Medicaid programs. © 2016 Wiley Periodicals, Inc.

Modeling the cost effectiveness of doula care associated with reductions in preterm birth and cesarean delivery

PubMed Central

Kozhimannil, Katy B; Hardeman, Rachel R.; Alarid-Escudero, Fernando; Vogelsang, Carrie; Blauer-Peterson, Cori; Howell, Elizabeth A.

2017-01-01

Background One in nine US infants is born before 37 weeks gestation, incurring medical costs 10 times higher than full-term infants. One in three infants is born by cesarean; cesarean births cost twice as much as vaginal births. We compared rates of preterm and cesarean birth among Medicaid recipients with prenatal access to doula care (non-medical maternal support) with similar women regionally. We used data on this association to mathematically model the potential cost effectiveness of Medicaid coverage of doula services. Methods Data came from two sources: all Medicaid-funded, singleton births at hospitals in the West North Central and East North Central US (n=65,147) in the 2012 Nationwide Inpatient Sample, and all Medicaid-funded singleton births (n=1,935) supported by a community-based doula organization in the Upper Midwest from 2010–2014. We analyzed routinely collected, de-identified administrative data. Multivariable regression analysis was used to estimate associations between doula care and outcomes. A probabilistic decision-analytic model was used for cost-effectiveness estimates. Results Women who received doula support had lower preterm and cesarean birth rates than Medicaid beneficiaries regionally (4.7% vs. 6.3%, and 20.4% vs. 34.2%). After adjustment for covariates, women with doula care had 22% lower odds of preterm birth (AOR=0.77, 95% CI[0.61–0.96]). Cost-effectiveness analyses indicate potential savings associated with doula support reimbursed at an average of $986, (ranging from $929 to $1,047 across states). Conclusions Based on associations between doula care and preterm and cesarean birth, coverage reimbursement for doula services would likely be cost saving or cost effective for state Medicaid programs. PMID:26762249

Postnatal Unit Bassinet Types When Rooming-In After Cesarean Birth: Implications for Breastfeeding and Infant Safety

PubMed Central

Tully, Kristin P.; Ball, Helen L.

2013-01-01

Background Postnatal unit rooming-in promotes breastfeeding. Previous research indicates that side-cars (three-sided bassinets that lock onto the maternal bed-frame) faciliate breastfeeding after vaginal birth more than stand-alone bassinets (standard rooming-in). No study has previously investigated side-car bassinet use after cesarean, despite the constraints on maternal-infant interactions that are inherent in recovery from this birth mode. Objective To test the effect of the side-car bassinet on postnatal unit breastfeeding frequency and other maternal-infant behaviors compared to a stand-alone bassinet following cesarean birth. Methods Participants were recruited and prenatally randomized to receive the side-car or stand-alone bassinet for their postnatal unit stay between January 2007 and March 2009 in Northeast England. Mother-infant interactions were filmed over the second postpartum night. Participants completed face-to-face interviews before and after filming. The main outcome measures were infant location, bassinet acceptability, and breastfeeding frequency. Other outcomes assessed were breastfeeding effort, maternal-infant contact, sleep states, midwife presence, and infant risk. Results Differences in breastfeeding frequency, maternal-infant sleep overlap, and midwife presence were not statistically significant. The 20 dyads allocated to side-car bassinets breastfed a median of 0.6 bouts/ hour compared to 0.4 bouts/hour for the 15 stand-alone bassinet dyads. Participants expressed overwhelming preference for the side-car bassinets. Bedsharing was equivalent between the groups, although the motivation for this practice may have differed. Infant handling was compromised with stand-alone bassinet use, including infants positioned on pillows while bedsharing with their sleeping mothers. Conclusions Women preferred the side-car but differences in breastfeeding frequency were not significant. More infant risks were observed with stand-alone bassinet use

After a Cesarean…What's a Birth Professional to Do?

PubMed Central

Andrews, Desirre; Humphries, Gretchen

2010-01-01

The discrepancy between the evidence supporting vaginal birth after cesarean and actual medical practice illuminates the larger issues of evidence-based care versus current obstetrical practice. Although the reasons for the disconnect between what we know to be healthy birth practices and what women actually experience are multiple and complex, a commitment to providing accurate education, truly client-centered support, and active patient advocacy will give women the ability to insist on best practice care for themselves and their babies. The International Cesarean Awareness Network believes that all childbirth professionals and advocates share a responsibility to promote change and must work together to be effective. PMID:21358830

[Pregnancy and delivery in patients with a personal history of cesarean section in Dakar: epidemiological, clinical, therapeutic and prognostic aspects].

PubMed

Koulimaya-Gombet, Cyr Espérance; Diouf, Abdoul Aziz; Diallo, Moussa; Dia, Anna; Sène, Codou; Moreau, Jean Charles; Diouf, Alassane

2017-01-01

The aim of our study was to determine hospitalization rate for vaginal birth after cesarean section in Pikine, to evaluate the quality of the management of pregnant women with previous cesarean section and to determine prognostic factors of the outcome of a trial of scar. We conducted a retrospective study based on medical records and operational protocols of patients who underwent vaginal birth after cesarean section over the period 1 January 2010 - 31 December 2011. We analyzed socio-demographic data, pregnancy follow-up, therapeutic modalities and prognosis. Data were collected and analyzed using Microsoft Office Excel 2007 software and SPSS software 17.0. The frequency of vaginal births after cesarean section was 9.6%. The average age of our patients was 29.4 years. Primiparous women accounted for 54%. Short spacing interval between births was found in 52.6% of cases. Based on the number of cesarean sections, the breakdown was as follows: patients with a history of one previous cesarean section (79.8%), patients with a history of two previous caesarean sections (17.9%) and patients with a history of three previous caesarean sections (2.3%). The number of antenatal consultations performed was greater than or equal to 3 in 79.8% of cases. Patients undergoing evacuation accounted for 54.2% and they were already in labor at the time of admission in 81.7% of cases. Trial of scar was authorized in 177 patients (34.3%) and, at the end of this test, 147 patients (83%) had vaginal birth, of whom 21.7% by vacuum extraction. Cesarean section was performed in 71.4% of cases with 245 emergency cesarean sections and 93 scheduled cesarean sections. A history of vaginal birth was a determining factor in normal delivery (p = 0.0001). There was also a significant relationship between mode of admission and decision to perform a cesarean section (p = 0.0001). Maternal mortality was 0.4%. Perinatal mortality rate was 28.2‰ of live births. We are witnessing a dramatic increase of

Vaginal Cleansing Before Cesarean Delivery: A Systematic Review and Meta-analysis.

PubMed

Caissutti, Claudia; Saccone, Gabriele; Zullo, Fabrizio; Quist-Nelson, Johanna; Felder, Laura; Ciardulli, Andrea; Berghella, Vincenzo

2017-09-01

To assess the efficacy of vaginal cleansing before cesarean delivery in reducing postoperative endometritis. MEDLINE, Ovid, EMBASE, Scopus, Clinicaltrials.gov, and Cochrane Library were searched from their inception to January 2017. Selection criteria included all randomized controlled trials comparing vaginal cleansing (ie, intervention group) with a control group (ie, either placebo or no intervention) in women undergoing cesarean delivery. Any method of vaginal cleansing with any type of antiseptic solution was included. The primary outcome was the incidence of endometritis. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of relative risk (RR) with 95% CI. Sixteen trials (4,837 women) on vaginal cleansing immediately before cesarean delivery were identified as relevant and included in the review. In most of the included studies, 10% povidone-iodine was used as an intervention. The most common way to perform the vaginal cleansing was the use of a sponge stick for approximately 30 seconds. Women who received vaginal cleansing before cesarean delivery had a significantly lower incidence of endometritis (4.5% compared with 8.8%; RR 0.52, 95% CI 0.37-0.72; 15 studies, 4,726 participants) and of postoperative fever (9.4% compared with 14.9%; RR 0.65, 95% CI 0.50-0.86; 11 studies, 4,098 participants) compared with the control group. In the planned subgroup analyses, the reduction in the incidence of endometritis with vaginal cleansing was limited to women in labor before cesarean delivery (8.1% compared with 13.8%; RR 0.52, 95% CI 0.28-0.97; four studies, 440 participants) or those with ruptured membranes (4.3% compared with 20.1%; RR 0.23, 95% CI 0.10-0.52; three studies, 272 participants). Vaginal cleansing immediately before cesarean delivery in women in labor and in women with ruptured membranes reduces the risk of postoperative endometritis. Because it is generally inexpensive and a

Pineal melatonin and the innate immune response: the TNF-alpha increase after cesarean section suppresses nocturnal melatonin production.

PubMed

Pontes, Gerlândia N; Cardoso, Elaine C; Carneiro-Sampaio, Magda M S; Markus, Regina P

2007-11-01

The nocturnal surge of melatonin is the endocrine expression of the circadian system and is essential for organizing the timing of various endogenous processes. Previous works suggest that, in the beginning of a defense response, the increase in circulating tumor necrosis factor-alpha (TNF-alpha) leads to a transient block of nocturnal melatonin production and promotes a disruption of internal time organization. In the present paper, the concentration of melatonin and cytokines [TNF-alpha, interferon-gamma (IFN-gamma), interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12] in the colostrum (postdelivery day 3) and in the milk (postdelivery days 10, 15, 20 and 30) obtained at midday and midnight from mothers who gave birth by vaginal or cesarean section were compared. The nocturnal melatonin surge observed 3 days after vaginal delivery was absent after cesarean section. IL-12 presented no daily variation in either case, while daily variations in IFN-gamma, IL-10, IL-4 and IL-5 were observed after vaginal delivery and cesarean section. On the other hand, the increase in TNF-alpha after cesarean section resulted in suppression of the nocturnal melatonin surge. Daily variation of IL-2 was only observed after recovery of the nocturnal melatonin surge, 30 days after cesarean section. The present paper supports the hypothesis of a cross-talk between the pineal gland and the immune system, which could represent a putative immune-pineal axis.

Urinary incontinence after vaginal delivery or cesarean section.

PubMed

Borges, João Bosco Ramos; Guarisi, Telma; Camargo, Ana Carolina Marchesini de; Gollop, Thomaz Rafael; Machado, Rogério Bonassi; Borges, Pítia Cárita de Godoy

2010-06-01

To assess the prevalence of stress urinary incontinence, urge incontinence and mixed urinary incontinence among women residing in the city of Jundiaí (São Paulo, Brazil), and the relation between the type of incontinence and the obstetric history of these women. A cross-sectional community-based study was conducted. A total of 332 women were interviewed; they were seen for whatever reason at the public primary healthcare units of the city of Jundiaí, from March 2005 to April 2006. A pre-tested questionnaire was administered and consisted of questions used in the EPINCONT Study (Epidemiology of Incontinence in the County of Nord-Trondelag). Statistical analysis was carried out using the χ2 test and odds ratio (95%CI). Urinary incontinence was a complaint for 23.5% of the women interviewed. Stress urinary incontinence prevailed (50%), followed by mixed urinary incontinence (35%) and urge incontinence (15%). Being in the age group of 35-64 years, having a body mass index of 30 or greater and having had only vaginal delivery or cesarean section, with uterine contraction, regardless of the number of pregnancies, were factors associated with stress urinary incontinence. However, being in the age group of 55 or older, having a body mass index of 30 or greater and having had three or more pregnancies, only with vaginal deliveries, were factors associated with mixed urinary incontinence. One third of the interviewees complained of some type of urinary incontinence, and half of them presented stress urinary incontinence. Cesarean section, only when not preceded by contractions, was not associated with stress urinary incontinence. The body mass index is only relevant when the stress factor is present.

National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births-Supporting Intended Vaginal Births.

PubMed

Lagrew, David C; Low, Lisa Kane; Brennan, Rita; Corry, Maureen P; Edmonds, Joyce K; Gilpin, Brian G; Frost, Jennifer; Pinger, Whitney; Reisner, Dale P; Jaffer, Sara

2018-03-01

Cesarean births and associated morbidity and mortality have reached near epidemic proportions. The National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care responded by developing a patient safety bundle to reduce the number of primary cesarean births. Safety bundles outline critical practices to implement in every maternity unit. This National Partnership for Maternity Safety bundle, as with other bundles, is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Bundle components may be adapted to individual facilities, but standardization within an institution is advised. Evidence-based resources and recommendations are provided to assist implementation.

College students' knowledge and attitudes about cesarean birth.

PubMed

Lampman, C; Phelps, A

1997-09-01

Numerous clinicians and researchers have expressed concern about the necessity and potential adverse consequences of many cesarean births in the United States. The purpose of this study was to explore college students' attitudes and beliefs about cesarean section. One hundred two college students (66% women) completed a 20-item questionnaire that asked if they viewed cesarean delivery as a potentially negative experience, as a normal or acceptable method of childbirth, and as medically necessary, and asked about their beliefs concerning risk and prevention of cesarean birth. The number of "undecided" responses in the study was striking (7.8% to 69.6% across the 20 items). In general, women and men responded similarly, although women were significantly more likely than men to say they would be profoundly disappointed if their babies had to be delivered by cesarean section. Despite expressing cynicism about the cesarean birth rate (40% agreed that many unnecessary cesarean births occurred) and not viewing the procedure as a normal way of giving birth (47%), most respondents (over 70%) disagreed that giving birth by cesarean would be a negative experience or would make a woman feel like a failure. A high level of uncertainty exists about certain aspects of cesarean birth among young women and men, highlighting the need for information for prospective parents. Most college students did not view the cesarean birth experience as either potentially negative or normal. Future research should explore coverage of cesarean birth in childbirth education classes and the roles physicians, nurses, and midwives play in preparing expectant parents for the possibility of cesarean delivery.

Maternal and neonatal copeptin levels at cesarean section and vaginal delivery.

PubMed

Foda, Ashraf A; Abdel Aal, Ibrahim A

2012-12-01

The objective of the study was to measure the copeptin levels in maternal serum and umbilical cord serum at cesarean section and vaginal delivery in normotensive pregnancy and pre-eclamptic women. This was a prospective study at Mansoura University Hospital, Egypt. Ninety cases were included. They were divided into six groups: (1) normal pregnancy near term, as a control group, (2) primiparas who had vaginal delivery, (3) primiparas who had vaginal delivery and mild preeclampsia, (4) elective repeat cesarean section, (5) intrapartum cesarean section for indications other than fetal distress, and (6) intrapartum cesarean section for fetal distress. Serum copeptin concentrations were quantified with an enzyme-linked immunosorbent assay (ELISA). Mean, standard deviation, and paired t-test were used to test for significant change in quantitative data. The vaginal delivery groups had higher levels of maternal serum copeptin than the elective cesarean section group (P<0.01). Higher maternal serum copeptin levels were found in cases with pre-eclampsia as compared with the normotensive cases. The maternal copeptin levels during intrapartum cesarean section were higher than that during elective repeat cesarean section. There was a significant correlation between maternal copeptin levels and the duration of the first stage. In the presence of fetal distress, umbilical cord serum copeptin levels were significantly higher than other groups. Vaginal delivery can be very painful and stressful, and is accompanied by a marked increase of maternal serum copeptin. Increased maternal levels of serum copeptin were found in cases with pre-eclampsia as compared with the normotensive cases, and it may be helpful in assessing the disease. Intrauterine fetal distress is a strong stimulus to the release of copeptin into the fetal circulation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Vaginal birth after caesarean delivery in Chinese women and Western immigrants in Shanghai.

PubMed

Minsart, Anne-Frederique; Liu, Hau; Moffett, Shannon; Chen, Crystal; Ji, Ninni

2017-05-01

Recent studies show a steep rise in caesarean sections in China. Most couples are now eligible to apply for a second child. This retrospective cohort study compares the prevalence of trial of labour and vaginal birth after caesarean section among Chinese and foreign women in Shanghai. In total, 135 of 368 women underwent trial of labour (36.68%), and of those, 77 (57.04%) had a vaginal birth. After inclusion in a multivariate model, factors associated with trial of labour were maternal age <35 years with an adjusted odds ratio of 2.58 (1.49-4.46), absence of a history of ≥3 abortions (2.22 (1.08-4.57)), and European citizenship (1.94 (1.05-3.59)). The prevalence of trial of labour and vaginal birth seems to mirror rates found in countries of origin, but despite a high rate of caesarean section, Chinese women had a higher rate of vaginal birth after caesarean section than North American and Australian women, in particular. Impact statement What is already known on this subject: Caesarean section (CS) rates are rising worldwide. Repeat CS contributes largely to these rates, although vaginal birth after CS (VBAC) rates varies widely between countries. What the results of this study add: North American and Australian women who deliver in Shanghai have low rates of attempted trial of labour after CS (TOLAC) and VBAC, with European women having the highest rate of TOLAC, followed by Chinese women. Implications for clinical practice and/or further research: These findings might reflect different levels of acceptance in line with respective national trends. Studies evaluating the influence of cultural norms on birth preferences after CS are needed. Further research is also needed to assess the overall acceptance of TOLAC in the context of the softening of the one-child policy in China.

Prevalence of and risk factors associated with cesarean section in Lebanon - A retrospective study based on a sample of 29,270 women.

PubMed

Zgheib, Sandy M; Kacim, Mohammad; Kostev, Karel

2017-12-01

During the last decades, there has been an alarming and dramatic increase in the number of cesarean births in both developed and undeveloped countries. This increase has not been clinically justified but, nevertheless, has raised an important number of issues. The aim of this study was to determine the risk factors associated with the high cesarean section rates in Lebanon. This study is based on a sample of 29,270 Lebanese women who were pregnant between 2000 and 2015. Among these, 14,327 gave birth by cesarean section and 14,943 gave birth vaginally. To identify the risk factors of cesarean section, logistic regression was applied as a statistical method using the SPSS statistical package. Of the 29,270 pregnant women included in the study, 49% had cesarean sections while 51% gave birth vaginally. Repeat cesarean section accounted for 23% while vaginal birth after cesarean accounted for only 0.2% of deliveries. In addition, weekdays were associated with a preference of providers to carry out more cesarean sections. According to an analysis of our data using logistic regression, the risk factors associated with the increase in cesarean section rates were advanced maternal age, elective cesarean section, malpresentation of fetus, multiple birth, prolonged pregnancy, prolonged labor, and fetal distress. Based on these results, it is recommended that a new health policy be implemented to reduce the number of unnecessary cesarean deliveries in Lebanon. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Failed Operative Vaginal Delivery

PubMed Central

Alexander, James M.; Leveno, Kenneth J.; Hauth, John C.; Landon, Mark B.; Gilbert, Sharon; Spong, Catherine Y.; Varner, Michael W.; Caritis, Steve N.; Meis, Paul; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; O'Sullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Gabbe, Steven G.

2010-01-01

Objective To compare maternal and neonatal outcomes in women undergoing a second stage cesarean after a trial of operative vaginal delivery with women undergoing a second stage cesarean without such an attempt. Methods This study is a secondary analysis of the women who underwent second stage cesarean. .The maternal outcomes examined included blood transfusion, endometritis, wound complication, anesthesia use, and maternal death. Infant outcomes examined included umbilical artery pH < 7.0, Apgar of 3 or less at 5 minutes, seizures within 24 hours of birth, hypoxic ischemic encephalopathy (HIE), stillbirth, skull fracture, and neonatal death. Results Of 3189 women who underwent second stage cesarean, operative vaginal delivery was attempted in 640. Labor characteristics were similar in the two groups with the exception of the admission to delivery time and cesarean indication. Those with an attempted operative vaginal delivery were more likely to undergo cesarean delivery for a non-reassuring fetal heart rate tracing (18.0% vs 13.9%, p=.01), have a wound complication (2.7% vs 1.0%; OR 2.65 95% CI 1.43–4.91), and require general anesthesia (8.0% vs 4.1%, OR 2.05 95% CI 1.44–2.91). Neonatal outcomes including umbilical artery pH less than 7.0, Apgar at or below 3 at 5 minutes, and hypoxic ischemic encephalopathy were more common for those with an attempted operative vaginal delivery. This was not significant when cases with a non-reassuring fetal heart rate tracing were removed. Conclusion Cesarean delivery after an attempt at operative vaginal delivery was not associated with adverse neonatal outcomes in the absence of a non-reassuring fetal heart rate tracing. PMID:20168101

Clinical Opinion: "Doing Something" About the Cesarean Delivery Rate.

PubMed

Clark, S L; Garite, T J; Hamilton, E J; Belfort, M A; Hankins, G D

2018-05-04

There is a general consensus that the cesarean delivery rate in the U.S. is too high, and that practice patterns of obstetricians are largely to blame for this situation. In reality, the U.S. cesarean delivery rate is the result of 3 forces largely beyond the control of the practicing clinician: patient expectations and misconceptions regarding the safety of labor, the medical-legal system, and limitations in technology. Efforts to "do something" about the cesarean delivery rate by promulgating practice directives which are marginally evidence-based or influenced by social pressures are both ineffective and potentially harmful. We examine both the recent ACOG/SMFM Care Consensus Statement "Safe Prevention of Primary Cesarean Delivery" document and the various iterations of the ACOG guidelines for vaginal birth after cesarean delivery in this context. Adherence to arbitrary time limits for active phase or second stage arrest without incorporating other clinical factors into the decision making process is unwise. In a similar manner, ever-changing practice standards for vaginal birth after cesarean driven by factors other than changing data are unlikely to be effective in lowering the cesarean delivery rate. Whether too high or too low, the current U.S. cesarean delivery rate is the expected result of the unique demographic, geographic and social forces driving it and is unlikely to change significantly given the limitations of current technology to otherwise satisfy the demands of these forces. Copyright © 2018 Elsevier Inc. All rights reserved.

Perinatal and maternal morbidity and mortality after attempted operative vaginal delivery at midpelvic station

PubMed Central

Muraca, Giulia M.; Sabr, Yasser; Lisonkova, Sarka; Skoll, Amanda; Brant, Rollin; Cundiff, Geoffrey W.; Joseph, K.S.

2017-01-01

BACKGROUND: Increased use of operative vaginal delivery (i.e., forceps or vacuum application), of which 20% occurs at midpelvic station, has been advocated to reduce the rate of cesarean delivery. We aimed to quantify severe perinatal and maternal morbidity and mortality associated with attempted midpelvic operative vaginal delivery. METHODS: We studied all term singleton deliveries in Canada between 2003 and 2013, by attempted midpelvic operative vaginal or cesarean delivery with labour (with and without prolonged second stage). The primary outcomes were composite severe perinatal morbidity and mortality (e.g., convulsions, assisted ventilation, severe birth trauma and perinatal death), and composite severe maternal morbidity and mortality (e.g., severe postpartum hemorrhage, shock, sepsis, cardiac complications, acute renal failure and death). RESULTS: The study population included 187 234 deliveries. Among women with dystocia and prolonged second stage of labour, midpelvic operative vaginal delivery was associated with higher rates of severe perinatal morbidity and mortality compared with cesarean delivery (forceps, adjusted odds ratio [AOR] 1.81, 95% confidence interval [CI] 1.24 to 2.64; vacuum, AOR 1.81, 95% CI 1.17 to 2.80; sequential instruments, AOR 3.19, 95% CI 1.73 to 5.88), especially with higher rates of severe birth trauma. Rates of severe maternal morbidity and mortality were not significantly different after operative vaginal delivery, although rates of obstetric trauma were higher (forceps, AOR 4.51, 95% CI 4.04 to 5.02; vacuum, AOR 2.70, 95% CI 2.35 to 3.09; sequential instruments, AOR 4.24, 95% CI 3.46 to 5.19). Among women with fetal distress, similar associations were seen for severe birth trauma and obstetric trauma, although vacuum was associated with lower rates of severe maternal morbidity and mortality (AOR 0.52, 95% CI 0.33 to 0.80). Associations tended to be stronger among women without a prolonged second stage. INTERPRETATION: Midpelvic

Cesarean Section - Multiple Languages

MedlinePlus

... Translations Your Recovery After Cesarean Birth (Part 1) - English PDF Your Recovery After Cesarean Birth (Part 1) - ... Media Your Recovery After Cesarean Birth (Part 2) - English PDF Your Recovery After Cesarean Birth (Part 2) - ...

Dystocia as a cause of untimely cesarean section.

PubMed

Djurić, Janko; Arsenijević, Slobodan; Banković, Dragic; Protrka, Zoran; Sorak, Marija; Dimitrijević, Aleksandra; Tanasković, Irena

2012-07-01

One of the most frequent indications for cesarean section is dystocia. It is impossible to predict, difficult to identify and coincident with the rapid expiry of the expected time, so it is important to point out some mistakes in expecting vaginal delivery. The aim of this study was to examine the frequency and the length of dystocia-related cesarean delivery, as well as the vitality of the newborn immediately after birth. A prospective 3-year study was conducted including a total number of 6470 deliveries regardless of whether they were completed using cesarean section after an unsuccessful attempt of spontaneous vaginal delivery or not. The Apgar score, a proved useful tool for the assessment of the vitality of newborn children in the first minute, was used. On the basis of the established indications, 653 (10.10%) of deliveries were completed using cesarean section. Dystocia was the third most common indication for cesarean section (16.38%). Deliveries in which dystocia was established as a diagnosis lasted much longer (p = 0.030) which resulted in weaker vitality of newborn children (p = 0.000) compared to the deliveries ended by spontaneous vaginal delivery. This study shows that deliveries caused by dystocia last much longer and newborn children are of weaker vitality compared to other deliveries caused not by dystocia. Decisions concerning cesarean section must be made in a timely fashion.

Financial incentives do not always work: an example of cesarean sections in Taiwan.

PubMed

Lo, Joan C

2008-10-01

To test the hypothesis that cesarean sections are less likely to be performed after equalizing the fees for vaginal births and cesarean sections. Population-based National Health Insurance inpatient claims in Taiwan are used. Pre-periods and post-periods are identified to investigate the impact of the policy changes. Logistic regressions are employed. The cesarean section rates for the first, second and higher-order births are 29, 37.4 and 39.3%, while the primary cesarean section rates are 29, 11.8 and 12.1%, respectively. After taking into consideration the case-mix and birth order, the second and higher-order births were approximately 60% less likely to be cesarean deliveries compared to the first births and the increase in the VBAC fee had an additional negative effect on them. A fee equalization policy was not found to influence the cesarean delivery. The total cesarean section rate was primarily determined by the cesarean section rate for the first birth. Cesarean section rates are greater for the higher-order births because of the practice "once a cesarean section, always a cesarean section". Against the background of a rapidly declining fertility rate, females play a more important role in the mode of delivery than ever before. As such, financial incentives designed specifically for obstetricians do not have the desired impact. Policies that are aimed at altering behavior should be designed within the social context.

Simultaneous uterine and urinary bladder rupture in an otherwise successful vaginal birth after cesarean delivery.

PubMed

Ho, Szu-Ying; Chang, Shuenn-Dhy; Liang, Ching-Chung

2010-12-01

Uterine rupture is the primary concern when a patient chooses a trial of labor after a cesarean section. Bladder rupture accompanied by uterine rupture should be taken into consideration if gross hematuria occurs. We report the case of a patient with uterine rupture during a trial of labor after cesarean delivery. She had a normal course of labor and no classic signs of uterine rupture. However, gross hematuria was noted after repair of the episiotomy. The patient began to complain of progressive abdominal pain, gross hematuria and oliguria. Cystoscopy revealed a direct communication between the bladder and the uterus. When opening the bladder peritoneum, rupture sites over the anterior uterus and posterior wall of the bladder were noted. Following primary repair of both wounds, a Foley catheter was left in place for 12 days. The patient had achieved a full recovery by the 2-year follow-up examination. Bladder injury and uterine rupture can occur at any time during labor. Gross hematuria immediately after delivery is the most common presentation. Cystoscopy is a good tool to identify the severity of bladder injury. Copyright © 2010 Elsevier. Published by Elsevier B.V. All rights reserved.

'Groping through the fog': a metasynthesis of women's experiences on VBAC (Vaginal birth after Caesarean section).

PubMed

Lundgren, Ingela; Begley, Cecily; Gross, Mechthild M; Bondas, Terese

2012-08-21

Vaginal birth after Caesarean section (VBAC) is a relevant question for a large number of women due to the internationally rising Caesarean section (CS) rate. There is a great deal of research based on quantitative studies but few qualitative studies about women's experiences. A metasynthesis based on the interpretative meta ethnography method was conducted. The inclusion criterion was peer-review qualitative articles from different disciplines about women's experiences of VBAC. Eleven articles were checked for quality, and eight articles were included in the synthesis. The included studies were from Australia (four), UK (three), and US (one), and studied women's experience in relation to different aspects of VBAC; decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. The main results are presented with the metaphor groping through the fog; for the women the issue of VBAC is like being in a fog, where decision-making and information from the health care system and professionals, both during pregnancy and the birth, is unclear and contrasting. The results are further presented with four themes: 'to be involved in decision about mode of delivery is difficult but important,' 'vaginal birth has several positive aspects mainly described by women,' 'vaginal birth after CS is a risky project,' and 'own strong responsibility for giving birth vaginally'. In order to promote VBAC, more studies are needed from different maternity settings and countries about women's experiences. Women need evidence-based information not only about the risks involved but also positive aspects of VBAC.

Early Discharge and Home Care After Unplanned Cesarean Birth: Nursing Care Time

PubMed Central

Brooten, Dorothy; Knapp, Helen; Borucki, Lynne; Jacobsen, Barbara; Finkler, Steven; Arnold, Lauren; Mennuti, Michael

2013-01-01

Objective This study examined the mean nursing time spent providing discharge planning and home care to women who delivered by unplanned cesarean birth and examined differences in nursing time required by women with and without morbidity. Design A secondary analysis of nursing time from a randomized trial of transitional care (discharge planning and home follow-up) provided to women after cesarean delivery. Setting An urban tertiary-care hospital. Patients The sample (N = 61) of black and white women who had unplanned cesarean births and their full-term newborns was selected randomly. Forty-four percent of the women had experienced pregnancy complications. Interventions Advanced practice nurses provided discharge planning and 8-week home follow-up consisting of home visits, telephone outreach, and daily telephone availability. Outcome Measure Nursing time required was dictated by patient need and provider judgment rather than by reimbursement plan. Results More than half of the women required more than two home visits; mean home visit time was 1 hour. For women who experienced morbidity mean discharge planning time was 20 minutes more and mean home visit time 40 minutes more. Conclusions Current health care services that provide one or two 1-hour home visits to childbearing women at high risk may not be meeting the education and resource needs of this group. PMID:8892128

Variation in Cesarean Birth Rates by Labor and Delivery Nurses.

PubMed

Edmonds, Joyce K; O'Hara, Michele; Clarke, Sean P; Shah, Neel T

To examine variation in the cesarean birth rates of women cared for by labor and delivery nurses. Retrospective cohort study. One high-volume labor and delivery unit at an academic medical center in a major metropolitan area. Labor and delivery nurses who cared for nulliparous women who gave birth to term, singleton fetuses in vertex presentation. Data were extracted from electronic hospital birth records from January 1, 2013 through June 30, 2015. Cesarean rates for individual nurses were calculated based on the number of women they attended who gave birth by cesarean. Nurses were grouped into quartiles by their cesarean rates, and the effect of these rates on the likelihood of cesarean birth was estimated by a logit regression model adjusting for patient-level characteristics and clustering of births within nurses. Seventy-two nurses attended 3,031 births. The mean nurse cesarean rate was 26% (95% confidence interval [23.9, 28.1]) and ranged from 8.3% to 48%. The adjusted odds of cesarean for births attended by nurses in the highest quartile was nearly 3 times (odds ratio = 2.73, 95% confidence interval [2.3, 3.3]) greater than for births attended by nurses in the lowest quartile. The labor and delivery nurse assigned to a woman may influence the likelihood of cesarean birth. Nurse-level cesarean birth data could be used to design practice improvement initiatives to improve nurse performance. More precise measurement of the relative influence of nurses on mode of birth is needed. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Labor induction and cesarean delivery: A prospective cohort study of first births in Pennsylvania, USA.

PubMed

Kjerulff, Kristen H; Attanasio, Laura B; Edmonds, Joyce K; Kozhimannil, Katy B; Repke, John T

2017-09-01

Mode of delivery at first childbirth largely determines mode of delivery at subsequent births, so it is particularly important to understand risk factors for cesarean delivery at first childbirth. In this study, we investigated risk factors for cesarean delivery among nulliparous women, with focus on the association between labor induction and cesarean delivery. A prospective cohort study of 2851 nulliparous women with singleton pregnancies who attempted vaginal delivery at hospitals in Pennsylvania, 2009-2011, was conducted. We used nested logistic regression models and multiple mediational analyses to investigate the role of three groups of variables in explaining the association between labor induction and unplanned cesarean delivery-the confounders of maternal characteristics and indications for induction, and the mediating (intrapartum) factors-including cervical dilatation, labor augmentation, epidural analgesia, dysfunctional labor, dystocia, fetal intolerance of labor, and maternal request of cesarean during labor. More than a third of the women were induced (34.3%) and 24.8% underwent cesarean delivery. Induced women were more likely to deliver by cesarean (35.9%) than women in spontaneous labor (18.9%), unadjusted OR 2.35 (95% CI 1.97-2.79). The intrapartum factors significantly mediated the association between labor induction and cesarean delivery (explaining 76.7% of this association), particularly cervical dilatation <3 cm at hospital admission, fetal intolerance of labor, and dystocia. The indications for labor induction only explained 6.2%. Increased risk of cesarean delivery after labor induction among nulliparous women is attributable mainly to lower cervical dilatation at hospital admission and higher rates of labor complications. © 2017 Wiley Periodicals, Inc.

Route of delivery and neonatal birth trauma.

PubMed

Moczygemba, Charmaine K; Paramsothy, Pangaja; Meikle, Susan; Kourtis, Athena P; Barfield, Wanda D; Kuklina, Elena; Posner, Samuel F; Whiteman, Maura K; Jamieson, Denise J

2010-04-01

We sought to examine rates of birth trauma in 2 groupings (all International Classification of Diseases, Ninth Revision codes for birth trauma, and as defined by the Agency for Healthcare Research and Quality Patient Safety Indicator [PSI]) among infants born by vaginal and cesarean delivery. Data on singleton infants were obtained from the 2004-2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The rates of Agency for Healthcare Research and Quality PSI and all birth trauma were 2.45 and 25.85 per 1000 births, respectively. Compared with vaginal, cesarean delivery was associated with increased odds of PSI birth trauma (odds ratio [OR], 1.71), primarily due to an increased risk for "other specified birth trauma" (OR, 2.61). Conversely, cesarean delivery was associated with decreased odds of all birth trauma (OR, 0.55), due to decreased odds of clavicle fractures (OR, 0.07), brachial plexus (OR, 0.10), and scalp injuries (OR, 0.55). Infants delivered by cesarean are at risk for different types of birth trauma from infants delivered vaginally. Copyright 2010 Mosby, Inc. All rights reserved.

Physician-led, hospital-linked, birth care centers can decrease cesarean section rates without increasing rates of adverse events.

PubMed

O'Hara, Margaret H; Frazier, Linda M; Stembridge, Travis W; McKay, Robert S; Mohr, Sandra N; Shalat, Stuart L

2013-09-01

This study compares outcomes at a hospital-linked, physician-led, birthing center to a traditional hospital labor and delivery service. Using de-identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998-2005. Compared with hospital service, birth care center delivery was associated with a lower rate of cesarean sections (adjusted Relative Risk = 0.73, 95% confidence interval 0.59-0.91; p < 0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk = 1.04, 95% confidence interval 0.97-1.13; p = 0.25) and a higher initiation of breastfeeding (adjusted Relative Risk = 1.28, 95% confidence interval 1.25-1.30; p ≤ 0.001). A maternal length of stay greater than 72 hours occurred less frequently in the birth care center (adjusted Relative Risk = 0.60, 95% confidence interval 0.55-0.66; p < 0.001). Comparing only women without major obstetrical risk factors, the differences in outcomes were reduced but not eliminated. Adverse maternal and infant outcomes were not increased at the birth care center. A hospital-linked, physician-led, birth care center has the potential to lower rates of cesarean sections without increasing rates of operative vaginal delivery or other adverse maternal and infant outcomes. © 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.

Promotion of family-centered birth with gentle cesarean delivery.

PubMed

Magee, Susanna R; Battle, Cynthia; Morton, John; Nothnagle, Melissa

2014-01-01

In this commentary we describe our experience developing a "gentle cesarean" program at a community hospital housing a family medicine residency program. The gentle cesarean technique has been popularized in recent obstetrics literature as a viable option to enhance the experience and outcomes of women and families undergoing cesarean delivery. Skin-to-skin placement of the infant in the operating room with no separation of mother and infant, reduction of extraneous noise, and initiation of breastfeeding in the operating room distinguish this technique from traditional cesarean delivery. Collaboration among family physicians, obstetricians, midwives, pediatricians, neonatologists, anesthesiologists, nurses, and operating room personnel facilitated the provision of gentle cesarean delivery to families requiring an operative birth. Among 144 gentle cesarean births performed from 2009 to 2012, complication rates were similar to or lower than those for traditional cesarean births. Gentle cesarean delivery is now standard of care at our institution. By sharing our experience, we hope to help other hospitals develop gentle cesarean programs. Family physicians should play an integral role in this process. © Copyright 2014 by the American Board of Family Medicine.

The relationship of Candida colonization of the oral and vaginal mucosae of mothers and oral mucosae of their newborns at birth.

PubMed

Al-Rusan, Rund M; Darwazeh, Azmi M G; Lataifeh, Isam M

2017-04-01

Vaginal Candida colonization is common during pregnancy. Vaginal Candida may transmit vertically to the mouth of newborns during labor. The aim of this study was to assess and compare oral Candida colonization between vaginally born newborns and cesarean-born newborns and to investigate the association of the mother's vaginal and oral Candida colonization and the newborn's oral colonization at the time of delivery. Culture swabs were collected from the oral and vaginal mucosae of 100 pregnant women and from the oral mucosa of their 100 full-term newborns. Fifty (50%) of the mothers gave birth vaginally and the other 50 (50%) by cesarean section. The prevalence of oral and vaginal Candida in pregnant mothers was 49% and 40%, respectively. Oral Candida colonization in newborns was 7%. Oral Candida was isolated from 5 of 50 (10%) in the vaginally born group and from 2 of 50 (4%) in the cesarean-born group (P = .44). In vaginally born group, oral Candida was isolated from 5 of 20 (25%) in those born to mothers with vaginal colonization of Candida, and 0 of 30 (0.0%) in mothers without vaginal colonization of Candida (P = .007). The mother's vaginal Candida may constitute an important source of oral Candida in the newborns, particularly in those delivered vaginally. Copyright © 2017 Elsevier Inc. All rights reserved.

Preventing primary cesarean births: midwifery care.

PubMed

Cox, Kim J; King, Tekoa L

2015-06-01

The incidence of cesarean birth in the United States is alarmingly high and cesareans are associated with added morbidities for women and newborns. Thus strategies to prevent cesarean particularly for low-risk, nulliparous women at term with a singleton fetus are needed. This article addresses evidence-based practices that may be used during intrapartum to avoid primary cesarean, including patience with progress in labor, intermittent auscultation, continuous labor support, upright positions, and free mobility. Second-stage labor practices, such delayed pushing and manual rotation of the fetus, are also reviewed. This package of midwifery-style care practices can potentially lower primary cesarean rates.

Cesarean childbirth in Puerto Rico: the facts.

PubMed

Vázquez-Calzada, J L

1997-12-01

According to the last Island-wide survey carried out in 1982 in Puerto Rico, the cesarean rate for the trienium of 1980-82 was estimated in 27 percent. Since 1989, an item about the type of delivery has been included in the live birth certificate. These data indicate that the incidence of cesarean deliveries continued to increase and by 1994 it amounted to 31 percent, undoubtedly the highest rate of the world. However, its fluctuation since 1990 suggests that this type of delivery has finally steadied in Puerto Rico. The high proportion of repeated cesareans and the low percentage of vaginal birth after cesarean (VBAC) deliveries were important factors contributing to the overall rate. Unexpectedly high risk mothers such as, adolescents, unwed and those of the lower socioeconomic status had highest cesarean rates than their encounterparts. Similarly, mothers who had the most adequate prenatal care had the highest percentages of surgical deliveries. In spite of dealing with a selected clientele, the cesarean rate in private hospitals was more than twice that of public institutions. In fact, a multiple correlation analysis demonstrate that the type of hospital of delivery was the most important correlate of a cesarean.

‘Groping through the fog’: a metasynthesis of women's experiences on VBAC (Vaginal birth after Caesarean section)

PubMed Central

2012-01-01

Background Vaginal birth after Caesarean section (VBAC) is a relevant question for a large number of women due to the internationally rising Caesarean section (CS) rate. There is a great deal of research based on quantitative studies but few qualitative studies about women's experiences. Method A metasynthesis based on the interpretative meta ethnography method was conducted. The inclusion criterion was peer-review qualitative articles from different disciplines about women's experiences of VBAC. Eleven articles were checked for quality, and eight articles were included in the synthesis. Results The included studies were from Australia (four), UK (three), and US (one), and studied women's experience in relation to different aspects of VBAC; decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. The main results are presented with the metaphor groping through the fog; for the women the issue of VBAC is like being in a fog, where decision-making and information from the health care system and professionals, both during pregnancy and the birth, is unclear and contrasting. The results are further presented with four themes: ‘to be involved in decision about mode of delivery is difficult but important,’ ‘vaginal birth has several positive aspects mainly described by women,’ ‘vaginal birth after CS is a risky project,’ and ‘own strong responsibility for giving birth vaginally'. Conclusion In order to promote VBAC, more studies are needed from different maternity settings and countries about women's experiences. Women need evidence-based information not only about the risks involved but also positive aspects of VBAC. PMID:22909230

Vernix caseosa peritonitis after vaginal delivery.

PubMed

Sadath, Shameema A; Abo Diba, Fathiya I; Nayak, Surendra; Shamali, Iman Al; Diejomaoh, Michael F

2013-01-01

Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Twenty-seven cases have been reported, and all occurred after cesarean section. We present a case of VCP following vaginal delivery; this may be the first case reported after vaginal delivery. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP. Clinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.

Impact of cesarean section on intermediate and late preterm births: United States, 2000-2003.

PubMed

Malloy, Michael H

2009-03-01

Cesarean section appears to be associated with increased risk of neonatal mortality among infants of low-risk term pregnancies, but it may offer some survival advantage among the most extremely preterm infants. The impact on intermediate (32-33 wk) and late preterm (34-36 wk) deliveries remains uncertain. The objective of this analysis was to compare the neonatal mortality rate (death at 0-27 days), the mechanical ventilation usage rate, and the incidence of hyaline membrane disease among intermediate and late preterm infants delivered by primary cesarean section compared with those delivered vaginally. United States Linked Birth and Infant Death Certificate files from the years 2000 to 2003 were used. Maternal demographic characteristics, medical complications, and labor and delivery complications were abstracted from the files along with infant information. Because of concern for misclassification of gestational age, a procedure was used to trim away births in which the birthweight of an infant for a specific gestational age was inconsistent. Adjusted odds ratios were calculated using logistic regression for the risk of the three outcomes of interest relative to the mode of delivery. A total of 422,001 live births were available with complete data from the trimmed data set (60% of untrimmed data). After adjustment by logistic regression for infant size at birth, birthweight, sex, Apgar score at 5 minutes less than 4, multiple births, breech presentation, presence of an anomaly, the presence of any maternal medical condition or complication of labor and delivery, labor induction, maternal race, age, education, and gravidity, the adjusted odds ratios (95% CI for neonatal mortality at gestational ages of 32, 33, 34, 35, and 36 wk) were, respectively, 1.69 (1.31-2.20), 1.79 (1.40-2.29), 1.08 (0.83-1.40), 2.31 (1.78-3.00), and 1.98 (1.50-2.62). These data suggest that for low-risk preterm infants at 32 to 36 weeks' gestation, independent of any reported risk factors

Vaginal birth after one previous caesarean section in a tertiary institution in Nigeria.

PubMed

Aisien, A O; Oronsaye, A U

2004-11-01

Vaginal birth after one previous lower segment caesarean section represents one of the most significant and challenging issues in obstetric practice. A 5-year retrospective study was carried out at the University of Benin Teaching Hospital between January 1999 and December 2003, to determine the incidence, the maternal and fetal outcome following vaginal delivery after one previous caesarean section with a view to evaluating its safety and efficacy. There were 5234 deliveries, with 395 cases of one previous caesarean section, giving an incidence of 7.5%. The incidences of emergency caesarean section, elective caesarean section and spontaneous vaginal delivery following trial of vaginal delivery were 34.7%, 9.4% and 48.1%, respectively. During the study period there were 1317 cases of caesarean section, giving an incidence of 25.2% caesarean section rate. The incidence of one previous section among all caesarean section births was 30%. The major morbidity following vaginal delivery was uterine rupture with an incidence of 1.5% and hysterectomy of 0.8%. Three of the uterine ruptures occurred before admission because the patients laboured at home. One maternal death occurred as a result of uterine rupture and postpartum haemorrhage, giving a maternal mortality ratio of 19/100,000 and a case fatality rate of 0.3%. The corrected perinatal mortality rate was 15.2/1000, mainly from obstructed labour, abruptio placenta and fetal distress. Both maternal and fetal mortalities from vaginal birth after one previous section were significantly less than the respective overall maternal and fetal mortality from the institution. The 1-minute apgar score of babies delivered by elective section was significantly (P < 0.001) higher than the apgar score of babies delivered by emergency section and vaginally. There was only one patient with wound dehiscence at elective section without associated perinatal death. Vaginal delivery following caesarean section is relatively safe. However

Childbirth Education Class and Birth Plans Are Associated with a Vaginal Delivery.

PubMed

Afshar, Yalda; Wang, Erica T; Mei, Jenny; Esakoff, Tania F; Pisarska, Margareta D; Gregory, Kimberly D

2017-03-01

To determine whether the mode of delivery was different between women who attended childbirth education (CBE) class, had a birth plan, or both compared with those who did not attend CBE class or have a birth plan. This is a retrospective cross-sectional study of women who delivered singleton gestations > 24 weeks at our institution between August 2011 and June 2014. Based on a self-report at the time of admission for labor, women were stratified into four categories: those who attended a CBE class, those with a birth plan, both, and those with neither CBE or birth plan. The primary outcome was the mode of delivery. Multivariate logistic regression analyses adjusting for clinical covariates were performed. In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older (p < 0.001), more likely to be nulliparous (p < 0.001), had a lower body mass index (p < 0.001), and were less likely to be African-American (p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery (CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls. Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates. © 2016 Wiley Periodicals, Inc.

Women's attitudes toward mode of delivery in South Korea--a society with high cesarean section rates.

PubMed

Lee, Sang-Il; Khang, Young-Ho; Lee, Moo-Song

2004-06-01

In South Korea, cesarean section rates (i.e., the proportion of all live births delivered by cesarean section) approached 40 percent in 2000. The relative contribution of physicians and women to this high rate has been a source of debate. This study explored attitudes toward mode of delivery among South Korean women. A nationwide cross-sectional telephone survey of 505 Korean women aged 20 to 49 years was conducted using a proportionate quota and systematic random sampling method. The response rate was 57.3 percent. Data were collected using a structured questionnaire consisting of 7 questions about vaginal and cesarean delivery. Over 95 percent of women preferred vaginal delivery during pregnancy and were willing to recommend this method to others. Of the women who delivered by cesarean section, 10.6 percent stated that they had requested a cesarean birth. Attitudes toward vaginal or cesarean delivery differed significantly according to a woman's education level. Most study participants showed more favorable attitudes toward vaginal delivery than cesarean delivery. This result does not support the assumption that the upsurge of cesarean section rates in South Korea is associated with women's positive attitudes toward cesarean section. The main cause of the rapid rise of cesarean section rates in South Korea during the past two decades have its origins in health care practitioners and the health care system in which they work.

[Association between cesarean birth and the risk of obesity in 6-17 year-olds].

PubMed

Wang, Z H; Xu, R B; Dong, Y H; Yang, Y D; Wang, S; Wang, X J; Yang, Z G; Zou, Z Y; Ma, J

2017-12-10

Objective: To explore the association between cesarean section and obesity in child and adolescent. Methods: In this study, a total number of 42 758 primary and middle school students aged between 6 and 17 were selected, using the stratified cluster sampling method in 93 primary and middle schools in Hunan, Ningxia, Tianjin, Chongqing, Liaoning, Shanghai and Guangdong provinces and autonomous regions. Log-Binomial regression model was used to analyze the association between cesarean section and obesity in childhood or adolescent. Results: Mean age of the subjects was (10.5±3.2) years. The overall rate of cesarean section among subjects attending primary or secondary schools was 42.3%, with 55.9% in boys and, 40.6% in girls respectively and with difference statistically significant ( P <0.001). The rate on obesity among those that received cesarean section (17.6%) was significantly higher than those who experienced vaginal delivery (10.2%) ( P <0.001). Results from the log-binomial regression model showed that cesarean section significantly increased the risk of obesity in child and adolescent ( OR =1.72, 95% CI : 1.63-1.82; P <0.001). After adjusting for factors as sex, residential areas (urban or rural), feeding patterns, frequencies of milk-feeding, eating high-energy foods, eating fried foods and the levels of parental education, family income, parental obesity, physical activity levels, gestational age and birth weight etc ., the differences were still statistically significant ( OR =1.48, 95% CI : 1.39-1.57; P <0.001). Conclusion: The rate of cesarean section among pregnant women in China appeared high which may significantly increase the risk of obesity in child or adolescent.

Comparison of induction of labor methods for unfavorable cervices in trial of labor after cesarean delivery.

PubMed

Shah, Utsavi; Bellows, Patricia; Drexler, Kathleen; Hawley, Lauren; Davidson, Christina; Sangi-Haghpeykar, Haleh; Gandhi, Manisha

2017-05-01

To compare induction of labor methods in patients attempting a trial of labor after cesarean (TOLAC) with an unfavorable cervix. This is a retrospective cohort study from patients attempting TOLAC from 2009 to 2013. Patients with a simplified Bishop score of three or less where labor was initiated with either a Cook balloon or oxytocin were included. Our primary outcome was mode of delivery. Our secondary outcomes included duration of labor and multiple maternal and neonatal morbidities. Two-hundred and fourteen women met inclusion criteria: 150 received oxytocin and 64 had the Cook balloon placed. The vaginal birth after cesarean delivery rate was significantly higher in the oxytocin group at 70.7% versus 50.0% in the Cook balloon group (p = 0.004). In the multivariable analysis, odds for cesarean delivery were two times higher with the Cook balloon than with oxytocin (Adjusted OR = 2.09, 95% CI = 1.05-4.18, p = 0.036). The duration of labor was longer with the Cook balloon versus oxytocin (21.9 versus 16.3 hours, p = 0.0002). There were no significant differences in maternal and neonatal health outcomes. Oxytocin induction of labor was associated with a higher rate of vaginal delivery and a shorter duration of labor compared to the Cook balloon in women undergoing TOLAC with an unfavorable cervix.

Outcomes of Spontaneous Labor in Women Undergoing Trial of Labor after Cesarean as Compared with Nulliparous Women: A Retrospective Cohort Study.

PubMed

Lassey, Sarah C; Robinson, Julian N; Kaimal, Anjali J; Little, Sarah E

2018-01-24

 The objective of this study was to compare spontaneous labor outcomes in women undergoing trial of labor after cesarean (TOLAC) and nulliparas to better counsel women.  A 4-year retrospective cohort. We included women at term in spontaneous labor with vertex singletons and no more than one prior cesarean delivery. In planned secondary analysis, we focused on a subset of women with a prior cesarean and a predicted likelihood of a successful vaginal delivery of 70% or more based on the Maternal-Fetal Medicine Units-vaginal birth after cesarean (VBAC) calculator.  Our cohort included 606 TOLACS and 606 nulliparas. Women undergoing TOLAC were more likely to undergo cesarean delivery (25.7 vs. 14.7%; p  < 0.001). Severe maternal hemorrhage (1.5 vs. 0.2%; p  = 0.02) and uterine rupture (1.9 vs. 0.0%; p  < 0.01) were more likely in the TOLAC group. For the subset of women with a predicted likelihood of VBAC of 70% or more, there were no differences in cesarean delivery (16.7 vs. 14.7%; p  = 0.51), maternal, or immediate neonatal complications.  Women undergoing TOLAC were more likely to have a cesarean delivery, hemorrhage, or uterine rupture. Those with more than 70% predicted likelihood of VBAC were no more likely to experience these outcomes. These findings help contextualize the risks of TOLAC for women considering this option. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Successful vaginal birth after caesarean section in patient with Ehler-Danlos syndrome type 2.

PubMed

Maraj, Hemant; Mohajer, Michelle; Bhattacharjee, Deepannita

2011-12-01

We present the case of a 31-year-old woman with Ehler-Danlos syndrome (EDS) type 2. She had a previous caesarean section and went on to have an uncomplicated vaginal birth in her last pregnancy. To our knowledge, this is the first case of a successful vaginal birth after caesarean section in a patient with EDS. EDS is a multisystem disorder involving a genetic defect in collagen and connective-tissue synthesis and structure. It is a heterogeneous group of 11 different inherited disorders. Obstetric complications in these patients include miscarriages, stillbirths, premature rupture of the membranes, preterm labour, uterine prolapse, uterine rupture and severe postpartum haemorrhage. There has been much controversy over the appropriate mode of delivery. Abdominal deliveries are complicated by delayed wound healing and increased perioperative blood loss. Vaginal deliveries may be complicated by tissue friability causing extensive perineal tears, pelvic floor and bladder lesions. Our case highlights that in specific, controlled situations it is possible to have a vaginal delivery even after previous caesarean section in patients with EDS.

Successful vaginal birth after caesarean section in patient with Ehler-Danlos syndrome type 2

PubMed Central

Maraj, Hemant; Mohajer, Michelle; Bhattacharjee, Deepannita

2011-01-01

We present the case of a 31-year-old woman with Ehler-Danlos syndrome (EDS) type 2. She had a previous caesarean section and went on to have an uncomplicated vaginal birth in her last pregnancy. To our knowledge, this is the first case of a successful vaginal birth after caesarean section in a patient with EDS. EDS is a multisystem disorder involving a genetic defect in collagen and connective-tissue synthesis and structure. It is a heterogeneous group of 11 different inherited disorders. Obstetric complications in these patients include miscarriages, stillbirths, premature rupture of the membranes, preterm labour, uterine prolapse, uterine rupture and severe postpartum haemorrhage. There has been much controversy over the appropriate mode of delivery. Abdominal deliveries are complicated by delayed wound healing and increased perioperative blood loss. Vaginal deliveries may be complicated by tissue friability causing extensive perineal tears, pelvic floor and bladder lesions. Our case highlights that in specific, controlled situations it is possible to have a vaginal delivery even after previous caesarean section in patients with EDS. PMID:27579117

Retrospective Chart Review of Skin-to-Skin Contact in the Operating Room and Administration of Analgesic and Anxiolytic Medication to Women After Cesarean Birth.

PubMed

Wagner, Debra L; Lawrence, Stephen; Xu, Jing; Melsom, Janice

2018-04-01

Transporting a newborn out of the operating room after cesarean birth can contribute to maternal awareness of discomfort, anxiety, and the need for administration of analgesics and anxiolytics for relief. This retrospective study analyzed the association between skin-to-skin contact in the operating room and administration of analgesics and anxiolytics to women in the operating and recovery rooms after cesarean birth. Our results indicated a trend toward decreased medication administration for women who experienced skin-to-skin contact and add to evidence supporting the incorporation of skin-to-skin contact in the operating room as the standard of care for cesarean birth. This practice has the potential to enhance the birth experience, promote breastfeeding, and provide greater safety with less exposure to opioids and benzodiazepines for women and their newborns. © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

The impact of nonclinical factors on repeat cesarean section.

PubMed

Stafford, R S

1991-01-02

Nonclinical factors, including the setting in which health care takes place, influence clinical decisions. This research measures the independent effects of organizational and socioeconomic factors on repeat cesarean section use in California. Of 45,425 births to women with previous cesarean sections in 1986, vaginal birth after cesarean section occurred in 10.9%. Sizable nonclinical variations were noted. By hospital ownership, rates ranged from 4.9% (for-profit hospitals) to 29.2% (University of California). Variations also existed by hospital teaching level (nonteaching hospitals, 7.0%, vs formalized teaching hospitals, 23.3%); payment source (private insurance, 8.1%, vs indigent services, 25.2%); and obstetric volume (low-volume hospitals, 5.4%, vs high-volume hospitals, 16.6%). Multiple logistic regression demonstrated that these variables had independent effects after accounting for their overlapping influences and the effects of patient characteristics. The observed variations demonstrate the prominence of nonclinical factors in decision making and question the clinical appropriateness of current practice patterns.

Weight loss in exclusively breastfed infants delivered by cesarean birth.

PubMed

Preer, Genevieve L; Newby, P K; Philipp, Barbara L

2012-05-01

Rates of exclusive breastfeeding during the postpartum hospital stay are a key measure of quality maternity care. Often, however, concern for excessive in-hospital weight loss leads to formula supplementation of breastfed infants. The American Academy of Pediatrics defines 7% weight loss as acceptable for breastfed newborns regardless of mode of delivery. Typical weight loss in exclusively breastfed infants delivered by cesarean birth has not been studied nor have possible correlates of greater weight loss in this population. To determine average weight loss in a cohort of exclusively breastfed infants delivered by cesarean birth and to identify correlates of greater than expected weight loss. We performed a retrospective chart review of exclusively breastfed infants delivered via cesarean birth at a Baby-Friendly hospital between 2005 and 2007. Average weight loss was calculated, and multivariate regression analysis was performed. Average weight loss during the hospital stay in our cohort of 200 infants was 7.2% ± 2.1% of birth weight, slightly greater than the American Academy of Pediatrics guideline of 7%. Absence of labor prior to delivery was significantly associated with a greater percentage of weight loss (P = .0004), as were lower gestational age (P = .0004) and higher birth weight (P < .0001). Maternal age, gravity, parity, infant sex, Apgar scores, and prior cesarean birth were not significantly associated. We conclude that for exclusively breastfed infants delivered by cesarean birth in a Baby-Friendly hospital, absence of labor prior to cesarean birth may be a previously unreported risk factor for greater than expected weight loss.

State variation in rates of cesarean and VBAC delivery: 1989 and 1993.

PubMed

Clarke, S C; Taffel, S M

1996-01-01

There is wide variation among states in rates of cesarean and vaginal births after cesarean (VBAC) deliveries. In general, states in the South have the highest cesarean rates, states in the West have the lowest, and states in the Northeast and Midwest are intermediate. Louisiana had the highest overall rate in 1993 (27.7 per 100 births) while Alaska had the lowest rate (15.2). The majority of states had declines in their cesarean rate between 1989 and 1993. Patterns in primary cesarean rates are similar to those of the overall rate-states in the South generally have the highest rates while states in the West have the lowest rates. Primary cesarean rates ranged between a high of 19.6 in Louisiana to a low of 10.6 in Wisconsin. In general, states with low cesarean rates have among the highest rates of VBAC delivery. Alaska had the highest VBAC rate (40.0), which was almost quadruple the rate of Louisiana (11.2), the state with the lowest rate. Most states had substantial increases in VBAC rates between 1989 and 1993. When examining cesarean rates by maternal age and birth order, states with the highest overall rates also have among the highest age/birth order-specific rates. Cesarean rates were lowest for mothers under 25 years of age having a second or higher order birth in Alaska, 10.4, and highest for mothers 35 years of age or over having a first birth in Mississippi, 51.3. Standardized cesarean rates which were adjusted for differences between states in maternal age and birth order distributions did not diminish the variation among areas.

Cabbage compression early breast care on breast engorgement in primiparous women after cesarean birth: a controlled clinical trial

PubMed Central

Lim, A-Reum; Song, Ji-Ah; Hur, Myung-Haeng; Lee, Mi-Kyoung; Lee, Myeong Soo

2015-01-01

This study aimed to compare the effects of cabbage compression early breast care (CCEBC) and early breast care (EBC) on breast pain, breast hardness with general nursing breast care (GNBC) in primiparous women after cesarean birth. Sixty participants were divided to three groups including CCEBC, EBC and GNBC. Each group was treated with its intervention respectively more than 10 minutes before breast feeding from day two to day four after delivery. The primary outcomes were breast pain and breast hardness. Both CCEBC and EBC showed significantly lower pain level than GNBC at day 4 after delivery. There are significant differences of breast hardness among three groups. CCEBC group showed significantly lower breast hardness compared with EBC and GNBC. Neither core body temperature nor breast skin temperature was significantly different among the three groups. In conclusion, CCEBC may effective in relieving breast pain and breast hardness compared with EBC alone and GNBC in primiparous women after a cesarean birth. PMID:26885074

Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison.

PubMed

Thornton, Patrick; McFarlin, Barbara L; Park, Chang; Rankin, Kristin; Schorn, Mavis; Finnegan, Lorna; Stapleton, Susan

2017-01-01

High rates of cesarean birth are a significant health care quality issue, and birth centers have shown potential to reduce rates of cesarean birth. Measuring this potential is complicated by lack of randomized trials and limited observational comparisons. Cesarean rates vary by provider type, setting, and clinical and nonclinical characteristics of women, but our understanding of these dynamics is incomplete. We sought to isolate labor setting from other risk factors in order to assess the effect of birth centers on the odds of cesarean birth. We generated low-risk cohorts admitted in labor to hospitals (n = 2527) and birth centers (n = 8776) using secondary data obtained from the American Association of Birth Centers (AABC). All women received prenatal care in the birth center and midwifery care in labor, but some chose hospital admission for labor. Analysis was intent to treat according to site of admission in spontaneous labor. We used propensity score adjustment and multivariable logistic regression to control for cohort differences and measured effect sizes associated with setting. There was a 37% (adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 0.50-0.79) to 38% (adjusted OR, 0.62; 95% CI, 0.49-0.79) decreased odds of cesarean in the birth center cohort and a remarkably low overall cesarean rate of less than 5% in both cohorts. These findings suggest that low rates of cesarean in birth centers are not attributable to labor setting alone. The entire birth center care model, including prenatal preparation and relationship-based midwifery care, should be studied, promoted, and implemented by policy makers interested in achieving appropriate cesarean rates in the United States. © 2016 by the American College of Nurse-Midwives.

Pelvic floor dysfunction in the immediate puerperium, and 1 month and 3 months after vaginal or cesarean delivery.

PubMed

Colla, Cássia; L Paiva, Luciana; Ferla, Lia; B Trento, Maria J; M P de Vargas, Isadora; A Dos Santos, Bianca; Ferreira, Charles F; L Ramos, José G

2018-06-07

To identify and assess postpartum pelvic floor dysfunction (PFD) between vaginal delivery, elective cesarean delivery (ECD), and intrapartum cesarean delivery (ICD). The present prospective observational study included women aged at least 18 years with no history of pelvic surgery or lower urinary tract malformation, and who had not undergone pelvic floor muscle (PFM) training in the preceding 12 months, who underwent delivery at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil between August 1, 2016, and May 31, 2017. Participants were assessed at 48 hours (phase 1), 1 month (phase 2), and 3 months (phase 3) after delivery. Assessments included the International Consultation on Incontinence Questionnaire, Short Form (ICIQ-SF); the Jorge-Wexner anal incontinence scale; a self-rated visual analog scale for pelvic pain; the pelvic organ prolapse quantification (POP-Q) system; and a PFM perineometer. A total of 227 women were assessed in phase 1 (141 vaginal deliveries; 28 ICDs; and 58 ECDs), 79 in phase 2, and 41 in phase 3. The ICIQ-SF, Jorge-Wexner scale, visual analog scale, and perineometer measurements did not identify significant differences in relation to the type of delivery (P>0.05). The type of delivery was not associated with differences in the short-term development of postpartum PFD. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

[Breech presentation terminated by cesarean section].

PubMed

Milasinović, L; Bregun-Dragić, N; Nikolić, L; Radeka, G

1992-01-01

The prospective study was carried out in 86 mothers and their newborns born in breech presentation; 41 were delivered by cesarean section, 45 vaginally. The incidence of prepathologic and pathologic CTGs was rather high in both groups (34.14% and 24.34%) as well as the presence of meconium in the amniotic fluid (34.15% and 22.22%). The infants delivered by cesarean section have significantly (p < 0.05) higher pH levels (7.28 +/- 0.068) than those delivered vaginally (7.25 +/- 0.093). The acidosis incidence (pH +/- 7.20) is significantly (p < 0.01) lower in the first (9.76%) than in the second (26.66%) group. In the early neonatal period 24.35% of the children in the first group and 35.55% of the children in the second group developed a disease (p < 0.05). The difference in the morbidity rate can also be found in the fact that in the studied group no intracranial hemorrhage was diagnosed while in the control group it was found in 17.77% of the children. Manifest cerebral disfunction syndrome was detected in 2.44% of the children delivered by cesarean section and in 8.88% of the children delivered vaginally. One child (2.22%) delivered with manual help has died. The morbidity of the mothers was significantly (p < 0.05) higher in women who gave birth abdominally (17.68%) than in those who gave birth vaginally (8.88%).

Geographic variation in cesarean delivery in the United States by payer.

PubMed

Henke, Rachel Mosher; Wier, Lauren M; Marder, William D; Friedman, Bernard S; Wong, Herbert S

2014-11-19

The rate of cesarean delivery in the United States is variable across geographic areas. The aims of this study are two-fold: (1) to determine whether the geographic variation in cesarean delivery rate is consistent for private insurance and Medicaid (2) to identify the patient, population, and market factors associated with cesarean rate and determine if these factors vary by payer. We used the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) to measure the cesarean rate at the Core-Based Statistical Area (CBSA) level. We linked the hospitalization data to data from other national sources to measure population and market characteristics. We calculated unadjusted and risk-adjusted CBSA cesarean rates by payer. For the second aim, we estimated a hierarchical logistical model with the hospitalization as the unit of analysis to determine the factors associated with cesarean delivery. The average CBSA cesarean rate for women with private insurance was higher (18.9 percent) than for women with Medicaid (16.4 percent). The factors predicting cesarean rate were largely consistent across payers, with the following exceptions: women under age 18 had a greater likelihood of cesarean section if they had Medicaid but had a greater likelihood of vaginal birth if they had private insurance; Asian and Native American women with private insurance had a greater likelihood of cesarean section but Asian and Native American women with Medicaid had a greater likelihood of vaginal birth. The percent African American in the population predicted increased cesarean rates for private insurance only; the number of acute care beds per capita predicted increased cesarean rate for women with Medicaid but not women with private insurance. Further we found the number of obstetricians/gynecologists per capita predicted increased cesarean rate for women with private insurance only, and the number of midwives per capita predicted increased vaginal birth rate for women

Increased rates of cesarean sections and large families: a potentially dangerous combination.

PubMed

Saleh, Ahmed M; Dudenhausen, Joachim W; Ahmed, Badreldeen

2017-07-26

Rates of cesarean sections have been on the rise over the past three decades all over the world, despite the ideal rate of 10-15% that had been set by the World Health Organization (WHO) in 1985, in Fortaleza, Brazil. This epidemic increase in the rate of cesarean delivery is due to many factors which include, cesarean delivery on request, advanced maternal age at first pregnancy, decrease in number of patients who are willing to try vaginal birth after cesarean delivery, virtual disappearance of vaginal breech delivery, perceived increase in the weight of the fetus and increase in the number of women with chronic medical conditions such as Diabetes Mellitus and congenital heart disease in the reproductive age. There is no doubt that cesarean delivery is a safe procedure and it is getting safer and safer for many reasons. However, like all other surgical procedures it is not without risks both to the mother and the new born. There is a substantial increase in the incidence of morbidly adherent placenta and the risk of scar pregnancy. In the Middle East and many African and Asian countries women tend to have large families. The number of previous cesarean section deliveries is directly proportional to the risk of developing morbidly adherent placenta. Morbidly adherent placenta is the most common cause of emergency postpartum hysterectomy, which is often associated with multiple surgical complications, severe maternal morbidity and mortality. The increased rates of cesarean sections lead to increased rates of scar pregnancies, which can have lethal consequences. Cesarean delivery has a negative impact on the infant immune system. This effect on the infant led to the introduction of a new concept called "Vaginal seeding". This refers to the practice of transferring some maternal vaginal fluid to the infant born via cesarean section in an effort to enhance its immune system.

Association of cesarean delivery with anemia in infants and children in 2 large longitudinal Chinese birth cohorts.

PubMed

Li, Hong-tian; Trasande, Leonardo; Zhu, Li-ping; Ye, Rong-wei; Zhou, Yu-bo; Liu, Jian-meng

2015-03-01

Cesarean delivery may reduce placental-fetal transfusion and thus increase the risk of early childhood anemia compared with vaginal delivery, but this notion has not been carefully studied in longitudinal cohorts. The aim was to assess the association of cesarean delivery with anemia in infants and children in 2 longitudinal Chinese birth cohorts from different socioeconomic settings. Cohort 1 was recruited from 5 counties in northeastern China and cohort 2 from 21 counties or cities in southeastern China. Cohort 1 involved 17,423 infants born during 2006-2009 to mothers with early pregnancy baseline hemoglobin concentrations ranging from 100 to 177 g/L, whereas cohort 2 involved 122,777 children born during 1993-1996 to mothers with baseline hemoglobin concentrations ranging from 60 to 190 g/L. The main outcomes were anemia at 6 and 12 mo in cohort 1 and at 58 mo in cohort 2. Multiple logistic regressions were used to estimate adjusted ORs of anemia for cesarean compared with vaginal delivery. Stratified analyses were performed by pre- and postlabor cesarean delivery and according to maternal baseline hemoglobin concentration (≤109, 110-119, 120-129, and ≥130 g/L). Cesarean delivery was not associated with anemia at 6 mo in cohort 1 (adjusted OR: 1.05; 95% CI: 0.93, 1.19); however, cesarean delivery was associated with increased anemia at 12 mo in cohort 1 (adjusted OR: 1.19; 95% CI: 1.04, 1.37) and at 58 mo in cohort 2 (adjusted OR: 1.11; 95% CI: 1.08, 1.15). The positive associations for anemia at 12 and 58 mo were consistent across maternal hemoglobin subgroups and persisted for cesarean delivery subtypes. Cesarean delivery is likely associated with anemia in children, which suggests a possible need for exploring changes in obstetric care that might prevent anemia in cesarean-delivered children. © 2015 American Society for Nutrition.

Physical health and recovery in the first 18 months postpartum: does cesarean section reduce long-term morbidity?

PubMed

Woolhouse, Hannah; Perlen, Susan; Gartland, Deirdre; Brown, Stephanie J

2012-09-01

Research examining long-term health outcomes for women after childbirth has been limited. The objective of this study was to investigate the natural history of common morbidities in the 18 months after the birth of a first child, and to explore the hypothesis that women who have a cesarean section for a first birth experience less overall morbidity in the postnatal period. A prospective nulliparous pregnancy cohort study was conducted of 1,507 women recruited in early pregnancy from six public hospitals in Melbourne, Australia (mean gestation 15 weeks). Follow-up questionnaires at 3, 6, 12, and 18 months postpartum included standardized measures of urinary and fecal incontinence, and a symptom checklist asking about common physical health problems. At 6, 12, and 18 months postpartum, no statistically significant differences were found in the proportion of women reporting three or more health problems by method of birth. Compared with women who had a spontaneous vaginal birth, women who had a cesarean section were more likely to report extreme tiredness at 6 months postpartum (adjusted OR: 1.39; 95% CI: 1.07-1.82) and at 12 months postpartum (adjusted OR: 1.40; 95% CI: 1.05-1.85), and were more likely to report back pain at 6 months postpartum (adjusted OR: 1.37; 95% CI: 1.06-1.77) and at 12 months postpartum (adjusted OR: 1.41; 95% CI: 1.06-1.87). Women who had a cesarean section were less likely to report urinary incontinence at 3, 6, and 12 months postpartum, respectively (adjusted OR: 0.26; 95% CI: 0.19-0.36; adjusted OR: 0.36; 95% CI: 0.25-0.52; adjusted OR: 0.48; 95% CI: 0.33-0.68). For all other physical health problems the pattern of morbidity did not differ between cesarean section and spontaneous vaginal birth. Physical health problems commonly persist or recur throughout the first 18 months postpartum, with potential long-term consequences for women's health. Cesarean section does not result in women experiencing less overall morbidity in the postpartum

Vaginal Microbiota in Pregnancy: Evaluation Based on Vaginal Flora, Birth Outcome, and Race

PubMed Central

Subramaniam, Akila; Kumar, Ranjit; Cliver, Suzanne P.; Zhi, Degui; Szychowski, Jeff M.; Abramovici, Adi; Biggio, Joseph R.; Lefkowitz, Elliot J.; Morrow, Casey; Edwards, Rodney K.

2016-01-01

Objective This study aims to evaluate vaginal microbiota differences by bacterial vaginosis (BV), birth timing, and race, and to estimate parameters to power future vaginal microbiome studies. Methods Previously, vaginal swabs were collected at 21 to 25 weeks (stored at −80°C), and vaginal smears evaluated for BV (Nugent criteria). In a blinded fashion, 40 samples were selected, creating 8 equal-sized groups stratified by race (black/white), BV (present/absent), and birth timing (preterm/term). Samples were thawed, DNA extracted, and prepared. Polymerase chain reaction (PCR) with primers targeting the 16S rDNA V4 region was used to prepare an amplicon library. PCR products were sequenced and analyzed using quantitative insight into microbial ecology; taxonomy was assigned using ribosomal database program classifier (threshold 0.8) against the modified Greengenes database. Results After quality control, 97,720 sequences (mean) per sample, single-end 250 base-reads, were analyzed. BV samples had greater microbiota diversity (p < 0.05)—with BVAB1, Prevotella, and unclassified genus, Bifidobacteriaceae family (all p < 0.001) more abundant; there was minimal content of Gardnerella or Mobiluncus. Microbiota did not differ by race or birth timing, but there was an association between certain microbial clusters and preterm birth (p = 0.07). To evaluate this difference, 159 patients per group are needed. Conclusions There are differences in the vaginal microbiota between patients with and without BV. Larger studies should assess the relationship between microbiota composition and preterm birth. PMID:26479170

A randomized comparative trial of two decision tools for pregnant women with prior cesareans.

PubMed

Eden, Karen B; Perrin, Nancy A; Vesco, Kimberly K; Guise, Jeanne-Marie

2014-01-01

Evaluate tools to help pregnant women with prior cesareans make informed decisions about having trials of labor. Randomized comparative trial. A research assistant with a laptop met the women in quiet locations at clinics and at health fairs. Pregnant women (N = 131) who had one prior cesarean and were eligible for vaginal birth after cesarean (VBAC) participated one time between 2005 and 2007. Women were randomized to receive either an evidence-based, interactive decision aid or two evidence-based educational brochures about cesarean delivery and VBAC. Effect on the decision-making process was assessed before and after the interventions. Compared to baseline, women in both groups felt more informed (F = 23.8, p < .001), were more clear about their birth priorities (F = 9.7, p = .002), felt more supported (F = 9.8, p = .002, and overall reported less conflict (F = 18.1, p < 0.001) after receiving either intervention. Women in their third trimesters reported greater clarity around birth priorities after using the interactive decision aid than women given brochures (F = 9.8, p = .003). Although both decision tools significantly reduced conflict around the birth decision compared to baseline, more work is needed to understand which format, the interactive decision aid or paper brochures, are more effective early and late in pregnancy. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Parturition pit: the bony imprint of vaginal birth.

PubMed

McArthur, Tatum A; Meyer, Isuzu; Jackson, Bradford; Pitt, Michael J; Larrison, Matthew C

2016-09-01

To retrospectively evaluate for pits along the dorsum of the pubic body in females and compare the presence/absence of these pits to vaginal birth data. We retrospectively reviewed females with vaginal birth data who underwent pelvic CT. The presence of pits along the dorsum of the pubic body, pit grade (0 = not present; 1 = faintly imperceptible; 2 = present; 3 = prominent), and the presence of osteitis condensans ilii, preauricular sulcus, and sacroiliac joint vacuum phenomenon were assessed on imaging. Musculoskeletal radiologists who were blinded to the birth data evaluated the CTs. 48 males were also evaluated for the presence of pits. 482 female patients underwent CT pelvis and 171 were excluded due to lack of vaginal birth data. Of the 311 study patients, 262 had prior vaginal birth(s) and 194 had pits on CT. Only 7 of the 49 patients without prior vaginal birth had pits. There was a statistically significant association between vaginal birth and presence of pits (p < 0.0001). Patients with more prominent pits (grades 2/3) had a greater number of vaginal births. As vaginal deliveries increased, the odds of having parturition pits greatly increased, adjusting for age and race at CT (p < 0.0001). No males had pits. Our study indicates that parturition pits are associated with prior vaginal birth and should be considered a characteristic of the female pelvis. The lytic appearance of prominent pits on imaging can simulate disease and create a diagnostic dilemma for interpreting radiologists.

Parturition Pit: The Bony Imprint of Vaginal Birth

PubMed Central

Meyer, Isuzu; Jackson, Bradford; Pitt, Michael J.; Larrison, Matthew C.

2017-01-01

Purpose To retrospectively evaluate for pits along the dorsum of the pubic body in females and compare the presence/absence of these pits to vaginal birth data. Materials and Methods We retrospectively reviewed females with vaginal birth data who underwent pelvic CT. The presence of pits along the dorsum of the pubic body, pit grade (0 = not present; 1 = faintly imperceptible; 2 = present; 3 = prominent), and the presence of osteitis condensans ilii, preauricular sulcus, and sacroiliac joint vacuum phenomenon were assessed on imaging. Musculoskeletal radiologists who were blinded to the birth data evaluated the CTs. 48 males were also evaluated for the presence of pits. Results 482 female patients underwent CT pelvis and 171 were excluded due to lack of vaginal birth data. Of the 311 study patients, 262 had prior vaginal birth(s) and 194 had pits on CT. Only 7 of the 49 patients without prior vaginal birth had pits. There was a statistically significant association between vaginal birth and presence of pits (p<0.0001). Patients with more prominent pits (grades 2/3) had a greater number of vaginal births. As vaginal deliveries increased, the odds of having parturition pits greatly increased, adjusting for age and race at CT (p<0.0001). No males had pits. Conclusion Our study indicates that parturition pits are associated prior vaginal birth and should be considered a characteristic of the female pelvis. The lytic appearance of prominent pits on imaging can simulate disease and create a diagnostic dilemma for interpreting radiologists. PMID:27270921

Women's experiences of planning a vaginal breech birth in Australia.

PubMed

Homer, Caroline Se; Watts, Nicole P; Petrovska, Karolina; Sjostedt, Chauncey M; Bisits, Andrew

2015-04-11

In many countries, planned vaginal breech birth (VBB) is a rare event. After the Term Breech Trial in 2000, VBB reduced and caesarean section for breech presentation increased. Despite this, women still request VBB. The objective of this study was to explore the experiences and decision-making processes of women who had sought a VBB. A qualitative study using descriptive exploratory design was undertaken. Twenty-two (n = 22) women who planned a VBB, regardless of eventual mode of birth were recruited. The women had given birth at one of two maternity hospitals in Australia that supported VBB. In-depth, semi-structured interviews using an interview guide were conducted. Interviews were analysed thematically. Twenty two women were interviewed; three quarters were primiparous (n = 16; 73%). Nine (41%) were already attending a hospital that supported VBB with the remaining women moving hospitals. All women actively sought a vaginal breech birth because the baby remained breech after an external cephalic version - 12 had a vaginal birth (55%) and 10 (45%) a caesarean section after labour commenced. There were four main themes: Reacting to a loss of choice and control, Wanting information that was trustworthy, Fighting the system and seeking support for VBB and The importance of 'having a go' at VBB. Women seeking a VBB value clear, consistent and relevant information in deciding about mode of birth. Women desire autonomy to choose vaginal breech birth and to be supported in their choice with high quality care.

Vaginal Microbiota in Pregnancy: Evaluation Based on Vaginal Flora, Birth Outcome, and Race.

PubMed

Subramaniam, Akila; Kumar, Ranjit; Cliver, Suzanne P; Zhi, Degui; Szychowski, Jeff M; Abramovici, Adi; Biggio, Joseph R; Lefkowitz, Elliot J; Morrow, Casey; Edwards, Rodney K

2016-03-01

This study aims to evaluate vaginal microbiota differences by bacterial vaginosis (BV), birth timing, and race, and to estimate parameters to power future vaginal microbiome studies. Previously, vaginal swabs were collected at 21 to 25 weeks (stored at -80°C), and vaginal smears evaluated for BV (Nugent criteria). In a blinded fashion, 40 samples were selected, creating 8 equal-sized groups stratified by race (black/white), BV (present/absent), and birth timing (preterm/term). Samples were thawed, DNA extracted, and prepared. Polymerase chain reaction (PCR) with primers targeting the 16S rDNA V4 region was used to prepare an amplicon library. PCR products were sequenced and analyzed using quantitative insight into microbial ecology; taxonomy was assigned using ribosomal database program classifier (threshold 0.8) against the modified Greengenes database. After quality control, 97,720 sequences (mean) per sample, single-end 250 base-reads, were analyzed. BV samples had greater microbiota diversity (p < 0.05)-with BVAB1, Prevotella, and unclassified genus, Bifidobacteriaceae family (all p < 0.001) more abundant; there was minimal content of Gardnerella or Mobiluncus. Microbiota did not differ by race or birth timing, but there was an association between certain microbial clusters and preterm birth (p = 0.07). To evaluate this difference, 159 patients per group are needed. There are differences in the vaginal microbiota between patients with and without BV. Larger studies should assess the relationship between microbiota composition and preterm birth. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk.

PubMed

Kindinger, Lindsay M; Bennett, Phillip R; Lee, Yun S; Marchesi, Julian R; Smith, Ann; Cacciatore, Stefano; Holmes, Elaine; Nicholson, Jeremy K; Teoh, T G; MacIntyre, David A

2017-01-19

Preterm birth is the primary cause of infant death worldwide. A short cervix in the second trimester of pregnancy is a risk factor for preterm birth. In specific patient cohorts, vaginal progesterone reduces this risk. Using 16S rRNA gene sequencing, we undertook a prospective study in women at risk of preterm birth (n = 161) to assess (1) the relationship between vaginal microbiota and cervical length in the second trimester and preterm birth risk and (2) the impact of vaginal progesterone on vaginal bacterial communities in women with a short cervix. Lactobacillus iners dominance at 16 weeks of gestation was significantly associated with both a short cervix <25 mm (n = 15, P < 0.05) and preterm birth <34 +0  weeks (n = 18; P < 0.01; 69% PPV). In contrast, Lactobacillus crispatus dominance was highly predictive of term birth (n = 127, 98% PPV). Cervical shortening and preterm birth were not associated with vaginal dysbiosis. A longitudinal characterization of vaginal microbiota (<18, 22, 28, and 34 weeks) was then undertaken in women receiving vaginal progesterone (400 mg/OD, n = 25) versus controls (n = 42). Progesterone did not alter vaginal bacterial community structure nor reduce L. iners-associated preterm birth (<34 weeks). L. iners dominance of the vaginal microbiota at 16 weeks of gestation is a risk factor for preterm birth, whereas L. crispatus dominance is protective against preterm birth. Vaginal progesterone does not appear to impact the pregnancy vaginal microbiota. Patients and clinicians who may be concerned about "infection risk" associated with the use of a vaginal pessary during high-risk pregnancy can be reassured.

[Clinical analysis of pregnancies after vaginal radical trachelectomy].

PubMed

Ma, Liang-kun; Cao, Dong-yan; Yang, Jia-xin; Qi, Qing-wei; Gao, Jin-song; Liu, Jun-tao; Yang, Jian-qiu; Xiang, Yang; Shen, Keng; Lang, Jing-he

2012-12-01

To explore the pregnancy outcome and obstetric management of pregnancy and delivery after vaginal radical trachelectomy (VRT). Forty-two cases of VRT from December 2003 to May 2012 in Peking Union Medical College Hospital were analyzed retrospectively. Among them ten cases got pregnant successfully. The average age of patient at VRT surgery was (30.6 ± 3.7) years old and average follow-up time was 29.5 months. There were 31 patients attempted conception. Ten of them got fourteen conceptions successfully. Overall conception rate was 45% (14/31). There were four cases of first trimester abortion. Among them, two were miscarriage, two were elective abortion. There was one case of ectopic pregnancy operation and non of second trimester loss. Nine cases reached the third trimester. The total preterm delivery rate was 4/9. There were two cases delivered before 32 gestational weeks (2/9). Cesarean section was performed through a transverse incision in all of nine cases. No uterine rupture and postpartum hemorrhage occurred. All newborns had good outcomes. The average follow-up time after postpartum was 22.9 months. All cases were disease-free. The conception rate of patients after VRT in our series is 45%. The preterm birth rate of pregnancy after VRT is higher. Routine cerclage of cervix during VRT procedure and pregnancy is not necessary. Cesarean section shortly after full term pregnancy through a transverse incision should be considered as a suitable and safe procedure.

Women's antenatal preferences for delivery route in a setting with high cesarean section rates and a medically dominated maternity system.

PubMed

Dweik, Diána; Girasek, Edmond; Töreki, Annamária; Mészáros, Gyula; Pál, Attila

2014-04-01

To assess birth preferences in a sample of Hungarian pregnant women and identify determinants of ambivalence or clear choices for cesarean section throughout pregnancy. Follow-up two-point questionnaire survey. University Department of Obstetrics and Gynecology in Hungary. A total of 413 women with singleton pregnancies where there was no awareness of medical contradictions to vaginal delivery, attending for routine ultrasound examination in mid-pregnancy from November 2011 to March 2012. Questionnaires completed in mid- and late pregnancy (gestational weeks 18-22 and 35-37) including the Wijma Delivery Expectancy/Experience Questionnaire A. Prevalence of women preferring cesarean section or being uncertain about what delivery route to choose, in case they had the choice; their demographic characteristics, attitudes toward birth issues and their Wijma Delivery Expectancy/Experience Questionnaire A scores, compared with women consistent in their preference for vaginal delivery. Of the 413 respondents, 365 (88.4%) were consistent in their preference for vaginal delivery. In logistic regression models the important contributors to describing preferences for cesarean section or uncertain preferences were previous cesarean section and maternal belief that cesarean section is more beneficial than vaginal delivery. The majority of pregnant women preferred vaginal delivery to cesarean section. Neither a higher Wijma Delivery Expectancy/Experience Questionnaire A score nor sociodemographic differences were important determinants of a preference for cesarean section or for an uncertain preference. On the other hand, previous cesarean section and certain preconceived maternal attitudes towards delivery were characteristic for these women. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

Time trends in births and cesarean deliveries among women with disabilities.

PubMed

Horner-Johnson, Willi; Biel, Frances M; Darney, Blair G; Caughey, Aaron B

2017-07-01

Although it is likely that childbearing among women with disabilities is increasing, no empirical data have been published on changes over time in the numbers of women with disabilities giving birth. Further, while it is known that women with disabilities are at increased risk of cesarean delivery, temporal trends in cesarean deliveries among women with disabilities have not been examined. To assess time trends in births by any mode and in primary cesarean deliveries among women with physical, sensory, or intellectual/developmental disabilities. We conducted a retrospective cohort study using linked vital records and hospital discharge data from all deliveries in California, 2000-2010 (n = 4,605,061). We identified women with potential disabilities using ICD-9 codes. We used descriptive statistics and visualizations to examine time patterns. Logistic regression analyses assessed the association between disability and primary cesarean delivery, stratified by year. Among all women giving birth, the proportion with a disability increased from 0.27% in 2000 to 0.80% in 2010. Women with disabilities had significantly elevated odds of primary cesarean delivery in each year, but the magnitude of the odds ratio decreased over time from 2.60 (95% CI = 2.25 = 2.99) in 2000 to 1.66 (95% CI = 1.51-1.81) in 2010. Adequate clinician training is needed to address the perinatal care needs of the increasing numbers of women with disabilities giving birth. Continued efforts to understand cesarean delivery patterns and reasons for cesarean deliveries may help guide further reductions in proportions of cesarean deliveries among women with disabilities relative to women without disabilities. Copyright © 2017 Elsevier Inc. All rights reserved.

Perinatal outcome and long-term follow-up of extremely low birth weight infants depending on the mode of delivery.

PubMed

Minguez-Milio, José Angel; Alcázar, Juan Luis; Aubá, María; Ruiz-Zambrana, Alvaro; Minguez, José

2011-10-01

To assess the effect of the mode of delivery (vaginal or cesarean section) on survival, morbidity, and long-term psychomotor development of extremely low birth weight (ELBW) infants. A longitudinal observational study including 138 ELBW infants (73 born by c-section and 65 vaginally) was conducted. We analyzed the survival and short-term morbidity. We also studied the long-term neurocognitive and motor development using the McCarthy Scales of Children's Abilities (MSCA). Mortality was significantly higher in newborns delivered vaginally (49.3%) than those delivered by c-section (23.1%). Newborns delivered vaginally had a higher incidence of retinopathy and peri-intraventricular hemorrhage (P-IVH). Children who died had lower gestational age at birth and lower birth weight. After multivariate analysis only birth weight, gestational age at birth and P-IVH were independently associated to mortality. Regarding the long-term evaluation (MSCA), we observed that children born by c-section had lower incidence of abnormal results. The mode of delivery does not affect survival. Cesarean section provides lower morbidity and better prognosis for neurodevelopment long-term outcome in ELBW infants.

Crew Resource Management for Obstetric and Neonatal Teams to Improve Communication During Cesarean Births.

PubMed

Mancuso, Mary P; Dziadkowiec, Oliwier; Kleiner, Catherine; Halverson-Carpenter, Katherine; Link, Terri; Barry, James

2016-01-01

To assess the effectiveness of crew resource management training and interventions on the quality and quantity of communication during cesarean births in a tertiary academic hospital's labor and birthing services. A prospective pre-post crew resource management training intervention. Tertiary academic hospital in the Western United States. All members of obstetric and neonatal teams that participated in cesarean births. Over a 5-month time period, all obstetric and neonatal staff were required to participate in team training in crew resource management critical language, communication, and team structure. Trained observers collected baseline data (n = 52) for 3 months on the quantity and quality of communications that occurred during cesarean births. Postintervention data (n = 50) were gathered for 3 months after team training. Analysis approach included use of Fisher's exact test, independent-samples t test, and multilevel generalized linear regression models with Poisson distribution. There was a statistically significant increase in quantity and quality of communication from pre- to postintervention assessment for obstetric and neonatal staff. Although the increase in quality was similarly great between both types of teams, increase in quantity was more substantial in obstetric staff. Principles of team communication training shown to be effective in increasing communication among team members in a variety of clinical areas were also effective in improving communication in the labor and birth setting during cesarean births. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Timing of delivery after external cephalic version and the risk for cesarean delivery.

PubMed

Kabiri, Doron; Elram, Tamar; Aboo-Dia, Mushira; Elami-Suzin, Matan; Elchalal, Uriel; Ezra, Yossef

2011-08-01

To estimate the association between time of delivery after external cephalic version at term and the risk for cesarean delivery. This retrospective cohort study included all successful external cephalic versions performed in a tertiary center between January 1997 and January 2010. Stepwise logistic regression was used to calculate the odds ratio (OR) for cesarean delivery. We included 483 external cephalic versions in this study, representing 53.1% of all external cephalic version attempts. The incidence of cesarean delivery for 139 women (29%) who gave birth less than 96 hours from external cephalic version was 16.5%; for 344 women (71%) who gave birth greater than 96 hours from external cephalic version, the incidence of cesarean delivery was 7.8% (P = .004). The adjusted OR for cesarean delivery was 2.541 (95% confidence interval 1.36-4.72). When stratified by parity, the risk for cesarean delivery when delivery occurred less than 96 hours after external cephalic version was 2.97 and 2.28 for nulliparous and multiparous women, respectively. Delivery at less than 96 hours after successful external cephalic version was associated with an increased risk for cesarean delivery. III.

Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success.

PubMed

Knight, H E; Gurol-Urganci, I; van der Meulen, J H; Mahmood, T A; Richmond, D H; Dougall, A; Cromwell, D A

2014-01-01

To investigate the demographic and obstetric factors associated with the uptake and success rate of vaginal birth after caesarean section (VBAC). Cohort study using data from Hospital Episode Statistics. English National Health Service. Women whose first birth resulted in a live singleton delivery by caesarean section between 1 April 2004 and 31 March 2011, and who had a second birth before 31 March 2012. Logistic regression to estimate adjusted odds ratios (OR). Attempted and successful VBAC. Among the 143,970 women in the cohort, 75,086 (52.2%) attempted a VBAC for their second birth. Younger women, those of non-white ethnicity and those living in a more deprived area had higher rates of attempted VBAC. Overall, 47,602 women (63.4%) who attempted a VBAC had a successful vaginal birth. Younger women and women of white ethnicity had higher success rates. Black women had a particularly low success rate (OR, 0.54; 95% confidence interval [CI], 0.50-0.57). Women who had an emergency caesarean section in their first birth also had a lower VBAC success rate, particularly those with a history of failed induction of labour (OR, 0.59; 95% CI, 0.53-0.67). In this national cohort, just over one-half of women with a primary caesarean section who were eligible for a trial of labour attempted a VBAC for their second birth. Of these, almost two-thirds successfully achieved a vaginal delivery. © 2013 Royal College of Obstetricians and Gynaecologists.

Birth-associated long-bone fractures.

PubMed

Basha, Asma; Amarin, Zouhair; Abu-Hassan, Freih

2013-11-01

To assess the incidence and outcome of neonatal long-bone fractures at a tertiary teaching hospital. A retrospective study of all neonates with long-bone fractures delivered at Jordan University Hospital between January 1, 2000, and December 31, 2010. Among a total of 34 519 live births, 8 neonates had a long-bone fracture (incidence 0.23/1000 live births); of these, 6 had a femur fracture (0.17/1000 live births) and 2 had a humerus fracture (0.05/1000 live births). The route of delivery was emergency cesarean delivery for 6 infants, elective cesarean delivery for 1 infant, and the vaginal route for 1 infant. The mean birth weight was 2723g. All neonates weighed more than 2200g and their gestational age was more than 35weeks, with the exception of 1 neonate born at 31weeks weighing 1500g. The mean time interval from birth to fracture diagnosis was 1.5days. All fractures healed with no residual deformity. Emergency cesarean delivery carries a higher risk of long-bone fracture than vaginal delivery. Prematurity, malpresentation, abnormal lie, and multiple pregnancies may predispose to long-bone fractures. The prognosis of birth-associated long-bone fractures is good. © 2013.

Comparison of Apgar scores in breech presentations between vaginal and cesarean delivery

PubMed Central

Fajar, Jonny Karunia; Andalas, Mohd; Harapan, Harapan

2017-01-01

Objective: The mode of delivery in breech presentation (BP) is controversial. Several studies have reported the advantages and disadvantages of delivery mode in BP. The aim of this study was to compare the Apgar scores in BPs between vaginal and cesarean delivery. Materials and Methods: A retrospective study was conducted at Dr. Zainoel Abidin General Hospital from January 2010 to December 2012. Data on the mode of delivery and Apgar scores at 1 and 5 min for infants with a BP were extracted from the medical records. Logistic regression was employed to assess the correlation between mode of delivery and Apgar scores. In addition, a meta-analysis was conducted to summarize findings from other regions. Results: A total of 205 (3.9%) BPs among 5252 deliveries between January 2010 and December 2012 were analyzed for this study. There were 26% (52 cases) vaginal and 74% (153 cases) cesarean deliveries. The mode of delivery for BP had a significant association with Apgar score at 1 min (odds ratio [OR] 95% confidence interval [CI] = 6.462 [2.476–16.870], P = 0.0001) and 5 min (OR 95% CI = 7.727 [1.416–42.175], P = 0.018). Our meta-analysis showed that the delivery mode had a significant association with Apgar score in BP (OR: 3.69; 95% CI: 2.18–6.26, P = 0.0001). Conclusions: There was a significant association between Apgar scores in BPs and mode of delivery. Our results suggest better outcomes for cesarean than vaginal delivery in BPs. PMID:28757760

Cesarean section and risk of obesity in childhood, adolescence, and early adulthood: evidence from 3 Brazilian birth cohorts123

PubMed Central

Matijasevich, Alicia; Hallal, Pedro C; Horta, Bernardo L; Barros, Aluísio J; Menezes, Ana B; Santos, Iná S; Gigante, Denise P; Victora, Cesar G

2012-01-01

Background: The number of cesarean sections (CSs) is increasing in many countries, and there are concerns about their short- and long-term effects. A recent Brazilian study showed a 58% higher prevalence of obesity in young adults born by CS than in young adults born vaginally. Because CS-born individuals do not make contact at birth with maternal vaginal and intestinal bacteria, the authors proposed that this could lead to long-term changes in the gut microbiota that could contribute to obesity. Objective: We assessed whether CS births lead to increased obesity during childhood, adolescence, and early adulthood in 3 birth cohorts. Design: We analyzed data from 3 birth-cohort studies started in 1982, 1993, and 2004 in Southern Brazil. Subjects were assessed at different ages until 23 y of age. Poisson regression was used to estimate prevalence ratios with adjustment for ≤15 socioeconomic, demographic, maternal, anthropometric, and behavioral covariates. Results: In the crude analyses, subjects born by CS had ∼50% higher prevalence of obesity at 4, 11, and 15 y of age but not at 23 y of age. After adjustment for covariates, prevalence ratios were markedly reduced and no longer significant for men or women. The only exception was an association for 4-y-old boys in the 1993 cohort, which was not observed in the other 2 cohorts or for girls. Conclusion: In these 3 birth cohorts, CSs do not seem to lead to an important increased risk of obesity during childhood, adolescence, or early adulthood. PMID:22237058

75 FR 3745 - NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights; Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-22

... clinicians believed that all of her future pregnancies required delivery by cesarean as well. However, in... placental problems in future pregnancies. Other important considerations that may influence decisionmaking... the pregnancy is relative to her due date, and the size and position of her baby. Given the complexity...

The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population-based cohort study.

PubMed

Peters, Lilian L; Thornton, Charlene; de Jonge, Ank; Khashan, Ali; Tracy, Mark; Downe, Soo; Feijen-de Jong, Esther I; Dahlen, Hannah G

2018-03-25

Spontaneous vaginal birth rates are decreasing worldwide, while cesarean delivery, instrumental births, and medical birth interventions are increasing. Emerging evidence suggests that birth interventions may have an effect on children's health. Therefore, the aim of our study was to examine the association between operative and medical birth interventions on the child's health during the first 28 days and up to 5 years of age. In New South Wales (Australia), population-linked data sets were analyzed, including data on maternal characteristics, child characteristics, mode of birth, interventions during labor and birth, and adverse health outcomes of the children (ie, jaundice, feeding problems, hypothermia, asthma, respiratory infections, gastrointestinal disorders, other infections, metabolic disorder, and eczema) registered with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification codes. Logistic regression analyses were performed for each adverse health outcome. Our analyses included 491 590 women and their children; of those 38% experienced a spontaneous vaginal birth. Infants who experienced an instrumental birth after induction or augmentation had the highest risk of jaundice, adjusted odds ratio (aOR) 2.75 (95% confidence interval [CI] 2.61-2.91) compared with spontaneous vaginal birth. Children born by cesarean delivery were particularly at statistically significantly increased risk for infections, eczema, and metabolic disorder, compared with spontaneous vaginal birth. Children born by emergency cesarean delivery showed the highest association for metabolic disorder, aOR 2.63 (95% CI 2.26-3.07). Children born by spontaneous vaginal birth had fewer short- and longer-term health problems, compared with those born after birth interventions. © 2018 the Authors. Birth published by Wiley Periodicals, Inc.

Length of stay after vaginal birth: sociodemographic and readiness-for-discharge factors.

PubMed

Weiss, Marianne; Ryan, Polly; Lokken, Lisa; Nelson, Magdalen

2004-06-01

The impact of reductions in postpartum length of stay have been widely reported, but factors influencing length of hospital stay after vaginal birth have received less attention. The study purpose was to compare the sociodemographic characteristics and readiness for discharge of new mothers and their newborns at 3 discharge time intervals, and to determine which variables were associated with postpartum length of stay. The study sample comprised 1,192 mothers who were discharged within 2 postpartum days after uncomplicated vaginal birth at a tertiary perinatal center in the midwestern United States. The sample was divided into 3 postpartum length-of-stay groups: group 1 (18-30 hr), group 2 (31-42 hr), and group 3 (43-54 hr). Sociodemographic and readiness-for-discharge data were collected by self-report and from a computerized hospital information system. Measures of readiness for discharge included perceived readiness (single item and Readiness for Discharge After Birth Scale), documented maternal and neonatal clinical problems, and feeding method. Compared with other groups, the longest length-of-stay group was older; of higher socioeconomic status and education; and with more primiparous, breastfeeding, white, married mothers who were living with the baby's father, had adequate home help, and had a private payor source. This group also reported greater readiness for discharge, but their newborns had more documented clinical problems during the postbirth hospitalization. In logistic regression modeling, earlier discharge was associated with young age, multiparity, public payor source, low socioeconomic status, lack of readiness for discharge, bottle-feeding, and absence of a neonatal clinical problem. Sociodemographic characteristics and readiness for discharge (clinical and perceived) were associated with length of postpartum hospital stay. Length of stay is an outcome of a complex interface between patient, provider, and payor influences on discharge timing

The maternal childbirth experience more than a decade after delivery.

PubMed

Bossano, Carla M; Townsend, Kelly M; Walton, Alexandra C; Blomquist, Joan L; Handa, Victoria L

2017-09-01

Maternal satisfaction with the birth experience is multidimensional and influenced by many factors, including mode of delivery. To date, few studies have investigated maternal satisfaction outside of the immediate postpartum period. This study investigated whether differences in satisfaction based on mode of delivery are observed more than a decade after delivery. This was a planned, supplementary analysis of data collected for the Mothers' Outcomes after Delivery study, a longitudinal cohort study of pelvic floor disorders in parous women and their association with mode of delivery. Obstetric and demographic data were obtained through patient surveys and obstetrical chart review. Maternal satisfaction with childbirth experience was assessed via the Salmon questionnaire, administered to Mothers' Outcomes after Delivery study participants >10 years from their first delivery. This validated questionnaire yields 3 scores: fulfillment, distress, and difficulty. These 3 scores were compared by mode of delivery (cesarean prior to labor, cesarean during labor, spontaneous vaginal delivery, and operative vaginal delivery). In addition, the impact of race, age, education level, parity, episiotomy, labor induction, and duration of second stage of labor on maternal satisfaction were examined. Among 576 women, 10.1-17.5 years from delivery, significant differences in satisfaction scores were noted by delivery mode. Salmon scale scores differed between women delivering by cesarean and those delivering vaginally: women delivering vaginally reported greater fulfillment (0.40 [-0.37 to 0.92] vs 0.15 [-0.88 to 0.66], P < .001) and less distress (-0.34 [-0.88 to 0.38] vs 0.20 [-0.70 to 0.93], P < .001) than those who delivered by cesarean. Women who delivered by cesarean prior to labor reported the greatest median fulfillment scores and the lowest median difficulty scores. Median distress scores were lowest among those who delivered by spontaneous vaginal birth. Among women who

Birth experience in women with low, intermediate or high levels of fear. Findings from the First Baby Study

PubMed Central

Elvander, Charlotte; Cnattingius, Sven; Kjerulff, Kristen H.

2013-01-01

Background Fear of childbirth and mode of delivery are two known factors that affect birth experience. The interactions between these two factors are unknown. The aim of this study was to estimate the effects of different levels of fear of birth and mode of delivery on birth experience 1 month after birth. Methods As part of an ongoing prospective study, we interviewed 3006 women in their third trimester and 1 month after first childbirth to assess fear of birth and birth experience. Logistic regression was performed to examine the interactions and associations between fear of birth, mode of delivery and birth experience. Results Compared to women with low levels of fear of birth, women with intermediate levels of fear and women with high levels of fear had a more negative birth experience and were more affected by an unplanned cesarean section or instrumental vaginal delivery. Compared to women with low levels of fears with a non-instrumental vaginal delivery, women with high levels of fear who were delivered by unplanned cesarean section had a 12-fold increased risk of reporting a negative birth experience (odds ratio 12.25; 95% confidence intervals 7.19-20.86). A non-instrumental vaginal delivery was associated with the most positive birth experience among the women in this study. Conclusions This study shows that both levels of prenatal fear of childbirth and mode of delivery are important for birth experience. Women with low fear of childbirth who had a non-instrumental vaginal delivery reported the most positive birth experience. PMID:24344710

Birth experience in women with low, intermediate or high levels of fear: findings from the first baby study.

PubMed

Elvander, Charlotte; Cnattingius, Sven; Kjerulff, Kristen H

2013-12-01

Fear of childbirth and mode of delivery are two known factors that affect birth experience. The interactions between these two factors are unknown. The aim of this study was to estimate the effects of different levels of fear of birth and mode of delivery on birth experience 1 month after birth. As part of an ongoing prospective study, we interviewed 3,006 women in their third trimester and 1 month after first childbirth to assess fear of birth and birth experience. Logistic regression was performed to examine the interactions and associations between fear of birth, mode of delivery and birth experience. Compared with women with low levels of fear of birth, women with intermediate levels of fear, and women with high levels of fear had a more negative birth experience and were more affected by an unplanned cesarean section or instrumental vaginal delivery. Compared with women with low levels of fears with a noninstrumental vaginal delivery, women with high levels of fear who were delivered by unplanned cesarean section had a 12-fold increased risk of reporting a negative birth experience (OR 12.25; 95% CI 7.19-20.86). A noninstrumental vaginal delivery was associated with the most positive birth experience among the women in this study. This study shows that both levels of prenatal fear of childbirth and mode of delivery are important for birth experience. Women with low fear of childbirth who had a noninstrumental vaginal delivery reported the most positive birth experience. © 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.

Neonatal outcome of very preterm twins: policy of planned vaginal or cesarean delivery.

PubMed

Sentilhes, Loïc; Oppenheimer, Anne; Bouhours, Anne-Charlotte; Normand, Estelle; Haddad, Bassam; Descamps, Philippe; Marpeau, Loïc; Goffinet, François; Kayem, Gilles

2015-07-01

The objective of the study was to compare neonatal mortality and morbidity in very preterm twins with the first twin in cephalic presentation in hospitals with a policy of planned vaginal delivery (PVD) and those with a policy of planned cesarean delivery (PCD). Women with preterm cephalic first twins delivered after preterm labor and/or premature preterm rupture of membranes from 26(0/7) to 31(6/7) weeks of gestation were identified from the databases of 6 perinatal centers and classified as PVD or PCD according to the center's management policy from 1999 to 2010. Severe neonatal morbidity was defined as any of the following: intraventricular hemorrhage grades 3-4, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, and hospital death. The independent effect of the planned mode of delivery, defined by the center's management policy, was tested and quantified with a 2-level multivariable logistic regression. The PVD group included 248 women, and the PCD group 63. Maternal characteristics did not differ between the 2 groups. The rate of vaginal delivery was 85.9% (213 of 248) vs 20.6% (13 of 63) (P < .001), and the rate of cesarean delivery for the second twin was 1.6% (4 of 248) vs 4.8% (3 of 63) (P = .13) for PVD and PCD. PVD had no independent effect on either newborn hospital mortality or severe neonatal composite morbidity. A policy of planned vaginal delivery of very preterm twins with the first twin in cephalic presentation does not increase either severe neonatal morbidity or mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION: CURRENT TRENDS AND OUTLOOK IN GHANA.

PubMed

Seffah, J D; Adu-Bonsaffoh, K

2014-01-01

The optimal mode of subsequent delivery of women with prior caesarean birth remains a subject of intense research and debate in contemporary obstetric practice especially in low resource settings like West Africa where there are obvious systemic and management-related challenges associated with trial of scar. However, there is evidence that vaginal birth after caesarean section (VBAC) is safe in appropriately selected women in addition to adequate intrapartum monitoring and ready access to theatre when emergency CS is indicated. The primary objective of the study was to determine the current trends and performance of VBAC in Ghana after decades of practice of trial of labour after caesarean section (TOLAC) in the mist of inherent challenges in deciding the optimal mode of childbirth for women with a previous caesarean birth. The secondary objective was to relate evidence based practice of TOLAC to obstetric practice in low resource settings like Ghana and provide recommendations for improving maternal and newborn health among women with prior caesarean birth. This was a retrospective study of the records of patients who had had a prior caesarean delivery and who then proceeded to deliver the next babies at the Korle Bu Teaching Hospital (KBTH) between Jan 2010 and Dec 2014. The data on demography, antenatal care, labour and delivery and outcomes were collected from the Labour and Recovery wards and the Biostatistics unit of the Maternity unit of the Hospital. Excluded were women with a previous CS who had multiple pregnancies and those with incomplete notes as well as those whose delivery plans were not predetermined antenatally.. The data were analyzed using SPSS version 20. There were 53,581 deliveries during the study period. Vaginal delivery was obtained in 31,870 (59.5%) pregnancies and 21,711(40.5%) had CS. Also, 6261 (11.7%) had had a prior CS and 2472 (39.5%) of these were selected for TOLAC while 2119 (33.8) were scheduled for planned repeat CS. There was

Clinical Factors Associated With Presentation Change of the Second Twin After Vaginal Delivery of the First Twin.

PubMed

Panelli, Danielle M; Easter, Sarah Rae; Bibbo, Carolina; Robinson, Julian N; Carusi, Daniela A

2017-11-01

To identify clinical factors associated with a change from vertex to nonvertex presentation in the second twin after vaginal birth of the first. We assembled a retrospective cohort of women with viable vertex-vertex twin pregnancies who delivered the presenting twin vaginally. Women whose second twin changed from vertex to nonvertex after vaginal birth of the first were classified as experiencing an intrapartum change in presentation. Characteristics associated with intrapartum presentation change in a univariate analysis with a P value ≤.10 were then evaluated in a multivariate logistic regression model. Four-hundred fifty women met inclusion criteria, of whom 55 (12%) had intrapartum presentation change of the second twin. Women experiencing intrapartum presentation change were more likely to be multiparous (69% compared with 47%, P<.01) and to have had a change in the presentation of the second twin between the most recent antepartum ultrasonogram and the ultrasonogram done on admission to labor and delivery (11% compared with 4%, P=.04). In an adjusted analysis, multiparity and gestational age less than 34 weeks were significantly associated with presentation change (adjusted odds ratio [OR] 2.9, 95% CI 1.5-5.6 and adjusted OR 2.6, 95% CI 1.1-5.9, respectively). Women with intrapartum presentation change were more likely to undergo cesarean delivery for their second twin (44% compared with 7%, P<.01) with an adjusted OR of 10.50 (95% CI 5.20-21.20) compared with those with stable intrapartum presentation. Twenty of the 24 (83%) cesarean deliveries performed in the intrapartum presentation change group were done for issues related to malpresentation. Multiparity and gestational age less than 34 weeks are associated with intrapartum presentation change of the second twin.

Cup detachment during vacuum-assisted vaginal delivery and birth outcome.

PubMed

Krispin, Eyal; Aviram, Amir; Salman, Lina; Chen, Rony; Wiznitzer, Arnon; Gabbay-Benziv, Rinat

2017-11-01

To determine the perinatal outcome associated with cup detachment during vacuum-assisted vaginal delivery (VAVD). A retrospective cohort study of all women attempting VAVD in a tertiary hospital (2012-2014). Singleton-term pregnancies were included. Antepartum fetal death and major fetal structural or chromosomal abnormalities were excluded. Primary outcome was neonatal birth trauma (subgaleal hematoma, subarachnoid hematoma, subdural hematoma, skull fracture, and/or erb's palsy). Secondary outcomes were maternal complications or other neonatal morbidities. Outcomes were compared between women after ≥1 cup detachment (study group) and the rest (control group). Logistic regression analysis was utilized to adjust results to potential confounders. Overall, 1779 women attempted VAVD during study period. Of them, in 146 (8.2%), the cup detached prior to delivery; 130/146 (89%) had a single detachment. After detachment, 4 (2.7%) delivered by cesarean section, 77 (52.7%) delivered after cup reapplication, and 65 (44.6%) delivered spontaneously. Women in the study group were more likely to undergo VAVD due to prolonged second stage, and were characterized by lower rates of metal cup use. Neonates in the detachment group had higher rates of subarachnoid hematoma and composite neonatal birth trauma (2.7 vs. 0.1% and 4.8 vs. 1.8%, respectively, p < 0.05). This remained significant after adjustment to potential confounders (subarachnoid hematoma aOR = 45.44, 95% CI 6.42-321.62 and neonatal birth trauma aOR = 2.62, 95% CI 1.1-6.22, p < 0.05 for all). Other neonatal and maternal morbidities were similar between groups. Cup detachment is associated with a higher rate of adverse neonatal outcome. Cup reapplication should be considered carefully.

Birth of cloned mice from vaginal smear cells after somatic cell nuclear transfer.

PubMed

Kuwayama, Hiroki; Tanabe, Yoshiaki; Wakayama, Teruhiko; Kishigami, Satoshi

2017-05-01

Less invasive methods for donor cell collection will facilitate reproduction of wild animals using somatic-cell nuclear transfer. Stages of the estrous cycle in mice have long been studies using somatic cells that can be collected from vaginal walls using cotton tipped swabs in a relatively non-invasive manner. In this study, we examined the feasibility of these cells as sources of nuclei for somatic-cell cloning using nuclear transfer. Estrous cycles generally comprise proestrus, estrus, metestrus, and diestrus stages. In the present experiments, more than 60% of cells were nucleated in vaginal smears from all but the estrus stage. However, after somatic-cell nuclear transfer of cells from proestrus, metestrus, and diestrus stages, 66%, 50%, and 72% of cloned embryos developed to the morula/blastocyst, and cloned female mouse birth rates after embryo transfer were 1.5%, 0.3%, and 1%, respectively. These results show that noninvasively collected vaginal smears contain somatic cells that can be used to clone female mice. Copyright © 2017. Published by Elsevier Inc.

Supporting Women Planning a Vaginal Breech Birth: An International Survey.

PubMed

Petrovska, Karolina; Watts, Nicole P; Catling, Christine; Bisits, Andrew; Homer, Caroline S E

2016-12-01

The aim of this study was to explore the experiences of women who planned a vaginal breech birth. An online survey was developed consisting of questions regarding women's experiences surrounding planned vaginal breech birth. The survey was distributed between April 2014 and January 2015 to closed membership Facebook groups that had a consumer focus on vaginal breech birth. In total, 204 unique responses to the survey were obtained from women who had sought the option of a vaginal breech birth in a previous pregnancy. Most women (80.8%) stated that they were happy with the birth choices they made, and a significant proportion (89.4%) would attempt a vaginal breech birth in subsequent pregnancies. Less than half of women were formally referred to a clinician skilled in vaginal breech birth when their baby was diagnosed breech (41.8%), while the remainder sourced a clinician themselves. Half of the women felt supported by their care provider (56.7%) and less than half (42.3%) felt supported by family and friends. The women who responded to this international survey sought the option of a vaginal breech birth, were subsequently happy with this decision, and would attempt a vaginal breech birth in their next pregnancy. Access to vaginal breech birth is important for some women; however, this choice may be challenging to achieve. Consistent information and support from clinicians is important to assist decision-making. © 2016 Wiley Periodicals, Inc.

The Vaginal Eukaryotic DNA Virome and Preterm Birth.

PubMed

Wylie, Kristine M; Wylie, Todd N; Cahill, Alison G; Macones, George A; Tuuli, Methodius G; Stout, Molly J

2018-05-05

Despite decades of attempts to link infectious agents to preterm birth, an exact causative microbe or community of microbes remains elusive. Culture-independent sequencing of vaginal bacterial communities demonstrates community characteristics are associated with preterm birth, although none are specific enough to apply clinically. Viruses are important components of the vaginal microbiome and have dynamic relationships with vaginal bacterial communities. We hypothesized that vaginal eukaryotic DNA viral communities (the "vaginal virome") either alone or in the context of bacterial communities are associated with preterm birth. The objective of this study was to use high-throughput sequencing to examine the vaginal eukaryotic DNA virome in a cohort of pregnant women and examine associations between vaginal community characteristics and preterm birth. This is a nested case-control study within a prospective cohort study of women with singleton pregnancies, not on supplemental progesterone, and without cervical cerclage in situ. Serial mid-vaginal swabs were obtained at routine prenatal visits. DNA was extracted, bacterial communities were characterized by 16S rRNA gene sequencing, and eukaryotic viral communities were characterized by enrichment of viral nucleic acid with the ViroCap targeted sequence capture panel followed by nucleic acid sequencing. Viral communities were analyzed according to presence/absence of viruses, diversity, dynamics over time, and association with bacterial community data obtained from the same specimens. Sixty subjects contributed 128 vaginal swabs longitudinally across pregnancy. Twenty-four patients delivered preterm. Participants were predominantly African-American (65%). Six families of eukaryotic DNA viruses were detected in the vaginal samples. At least 1 virus was detected in 80% of women. No specific virus or group of viruses was associated with preterm delivery. Higher viral richness was significantly associated with preterm

MATERNAL ACCOUNTS OF THEIR BREASTFEEDING INTENT AND EARLY CHALLENGES AFTER CESAREAN CHILDBIRTH

PubMed Central

Tully, Kristin P.; Ball, Helen L.

2013-01-01

Background Breastfeeding outcomes are often worse after cesarean section compared to vaginal childbirth. Objectives This study characterizes mothers’ breastfeeding intentions and their infant feeding experiences after cesarean childbirth. Methods Data are from 115 mothers on a postnatal unit in Northeast England during February 2006 to March 2009. Interviews were conducted an average of 1.5 days (range 1–6 days) after the women underwent unscheduled or scheduled cesarean. Results Thematic analysis of the data suggested breastfeeding was mostly considered the “right thing to do,” preferable, natural, and “supposedly healthier,” but tiring and painful. Advantages of supplementation involved more satiated infants, feeding ease, and longer sleep bouts. The need for “thinking about yourself” was part of cesarean recovery. Infrequent feeding was concerning but also enabled maternal rest. Other breastfeeding obstacles were maternal mobility limitations, positioning difficulties, and frustration at the need for assistance. Participants were confused about nocturnal infant wakings, leading many to determine that they had insufficient milk. Mothers were surprised that sub-clinically poor infant condition was common following cesarean section. Some breastfeeding difficulty stemmed from “mucus” expulsion that had to occur before the infants could be “interested” in feeding. Women who cited motivations for breastfeeding that included benefit to themselves were more likely to exclusively breastfeed on the postnatal unit after their cesareans than those who reported infant-only motivations. Conclusions For the majority of mothers, breastfeeding after a cesarean is affected by interrelated and compounding difficulties. Provision of more relational breastfeeding information may enable families to better anticipate early feeding experiences after cesarean section childbirth. PMID:24252711

Gestation at birth, mode of birth, infant feeding and childhood hospitalization with infection.

PubMed

Bentley, Jason P; Burgner, David P; Shand, Antonia W; Bell, Jane C; Miller, Jessica E; Nassar, Natasha

2018-05-16

Infections are a leading cause of mortality and morbidity in preschool children. We aimed to assess the impact of the co-occurrence of cesarean section, early birth and formula feeding on hospitalization with infection in early childhood. Population-based retrospective record-linkage cohort study of 488 603 singleton livebirths ≥32 weeks gestational age in New South Wales, Australia, 2007-2012. Multivariable Cox-regression was used to estimate independent and combined adjusted associations of gestational age, mode of birth (vaginal or cesarean section by labor onset) and formula feeding with time to first and repeat hospitalization with infection for children <5 years of age. 95 346 (19.5%) children were hospitalized with infection, and of these 24.8% (23 615) more than once. Median age at first and repeat hospitalization was 1.1 and 1.7 years, respectively. Earlier gestation, modes of birth other than spontaneous vaginal, and formula feeding were independently associated with an increased risk of first and repeat hospitalization with infection. At 32-36 weeks gestation, co-occurrence of perinatal factors (Cf. spontaneous vaginal birth at 39+ weeks without formula feeding) was associated with a 2-fold and 1.5-fold increased risk of first and repeat hospitalization, respectively. For births at 37-38 weeks, the increased risk was 1.5-fold and 1.25-fold for first and repeat hospitalization, respectively. Cesarean section, labor induction, birth <39 weeks and formula feeding increase the risk of infection-related hospitalization in childhood, which increases further when these factors co-occur. Reducing early planned birth and supporting breastfeeding are potentially cost-effective approaches to reducing these hospitalizations. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Cesarean Delivery Changes the Natural Position of the Uterus on Transvaginal Ultrasonography.

PubMed

Kaelin Agten, Andrea; Honart, Anne; Monteagudo, Ana; McClelland, Spencer; Basher, Basmy; Timor-Tritsch, Ilan E

2018-05-01

To assess whether cesarean delivery changes the natural position of the uterus. In this retrospective Institutional Review Board-approved cohort study, we conducted a search of our university gynecologic ultrasonography (US) database. Patients with transvaginal US images before and after either vaginal or cesarean delivery between 2012 and 2015 were included. Women with prior cesarean delivery were excluded. Two readers independently measured antepartum and postpartum flexion angles between the longitudinal axis of the uterine body and the cervix. We calculated intraclass correlation coefficients to measure inter-reader agreement. Antepartum and postpartum uterine flexion angles were compared between patients with vaginal and cesarean delivery. We included 173 patients (107 vaginal and 66 cesarean delivery). The mean interval between scans ± SD was 18 ± 10 months. Inter-reader agreement for flexion angles was almost perfect (intraclass correlation coefficients: antepartum, 0.939; postpartum, 0.969; both P < .001). There was no difference in mean antepartum flexion angles for cesarean delivery (154.8° ± 45.7°) versus vaginal delivery (145.8° ± 43.7°; P = .216). Mean postpartum flexion angles were higher after cesarean delivery (180.4° ± 51.2°) versus vaginal delivery (152.8° ± 47.7°; P = .001. Differences in antepartum and postpartum flexion angles between cesarean and vaginal delivery were statistically significant (25.6° versus 7.0°; P = .027). Cesarean delivery can change the uterine flexion angle to a more retroflexed position. Therefore, all women with a history of cesarean delivery should undergo a transvaginal US examination before any gynecologic surgery or intrauterine device placement to reduce the possibility of surgical complications. © 2017 by the American Institute of Ultrasound in Medicine.

Impact of clinical audits on cesarean section rate.

PubMed

Peng, Fu-Shiang; Lin, Hsien-Ming; Lin, Ho-Hsiung; Tu, Fung-Chao; Hsiao, Chin-Fen; Hsiao, Sheng-Mou

2016-08-01

Many countries have noted a substantial increase in the cesarean section rate (CSR). Several methods for lowering the CSR have been described. Understanding the impact of clinical audits on the CSR may aid in lowering CSR. Thus, our aim is to elucidate the effect of clinical audits on the CSR. We retrospectively analyzed 3781 pregnant women who gave birth in a medical center between January 2008 and January 2011. Pregnant women who delivered between January 2008 and July 2009 were enrolled as the pre-audit group (n = 1592). After August 2009, all cesarean section cases that were audited were enrolled in the audit group (n = 2189). The CSR was compared between groups. The overall CSR (34.5% vs. 31.1%, adjusted odds ratio [OR] = 0.83, p = 0.008) and the cesarean section rate due to dystocia (9.6% vs. 6.2%, p < 0.001) were significantly lower in the audit group than the pre-audit group. However, there was no significant difference in the rate of operative vaginal delivery between groups. Consensus on the unnecessity for cesarean section was achieved in 16 (8.2%) of 195 audit cases in the monthly audit conference. In nulliparous pregnant women (n = 2148), multivariate analysis revealed that clinical audit (OR = 0.78), maternal age (OR = 1.10), gestational age at delivery (OR = 0.80), and fetal body weight at birth (OR = 1.0005) were independent predictors of cesarean section (all p < 0.05). Most variables of maternal and perinatal morbidity and mortality did not differ before and after audits were implemented. Clinical audits appear to be an effective strategy for reducing the CSR. Therefore, we recommend strict monitoring of the indications in dystocia for cesarean section to reduce the CSR. Copyright © 2016. Published by Elsevier B.V.

[Cesarean birth: justifying indication or justified concern?].

PubMed

Muñoz-Enciso, José Manuel; Rosales-Aujang, Enrique; Domínguez-Ponce, Guillermo; Serrano-Díaz, César Leopoldo

2011-02-01

Caesarean section is the most common surgery performed in all hospitals of second level of care in the health sector and more frequently in private hospitals in Mexico. To determine the behavior that caesarean section in different hospitals in the health sector in the city of Aguascalientes and analyze the indications during the same period. A descriptive and cross in the top four secondary hospitals in the health sector of the state of Aguascalientes, which together account for 81% of obstetric care in the state, from 1 September to 31 October 2008. Were analyzed: indication of cesarean section and their classification, previous pregnancies, marital status, gestational age, weight and minute Apgar newborn and given birth control during the event. were recorded during the study period, 2.964 pregnancies after 29 weeks, of whom 1.195 were resolved by Caesarean section with an overall rate of 40.3%. We found 45 different indications, which undoubtedly reflect the great diversity of views on the institutional medical staff to schedule a cesarean section. Although each institution has different resources and a population with different characteristics, treatment protocols should be developed by staff of each hospital to have the test as a cornerstone of labor, also request a second opinion before a caesarean section, all try to reduce the frequency of cesarean section.

Prior Prelabor or Intrapartum Cesarean Delivery and Risk of Placenta Previa

PubMed Central

Downes, Katheryne L.; Hinkle, Stefanie N.; Sjaarda, Lindsey A.; Albert, Paul S.; Grantz, Katherine L.

2015-01-01

Objective To examine the association between previous cesarean delivery and subsequent placenta previa while distinguishing cesarean delivery prior to onset of labor from intrapartum cesarean delivery. Study Design Retrospective cohort study of electronic medical records from 20 Utah hospitals (2002–2010) with restriction to the first two singleton deliveries of women nulliparous at study entry (n=26,987). First pregnancy delivery mode was classified as 1) vaginal (reference); 2) cesarean delivery prior to labor onset (prelabor); or 3) cesarean delivery after labor onset (intrapartum). Risk of second delivery previa was estimated by prior delivery mode using logistic regression and adjusted for maternal age, insurance, smoking, co-morbidities, prior pregnancy loss, and history of previa. Results The majority of first deliveries were vaginal (82%, n=22,142), followed by intrapartum cesarean delivery (14.6%, n=3,931), or prelabor cesarean delivery (3.4%, n=914). Incidence of second delivery previa was 0.29% (n=78) and differed by prior delivery mode: vaginal, 0.24%; prelabor cesarean delivery, 0.98%; intrapartum cesarean delivery, 0.38% (P<0.001). Relative to vaginal delivery, prior prelabor cesarean delivery was associated with an increased risk of second delivery previa (adjusted odds ratio, 2.62 [95% confidence interval, 1.24–5.56]). There was no significant association between prior intrapartum cesarean delivery and previa [adjusted odds ratio, 1.22 (95% confidence interval, 0.68–2.19)]. Conclusion Prior prelabor cesarean delivery was associated with a more than two-fold significantly increased risk of previa in the second delivery, while the approximately 20% increased risk of previa associated with prior intrapartum cesarean delivery was not significant. Although rare, the increased risk of placenta previa after prior prelabor cesarean delivery may be important when considering non-medically indicated prelabor cesarean delivery. PMID:25576818

Previous prelabor or intrapartum cesarean delivery and risk of placenta previa.

PubMed

Downes, Katheryne L; Hinkle, Stefanie N; Sjaarda, Lindsey A; Albert, Paul S; Grantz, Katherine L

2015-05-01

The purpose of this study was to examine the association between previous cesarean delivery and subsequent placenta previa while distinguishing cesarean delivery before the onset of labor from intrapartum cesarean delivery. We conducted a retrospective cohort study of electronic medical records from 20 Utah hospitals (2002-2010) with restriction to the first 2 singleton deliveries of nulliparous women at study entry (n=26,987). First pregnancy delivery mode was classified as (1) vaginal (reference), (2) cesarean delivery before labor onset (prelabor), or (3) cesarean delivery after labor onset (intrapartum). Risk of second delivery previa was estimated by previous delivery mode with the use of logistic regression and was adjusted for maternal age, insurance, smoking, comorbidities, previous pregnancy loss, and history of previa. Most first deliveries were vaginal (82%; n=22,142), followed by intrapartum cesarean delivery (14.6%; n=3931), or prelabor cesarean delivery (3.4%; n=914). Incidence of second delivery previa was 0.29% (n=78) and differed by previous delivery mode: vaginal, 0.24%; prelabor cesarean delivery, 0.98%; intrapartum cesarean delivery, 0.38% (P<.001). Relative to vaginal delivery, previous prelabor cesarean delivery was associated with an increased risk of second delivery previa (adjusted odds ratio, 2.62; 95% confidence interval, 1.24-5.56). There was no significant association between previous intrapartum cesarean delivery and previa (adjusted odds ratio, 1.22; 95% confidence interval, 0.68-2.19). Previous prelabor cesarean delivery was associated with a >2-fold significantly increased risk of previa in the second delivery, although the approximately 20% increased risk of previa that was associated with previous intrapartum cesarean delivery was not significant. Although rare, the increased risk of placenta previa after previous prelabor cesarean delivery may be important when considering nonmedically indicated prelabor cesarean delivery

Blood transfusion during pregnancy, birth, and the postnatal period.

PubMed

Patterson, Jillian A; Roberts, Christine L; Bowen, Jennifer R; Irving, David O; Isbister, James P; Morris, Jonathan M; Ford, Jane B

2014-01-01

To identify risk factors for transfusion and trends in transfusion rates across pregnancy and the postnatal period. Linked hospital and birth data on all births in hospitals in New South Wales, Australia, between 2001 and 2010 were used to identify blood transfusions for women during pregnancy, at birth, and in the 6 weeks postpartum. Poisson regression was used to identify risk factors for red cell transfusion in the birth admission. Separate models were fitted for cesarean and vaginal births. Between 2001 and 2010, there were 12,147 transfusions across 891,914 pregnancies, with a transfusion rate of 1.4%. The transfusion rate increased steadily from 1.2% in 2001 to 1.6% in 2010. The majority of transfusions (91%) occurred during the birth admission, and 81% of these transfusions were associated with a diagnosis of hemorrhage. Women with bleeding or platelet disorders (vaginal: number transfused 529, relative risk [RR] 7.8, 99% confidence interval [CI] 6.9-8.7, cesarean: n=592, RR 8.7, CI 7.7-9.7) and placenta previa: (vaginal n=73, RR 4.6, CI 3.4-6.3, cesarean: n=875, RR 5.7, CI 5.1-6.4) were at highest risk of transfusion. Among vaginal births, increased risk was evident for forceps (n=1,036, RR 2.8, CI 2.5-3.0) or vacuum births (n=1,073, RR 1.9, CI 1.7-2.0) compared with nonoperative births. Rates of obstetric blood product transfusion have increased by 33% since 2001, with the majority of this associated with hemorrhage. Women with bleeding or platelet disorders and placenta previa are at increased risk of transfusion and should be treated accordingly. II.

Prenatal attitudes toward vaginal delivery and actual delivery mode: Variation by race/ethnicity and socioeconomic status.

PubMed

Attanasio, Laura B; Hardeman, Rachel R; Kozhimannil, Katy B; Kjerulff, Kristen H

2017-12-01

Researchers documenting persistent racial/ethnic and socioeconomic status disparities in chances of cesarean delivery have speculated that women's birth attitudes and preferences may partially explain these differences, but no studies have directly tested this hypothesis. We examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. Data were from the First Baby Study, a cohort of 3006 women who gave birth to a first baby in Pennsylvania between 2009 and 2011. We used regression models to examine (1) predictors of prenatal attitudes toward vaginal delivery, and (2) the association between prenatal attitudes and actual delivery mode. To assess moderation, we estimated models adding interaction terms. Prenatal attitudes toward vaginal delivery were not associated with race/ethnicity or socioeconomic status. Positive attitudes toward vaginal delivery were associated with lower odds of cesarean delivery (AOR=0.60, P < .001). However, vaginal delivery attitudes were only related to delivery mode among women who were white, highly educated, and privately insured. There are racial/ethnic differences in chances of cesarean delivery, and these differences are not explained by birth attitudes. Furthermore, our findings suggest that white and high-socioeconomic status women may be more able to realize their preferences in childbirth. © 2017 Wiley Periodicals, Inc.

Prophylactic antibiotics for manual removal of retained placenta in vaginal birth.

PubMed

Chongsomchai, Chompilas; Lumbiganon, Pisake; Laopaiboon, Malinee

2014-10-20

Retained placenta is a potentially life-threatening condition because of its association with postpartum hemorrhage. Manual removal of placenta increases the likelihood of bacterial contamination in the uterine cavity. To compare the effectiveness and side-effects of routine antibiotic use for manual removal of placenta in vaginal birth in women who received antibiotic prophylaxis and those who did not and to identify the appropriate regimen of antibiotic prophylaxis for this procedure. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014). All randomized controlled trials comparing antibiotic prophylaxis and placebo or non antibiotic use to prevent endometritis after manual removal of placenta in vaginal birth. There are no included trials. In future updates, if we identify eligible trials, two review authors will independently assess trial quality and extract data No studies that met the inclusion criteria were identified. There are no randomized controlled trials to evaluate the effectiveness of antibiotic prophylaxis to prevent endometritis after manual removal of placenta in vaginal birth.

Early pregnancy vaginal microbiome trends and preterm birth.

PubMed

Stout, Molly J; Zhou, Yanjiao; Wylie, Kristine M; Tarr, Phillip I; Macones, George A; Tuuli, Methodius G

2017-09-01

Despite decades of attempts to link infectious agents to preterm birth, an exact causative microbe or community of microbes remains elusive. Nonculture 16S ribosomal RNA gene sequencing suggests important racial differences and pregnancy specific changes in the vaginal microbial communities. A recent study examining the association of the vaginal microbiome and preterm birth documented important findings but was performed in a predominantly white cohort. Given the important racial differences in bacterial communities within the vagina as well as persistent racial disparities in preterm birth, it is important to examine cohorts with varied demographic compositions. To characterize vaginal microbial community characteristics in a large, predominantly African-American, longitudinal cohort of pregnant women and test whether particular vaginal microbial community characteristics are associated with the risk for subsequent preterm birth. This is a nested case-control study within a prospective cohort study of women with singleton pregnancies, not on supplemental progesterone, and without cervical cerclage in situ. Serial mid-vaginal swabs were obtained by speculum exam at their routine prenatal visits. Sequencing of the V1V3 region of the 16S rRNA gene was performed on the Roche 454 platform. Alpha diversity community characteristics including richness, Shannon diversity, and evenness as well as beta diversity metrics including Bray Curtis Dissimilarity and specific taxon abundance were compared longitudinally in women who delivered preterm to those who delivered at term. A total of 77 subjects contributed 149 vaginal swabs longitudinally across pregnancy. Participants were predominantly African-American (69%) and had a preterm birth rate of 31%. In subjects with subsequent term delivery, the vaginal microbiome demonstrated stable community richness and Shannon diversity, whereas subjects with subsequent preterm delivery had significantly decreased vaginal richness

Media Representations of Breech Birth: A Prospective Analysis of Web-Based News Reports.

PubMed

Petrovska, Karolina; Sheehan, Athena; Homer, Caroline S E

2017-07-01

Recent research has demonstrated that the media presentation of childbirth is highly medicalized, often portraying birth as risky and dramatic. Media representation of breech presentation and birth is unexplored in this context. This study aimed to explore the content and tone of news media reports relating to breech presentation and breech birth. Google alerts were created using the terms breech and breech birth in online English-language news sites over a 3-year period from January 1, 2013, to December 31, 2015. Alerts were received daily and filed for analysis, and data were analyzed to generate themes. A total of 138 web-based news reports were gathered from 9 countries. Five themes that arose from the data included the problem of breech presentation, the high drama of vaginal breech birth, the safe option of cesarean birth versus dangers of vaginal breech birth, the defiant mother versus the saintly mother, and vaginal breech birth and medical misadventure. Media reports in this study predominantly demonstrated negative views toward breech presentation and vaginal breech birth. Cesarean birth was portrayed as the safe option for breech birth, while vaginal breech birth was associated with poor outcomes. Media presentations may impact decision making about mode of birth for pregnant women with a breech fetus. Health care providers can play an important role in balancing the media depiction of planned vaginal breech birth by providing nonjudgmental, evidence-based information to such women to facilitate informed decision making for birth. © 2017 by the American College of Nurse-Midwives.

Neonatal Morbidity and Mortality After Elective Cesarean Delivery

PubMed Central

Signore, Caroline; Klebanoff, Mark

2008-01-01

As overall cesarean delivery rates have continued to rise, there has been growing interest in the rates of elective cesarean delivery (ECD), and its relative benefits and harms for the mother and neonate. This article explores the effects of elective cesarean delivery at term on neonatal morbidity and mortality. Available data are subject to a number of limitations, and do not provide conclusive evidence regarding the safety of planned elective cesarean versus planned vaginal delivery. Nevertheless, some data suggest an association between ECD and increased neonatal respiratory morbidity and lacerations, and possibly decreased central and peripheral nervous system injury. Potentially increased risks of neonatal mortality with ECD at term may be counterbalanced by risks of fetal demise in ongoing pregnancies. Patients and physicians considering ECD should carefully review competing risks and benefits; further research is needed to inform these discussions. PMID:18456074

Repeat cesarean delivery: what indications are recorded in the medical chart?

PubMed

Lydon-Rochelle, Mona T; Gardella, Carolyn; Cárdenas, Vicky; Easterling, Thomas R

2006-03-01

National surveillance estimates reported a troubling 63 percent decline in the rate of vaginal birth after cesarean delivery (VBAC) from 1996 (28.3%) to 2003 (10.6%), with subsequent rising rates of repeat cesarean delivery. The study objective was to examine patterns of documented indications for repeat cesarean delivery in women with and without labor. We conducted a population-based validation study of 19 nonfederal short-stay hospitals in Washington state. Of the 4,541 women who had live births in 2000, 11 percent (n = 493) had repeat cesarean without labor and 3 percent (n = 138) had repeat cesarean with labor. Incidence of medical conditions and pregnancy complications, patterns of documented indications for repeat cesarean delivery, and perioperative complications in relation to repeat cesarean delivery with and without labor were calculated. Of the 493 women who underwent a repeat cesarean delivery without labor, "elective"(36%) and "maternal request"(18%) were the most common indications. Indications for maternal medical conditions (3.0%) were uncommon. Among the 138 women with repeat cesarean delivery with labor, 60.1 percent had failure to progress, 24.6 percent a non-reassuring fetal heart rate, 8.0 percent cephalopelvic disproportion, and 7.2 percent maternal request during labor. Fetal indications were less common (5.8%). Breech, failed vacuum, abruptio placentae, maternal complications, and failed forceps were all indicated less than 5.0 percent. Women's perioperative complications did not vary significantly between women without and with labor. Regardless of a woman's labor status, nearly 10 percent of women with repeat cesarean delivery had no documented indication as to why a cesarean delivery was performed. "Elective" and "maternal request" were common indications among women undergoing repeat cesarean delivery without labor, and nearly 10 percent of women had undocumented indications for repeat cesarean delivery in their medical record

Women's autonomy and scheduled cesarean sections in Brazil: a cautionary tale.

PubMed

Potter, Joseph E; Hopkins, Kristine; Faúndes, Anibal; Perpétuo, Ignez

2008-03-01

In Brazil, one-fourth of all women deliver in the private sector, where the rate of cesarean deliveries is extremely high (70%). Most (64%) private sector cesareans are scheduled, although many women would have preferred a vaginal delivery. The question this study addresses is whether childbearing women were induced to accept the procedure by their physicians, and if so, how? Three face-to-face structured interviews were conducted with 1,612 women (519 private sector and 1,093 public sector) early in pregnancy, approximately 1 month before their due date, and approximately 1 month postpartum. For all private sector patients having a scheduled cesarean section, women's self-reported reasons given for programming surgical delivery were classified into three groups according to obstetrical justification. After loss to follow-up (19.2% of private sector and 34.4% of public sector), our final sample included 1,136 women (419 private sector and 717 public sector). Compared with public sector participants in the final sample, on average, private sector participants were older by 3.4 years (28.7 vs 25.3 yr), had 0.4 fewer previous deliveries (0.6 vs 1.0), and had 3.4 more years of education (11.0 vs 7.6 yr). The final samples also differed slightly with respect to preference for vaginal delivery: 72.3 percent among those in the private sector and 79.6 percent in public sector. The cesarean section rate was 72 percent in the private sector and 31 percent in the public sector. Of the women with reports about the timing of the cesarean decision, 64.4 percent had a scheduled cesarean delivery in the private sector compared with 23.7 percent in the public sector. Many cesarean sections were scheduled for an "unjustified" medical reason, especially among women who, during pregnancy, had declared a preference for a vaginal delivery. Among 96 women in this latter group, the reason reported for the procedure was unjustified in 33 cases. On the other hand, more cesarean deliveries

Twin vaginal delivery: innovate or abdicate.

PubMed

Easter, Sarah Rae; Taouk, Laura; Schulkin, Jay; Robinson, Julian N

2017-05-01

Neonatal safety data along with national guidelines have prompted renewed interest in vaginal delivery of twins, particularly in the case of the noncephalic second twin. Yet, the rising rate of twin cesarean deliveries, coupled with the national decline in operative obstetrics, raises concerns about the availability of providers who are skilled in twin vaginal birth. Providers are key stakeholders for increasing rates of twin vaginal delivery. We surveyed a group of practicing obstetricians to explore potential barriers to the vaginal birth of twins with a focus on delivery of the noncephalic second twin. Among 107 responding providers, only 57% would deliver a noncephalic second twin by breech extraction. Providers who preferred breech extraction had a higher rate of maternal-fetal medicine subspecialty training (26.2% vs 4.3%; P<.01) and were more likely to be in an academic practice environment (36.1% vs 10.9%; P<.01) and to practice in high-volume centers that deliver >30 sets of twins annually (57.4% vs 34.8%; P=.02). Most providers (54.2%) were familiar with the findings from the recent randomized trial that demonstrated the safety of twin vaginal birth. However, knowledge of the trial was not associated statistically with a preference for breech extraction (62.3% vs 43.5%; P=.05). Providers who preferred breech extraction were more likely to agree with recent society guidelines that encourage the vaginal birth of twins (86.9% vs 63.0%; P<.01). In an adjusted analysis, the 46% of providers with a perceived need for more training were far less likely to prefer breech extraction for delivery of a noncephalic second twin (adjusted odds ratio, 0.38; 95% confidence interval, 0.16-0.95). Furthermore, 57% of providers who would not offer their patient breech extraction would be willing to consult a colleague for support with a noncephalic twin delivery. These results suggest that scientific evidence and society opinion are likely insufficient to reverse the national

Pregnancy outcome and obstetric management after vaginal radical trachelectomy.

PubMed

Ma, L-K; Cao, D-Y; Yang, J-X; Liu, J-T; Shen, K; Lang, J-H

2014-10-01

Radical vaginal trachelectomy (VRT) is widely prescribed as a surgical procedure to treat early-stage cervical cancer while preserving fertility. However, the ideal obstetric standard of care for patients who have undergone VRT has not yet been established. Aim of this rerport is to analyze pregnancy outcomes and optimal obstetric management during pregnancy and delivery after vaginal radical trachelectomy (VRT). Forty-six cases of VRT from December 2003 to April 2013 in Peking Union Medical College Hospital were analyzed. The mean age of the patients at the time of VRT was 30.6 years and the mean follow-up time was 39.5 months. Of the 32 patients who attempted to conceive, 12 had 16 successful conceptions. There were two miscarriages and two elective abortions. One case of ectopic pregnancy and one case of second trimester loss occurred in this cohort. Ten cases reached the third trimester. Two patients delivered before 32 weeks, and four before 37 weeks. The total preterm delivery rate was 60%. All ten patients delivered by Cesarean section through a high transverse uterine incision. No uterine rupture or postpartum hemorrhage occurred. There is an increased occurrence of preterm delivery after VRT. Cesarean section after full term pregnancy through a high transverse incision should be considered as a suitable and safe procedure.

Respiratory morbidity in twins by birth order, gestational age and mode of delivery.

PubMed

Bricelj, Katja; Tul, Natasa; Lasic, Mateja; Bregar, Andreja Trojner; Verdenik, Ivan; Lucovnik, Miha; Blickstein, Isaac

2016-10-01

To evaluate the relationship between respiratory morbidity in twins by gestational age, birth order and mode of delivery. All twin deliveries at <37 weeks, registered in a national database, in the period 2003-2012 were classified into four gestational age groups: 33-36, 30-32, 28-29, and <28 weeks. Outcome variables included transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS) and need for assisted ventilation. A total of 1836 twins were born vaginally, and 2142 twins were born by cesarean delivery, for a grand total of 3978 twins. TTN did not appear to be related to birth order and to the mode of delivery. In contrast, RDS was more frequent among the second born twins in the vaginal birth groups born at 30-36 weeks [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.2-5.1 and OR 2.0, 95% CI 1.2-3.5 for 33-36 weeks and 30-32 weeks, respectively], whereas this trend was seen in the cesarean birth groups born earlier (OR 3.8, 95% CI 1.1-13.0 for 28-29 weeks). Cesarean delivery significantly increased the frequency of RDS in twin A as well as in twin B compared with vaginal birth, but only at gestational ages <30 weeks. Mode of delivery and birth order have a gestational age dependent effect on the incidence of RDS.

Cesarean birth in the border region: a descriptive analysis based on US Hispanic and Mexican birth certificates.

PubMed

McDonald, Jill A; Mojarro Davila, Octavio; Sutton, Paul D; Ventura, Stephanie J

2015-01-01

Cesarean birth (CB) is more prevalent in the US-Mexico border region than among all US Hispanics. Comparable data from US and Mexican birth certificates can be used to compare prevalence and identify risk factors on either side of the border. Using 2009 US and Mexican birth certificates, we compared the characteristics of US Hispanic and Mexican CBs in six geographic subgroups: US and Mexican border counties/municipios, US and Mexican non-border counties/municipios and the US and Mexico overall. We also explored cesarean prevalence over time. During 2000-2009, CB rates increased from 22.1 to 31.6 % among US Hispanics and from 25.9 to 37.9 % among Hispanics in the US border region. 2009 rates were 44.5 % in Mexico and 43.1 % in the Mexican border region. In both countries, CB rates were similar for primiparas and multiparas. Higher education, being married and parity >4 were associated with CB in Mexico; being married was associated in the US. Hispanic rates were higher in the US border than non-border region for all age groups. Along the border, cesarean rates for Hispanics were highest in Texas (43.5 %) and neighboring Tamaulipas (49.8 %). Higher cesarean prevalence in Mexico than in US Hispanics, while unexplained, is consistent with high prevalence in some Latin American countries. Higher cesarean prevalence among Hispanics in the US border region than among Hispanics nationwide cannot be explained by maternal age or parity. Medical indications are also unlikely to explain such high rates, which are undesirable for mothers and infants.

Routine antibiotic prophylaxis after normal vaginal birth for reducing maternal infectious morbidity.

PubMed

Bonet, Mercedes; Ota, Erika; Chibueze, Chioma E; Oladapo, Olufemi T

2017-11-13

Infectious morbidities contribute to considerable maternal and perinatal morbidity and mortality, including women at no apparent increased risk of infection. To reduce the incidence of infections, antibiotics are often administered to women after uncomplicated childbirth, particularly in settings where women are at higher risk of puerperal infectious morbidities. To assess whether routine administration of prophylactic antibiotics to women after normal (uncomplicated) vaginal birth, compared with placebo or no antibiotic prophylaxis, reduces postpartum maternal infectious morbidities and improves outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2017), LILACS, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (22 August 2017) and reference lists of retrieved studies. We planned to include randomised or quasi-randomised trials evaluating the use of prophylactic antibiotics versus placebo or no antibiotic prophylaxis. Trials using a cluster-randomised design would have been eligible for inclusion, but we found none.In future updates of this review, we will include studies published in abstract form only, provided sufficient information is available to assess risks of bias. We will consider excluded abstracts for inclusion once the full publication is available, or the authors provide more information.Trials using a cross-over design are not eligible for inclusion in this review. Two review authors conducted independent assessment of trials for inclusion and risks of bias. They independently extracted data and checked them for accuracy, resolving differences in assessments by discussion. They evaluated methodological quality using standard Cochrane criteria and the GRADE approach.We present the summaries as risk ratios (RRs) and mean difference (MDs) using fixed- or random-effect models. For one primary outcome we found considerable heterogeneity and interaction. We explored further using

Upcoming strategies in obstetrics: how the technology of clinical audit may reduce cesarean birth.

PubMed

Paracchini, Sara; Masturzo, Bianca; Tangolo, Domenico; Roletti, Enrica; Piazzese, Annalisa; Attini, Rossella; Rolfo, Alessandro; Todros, Tullia

2017-12-01

high gap between observed and adequate scores, the significant potential of improvement and the high incidence of the event, as they account for the 20% of average cesarean deliveries in our unit in the period of the study. Thus, we implemented a plan of improvement that consisted on introduction in clinical practice of the cervical ripening balloon for women who desire a trial of labor after CS (TOLAC), congress sessions and training to clinicians, information and counselling to pregnant woman with a previous cesarean. The impact of the implemented measures of correction applied for two years was evaluated with a re-audit on 40 patients, from May to April 2016. The cesarean birth after cesarean (CBAC) rate observed after the re-audit was 62% (32/50), significantly lower compared to the previous 80% P<0.01. Thus, the established plan of improvement induces a reduction in CBAC rate of 24%. Clinical audit is a powerful instrument that can improve standards of care. In our Unit, clinical audit on elective cesarean leads to the identification of an excess in repeated cesareans and a significant reduction of them. However, to realize an effective improvement we are planning furthers audits.

Rectal Cancer Diagnosed after Cesarean Section in Which High Microsatellite Instability Indicated the Presence of Lynch Syndrome

PubMed Central

Okuda, Tomohiro; Ishii, Hiroshi; Yamashita, Sadao; Matsuo, Seiki; Okimura, Hiroyuki

2015-01-01

We report a case of rectal cancer with microsatellite instability (MSI) that probably resulted from Lynch syndrome and that was diagnosed after Cesarean section. The patient was a 28-year-old woman (gravid 1, para 1) without a significant medical history. At 35 gestational weeks, vaginal ultrasonography revealed a 5 cm tumor behind the uterine cervix, which was diagnosed as a uterine myoma. The tumor gradually increased in size and blocked the birth canal, resulting in the patient undergoing an emergency Cesarean section. Postoperatively, the tumor was diagnosed as rectal cancer with MSI. After concurrent chemoradiation therapy, a lower anterior resection was performed. The patient's family history revealed she met the criteria of the revised Bethesda guidelines for testing the colorectal tumor for MSI. Testing revealed that the tumor did indeed show high MSI and, combined with the family history, suggested this could be a case of Lynch syndrome. Our findings emphasize the importance of considering the possibility of Lynch syndrome in pregnant women with colorectal cancer, particularly those with a family history of this condition. We suggest that the presence of Lynch syndrome should also be considered for any young woman with endometrial, ovarian, or colorectal cancer. PMID:26064726

Conservative Management of Placenta Accreta/Increta after Vaginal Birth

PubMed Central

Peiffer, S.; Reinhard, J.; Reitter, A.; Louwen, F.

2012-01-01

Aim: Aim of the study was to show that conservative management with preservation of the uterus and of fertility is possible in patients with placenta accreta/increta after vaginal delivery. Method: A retrospective analysis of patients with placental attachment disorders after vaginal delivery was done in a perinatal centre between November 2009 and April 2011. The patient collective was identified using the ICD-10 codes for placenta accreta/increta/percreta, and patient records were analysed for risk factors, maternal morbidity, preservation of the uterus and of fertility, and neonatal outcome. Results: Three cases of placenta increta were identified in the last 1.5 years out of a total of 1457 vaginal deliveries, and all 3 cases were treated conservatively. Mean maternal age was 35.3 years; gestational age ranged from 39 to 41 weeks, and mean duration between delivery of the child and delivery of the placenta was 44.67 days (range: 14–100 days). Two patients developed symptoms of endomyometritis, including fever, leukocytosis and increased CRP levels. All 3 women were successfully managed with preservation of the uterus. Conclusion: In selected cases with placenta accreta/increta after vaginal delivery, it is possible to avoid surgical procedures, particularly hysterectomy procedures, and successfully manage these patients conservatively with preservation of the uterus. PMID:25308979

Cesarean Births and Attachment Behaviors of Fathers.

DTIC Science & Technology

1984-01-01

Experienced Fathers Has parented one or more children . 3. Full-term Infants Infant weighing not less than 5 pounds (2500 grams) and between 37 and 42 weeks...of attachment, (b) paternal attachment, and (c) cesarean birth. The Concept of Attachment The study of maternal behavior in animals has stimulated...others to investigate the development of the mother-infant relationship in man. Recently, there have been studies on maternal and paternal attachment

Time Duration of Oxygen Adaptation Immediately after Birth; Monitoring by Pulse Oximeter in Perinatal Period of the Infants at Charoenkrung Pracharak Hospital.

PubMed

Suwattanaphim, Suparach; Yodavuhd, Sirisanpang; Puangsa-art, Supalarp

2015-07-01

Oxygen Saturation is one of the important data to determine patient status and worldwide applied in several situations. Evaluation about status of immediate perinatal period of the infant usually uses clinical assessment, Apgar scoring, which had been used for a long time without other scientific measurement. Pulse oximeter the non-invasive measurement of oxygen saturation, may play role for oxygen saturation evaluation in newborn that immediately change from intra to extra uterine environment. Monitoring the time duration that immediately born infants by normal labor or Cesarean section modes, used to archived target oxygen saturation (SpO) and looking for the other factors that influence oxygen saturation adaptation. The data of the 553 infants born in Charoenkrung Pracharak Hospital, Bangkok, Thailand between October 2012 and April 2013 were collected. The 204 healthy newborns that met all criteria were studied. All infants were recorded pulse oximeter from the second to the tenth minute after birth. They were grouped by several factors such as maternal gravidity, gestational age, mode of delivery, Apgar score, birth weight, and sex. Time interval to achieve target oxygen saturation (SpO2 ≥ 90%) was collected for analysis. The oxygen saturation of infants immediately after birth showed an increase. Median time interval was 6.5 (2-10) minutes for 90% saturation and 7 (2-10) minutes for 95% saturation, respectively. Only mode of delivery showed statistical significant time difference (p < 0.001). A Cox proportional hazards analysis of the Kaplan-Meier curves demonstrated that infants born by cesarean delivery took significantly longer time to reach a stable SpO2 ≥ 90% than infants born by vaginal delivery (95% CI = 1.28 to 2.74; p < 0.01). A newly born infant has to take 6.5 minutes (2-10) after birth to adjust their oxygen saturation to reach normal higher level of extra uterine life, median SpO2 of 90%. Furthermore, mode of delivery makes a significant

Vaginal Birth After Caesarean Section in Low Resource Settings: The Clinical and Ethical Dilemma.

PubMed

Wanyonyi, Sikolia; Muriithi, Francis G

2015-10-01

Vaginal birth after Caesarean section (VBAC) has long been practised in low resource settings using unconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice has been informed by observational studies with many deficiencies; this is so despite other studies from settings in which the standard of care is much better that show that elective repeat Caesarean section (ERCS) may actually be safer than VBAC. This raises questions about whether we should insist on a dangerous practice when there are safer alternatives. We highlight some of the challenges faced in making this decision, and discuss why the fear of ERCS may not be justified after all in low resource settings. Since a reduction in rates of Caesarean section may not be applicable in these regions, because their rates are already low, the emphasis should instead be on adequate birth spacing and safer primary operative delivery.

Barriers and facilitators for vaginal breech births in Australia: Clinician's experiences.

PubMed

Catling, C; Petrovska, K; Watts, N; Bisits, A; Homer, C S E

2016-04-01

Since the Term Breech Trial in 2000, few Australian clinicians have been able to maintain their skills to facilitate vaginal breech births. The overwhelming majority of women with a breech presentation have been given one birth option, that is, caesarean section. The aim of this study was to explore clinician's experiences of caring for women when facilitating a vaginal breech birth. A descriptive exploratory design was undertaken. Nine clinicians (obstetricians and midwives) from two tertiary hospitals in Australia who regularly facilitate vaginal breech birth were interviewed. The interviews were analysed thematically. Participants were five obstetricians and four midwives. There were two overarching themes that arose from the data: Facilitation of and Barriers to vaginal breech birth. A number of sub-themes are described in the paper. In order to facilitate vaginal breech birth and ensure it is given as an option to women, it is necessary to educate, upskill and support colleagues to increase their confidence and abilities, carefully counsel and select suitable women, and approach the option in a calm, collaborative way. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Influence of fetal birth weight on perinatal outcome in planned vaginal births.

PubMed

Temerinac, Dunja; Chen, Xi; Sütterlin, Marc; Kehl, Sven

2014-02-01

The aim of this study was to provide information for better obstetric counseling by analyzing the impact of fetal birth weight (BW) on fetal and maternal outcome when vaginal birth is planned in a university hospital. In this retrospective study from January 1st 2006 to December 31st 2011, 5,177 singleton, alive deliveries at or >37 gestational weeks were assessed with regard to the fetal BW when vaginal birth was attempted. The normal BW group was defined as ≥2,500 <4,500 g. For comparison, further BW groups were defined as: group 1 <2,500 g, group 2 ≥4,000 <4,250 g, group 3 ≥4,250 <4,500 g and group 4 ≥4,500 g. Outcome criteria were mode of delivery and perineal lacerations as well as the pH and base excess of the umbilical cord artery, the Apgar score after 5 min and occurrence of shoulder dystocia. The set of controlling variables included maternal height, maternal weight, maternal age, gestational age, neonatal sex and parity. Second stage caesarean section is significantly more likely when fetal BW is under 2,500 g (30.7 vs. 15.5 % in the normal BW group, odds ratio 3.01, 95 % confidence interval 2.03-4.46, p value < 0.001). Shoulder dystocia occurred significantly more often when fetal BW was over 4,250 g (group 3: odds ratio 4.95, 95 % confidence interval 1.74-14.10, p value 0.003, group 4: odds ratio 19.96, 95 % confidence interval 7.61-52.38, p value < 0.001). The risk of an Apgar score after 5 min below 7 increased, when fetal BW was below 2,500 g (odds ratio 9.28, 95 % confidence interval 3.15-27.35, p value < 0.001) or above 4,500 g (odds ratio 5.65, 95 % confidence interval 1.22-26.24, p value 0.027). All groups were comparable to the normal group regarding pH and base excess of the umbilical cord artery as well as the risk for severe (third and fourth degree) perineal lacerations. Although a fetal birth weight under 2,500 g and a birth weight over 4,250 g are associated with some risks, there is no general contraindication for an attempt to

Minimizing genital tract trauma and related pain following spontaneous vaginal birth.

PubMed

Albers, Leah L; Borders, Noelle

2007-01-01

Genital tract trauma is common following vaginal childbirth, and perineal pain is a frequent symptom reported by new mothers. The following techniques and care measures are associated with lower rates of obstetric lacerations and related pain following spontaneous vaginal birth: antenatal perineal massage for nulliparous women, upright or lateral positions for birth, avoidance of Valsalva pushing, delayed pushing with epidural analgesia, avoidance of episiotomy, controlled delivery of the baby's head, use of Dexon (U.S. Surgical; Norwalk, CT) or Vicryl (Ethicon, Inc., Somerville, NJ) suture material, the "Fleming method" for suturing lacerations, and oral or rectal ibuprofen for perineal pain relief after delivery. Further research is warranted to determine the role of prenatal pelvic floor (Kegel) exercises, general exercise, and body mass index in reducing obstetric trauma, and also the role of pelvic floor and general exercise in pelvic floor recovery after childbirth.

Delivery by Cesarean Section is not Associated With Decreased at-Birth Fracture Rates in Osteogenesis Imperfecta

PubMed Central

Bellur, S; Jain, M; Cuthbertson, D; Krakow, D; Shapiro, JR; Steiner, RD; Smith, PA; Bober, MB; Hart, T; Krischer, J; Mullins, M; Byers, PH; Pepin, M; Durigova, M; Glorieux, FH; Rauch, F; Sutton, VR; Lee, B; Nagamani, SC

2015-01-01

Purpose Osteogenesis imperfecta (OI) predisposes to recurrent fractures. The moderate-to-severe forms of OI present with antenatal fractures and the mode of delivery that would be safest for the fetus is not known. Methods We conducted systematic analyses on the largest cohort of individuals (n=540) with OI enrolled to-date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared in individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates including method of delivery on fracture-related outcomes. Results When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean section (CS). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CS for delivery. Conclusion Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI shows that delivery by CS is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CS should be performed only for other maternal or fetal indications, but not for the sole purpose of fracture prevention in OI. PMID:26426884

The U.S. Twin Delivery Volume and Association with Cesarean Delivery Rates: A Hospital-Level Analysis.

PubMed

Easter, Sarah Rae; Robinson, Julian N; Carusi, Daniela; Little, Sarah E

2018-03-01

 The objective of this study was to test whether hospitals experienced in twin delivery have lower rates of cesarean delivery for twins.  We divided obstetric hospitals in the 2011 National Inpatient Sample by quartile of annual twin deliveries and compared twin cesarean delivery rates between hospitals with weighted linear regression. We used Pearson's coefficients to correlate a hospital's twin cesarean delivery rate to its overall cesarean delivery and vaginal birth after cesarean (VBAC) rates.  Annual twin delivery volume ranged from 1 to 506 across the 547 analyzed hospitals with a median of 10 and mode of 3. Adjusted rates of cesarean delivery were independent of delivery volume with a rate of 75.5 versus 74.8% in the lowest and highest volume hospitals ( p  = 0.09 across quartiles). A hospital's cesarean delivery rate for twins moderately correlated with the overall cesarean rate ( r  = 0.52, p  < 0.01) and inversely correlated with VBAC rate ( r  =  - 0.42, p  < 0.01).  Most U.S. obstetrical units perform a low volume of twin deliveries with no decrease in cesarean delivery rates at higher volume hospitals. Twin cesarean delivery rates correlate with other obstetric parameters such as singleton cesarean delivery and VBAC rates suggesting twin cesarean delivery rate is more closely related to a hospital's general obstetric practice than its twin delivery volume. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The incidence and risk factors for retained placenta after vaginal delivery - a single center experience.

PubMed

Ashwal, Eran; Melamed, Nir; Hiersch, Liran; Wiznitzer, Arnon; Yogev, Yariv; Peled, Yoav

2014-12-01

We aimed to determine the incidence and risk factors for retained placenta immediately after vaginal delivery in a single, university-affiliated tertiary center. A case-control study. Women who delivered vaginally and diagnosed with suspected retained placenta were compared to control group of women with spontaneous vaginal delivery with spontaneous non-complicated placental separation between the years 2007 and 2012. Eligibility was limited to singleton fetuses in vertex presentation with no history of more than one cesarean section, stillbirth or major fetal anomaly. Overall, 33,925 women delivered vaginally, of them, 491 (1.4%) underwent revision of uterine cavity due to suspected retained placenta. Women with retained placenta were characterized by a higher rate of previous cesarean section (OR 1.71, 95% CI 1.23-2.36), previous abortions, lower parity (OR 0.79, 95% CI 0.68-0.91), lower gestational age at delivery. Hypertensive disorders, oligohydramnios and labor and delivery interventions as induction of labor (OR 1.84, 95% CI 1.30-2.59), neuro-axial analgesia (OR 1.60, 95% CI 1.27-2.00) and vacuum delivery (OR 1.89, 95% CI 1.48-2.41) were independently associated with uterine revision for retained placenta. Risk factors for manual revision due to retained placenta can be recognized. This data should be taken into consideration in the assessment of women immediately after delivery.

Neonatal clavicle fracture in cesarean delivery: incidence and risk factors.

PubMed

Choi, Hyun Ah; Lee, Yeon Kyung; Ko, Sun Young; Shin, Son Moon

2017-07-01

Neonatal clavicle fracture in cesarean delivery is rare and has not been extensively studied. We performed a retrospective review of cesarean deliveries with neonatal clavicle fracture during a 12-year period. Maternal and neonatal factors as well as surgical factors related to cesarean delivery for the fracture were determined and compared to the control group to analyze their significance. Among a total 89 367 deliveries during the study period, 36 286 babies were born via cesarean section. Nineteen cases of clavicle fractures in cesarean section were identified (0.05% of total live births via cesarean section). In the analysis of maternal and neonatal risk factors, birthweight, birthweight ≥ 4000  g and maternal age were significantly associated with clavicle fracture in cesarean section. However, clavicle fractures were not correlated with the selected surgical factors such as indication for cesarean section, skin incision to delivery time and incision type of skin and uterus. Logistic regression analysis showed that birthweight was the major risk factor for clavicle fracture. Clavicle fractures complicated 0.05% of cesarean deliveries. The main risk factor related to a clavicle fracture in cesarean section was the birthweight of an infant. As reported in previous studies associated with vaginal delivery, clavicle fracture is considered to be an unavoidable event and may not be eliminated, even in cesarean delivery.

High prevalence of cesarean section births in private sector health facilities- analysis of district level household survey-4 (DLHS-4) of India.

PubMed

Singh, Priyanka; Hashmi, Gulfam; Swain, Prafulla Kumar

2018-05-10

Worldwide rising cesarean section (CS) births is an issue of concern. In India, with increase in institutional deliveries there has also been an increase in cesarean section births. Aim of the study is to quantify the prevalence of cesarean section births in public and private health facility, and also to determine the factors associated with cesarean section births. We analyzed data from district level household survey data 4 (DLHS-4) combined individual level dataset for 19 states/UTs of India comprising 24,398 deliveries resulting in 22,111 live births for year 2011. The percentages and Chi-square has been computed for the select variables viz. Socio demographic, maternal, antenatal care and delivery related based on type of births (CS Vs normal births). The multiple logistic regression model has been used to identify the potential risk factors associated with CS births. Of 22,111 live birth analyzed 49.2% were delivered at public sector, 31.9% at private sector and 18.9% were home deliveries. Prevalence of CS births were 13.7% (95% CI; 13.0- 14.3%) and 37.9% (95% CI; 36.7- 39.0%) in the public and private sectors, respectively. Higher odds of CS births were observed with- delivery at private health facility (OR 3.79; 95% C.I 3.06-4.72), urban residence (OR 1.15; 95% C.I 1.00- 1.35), first delivery after 35 years of maternal age (OR 5.5; 95% C.I 1.85- 16.4), hypertension in pregnancy (OR 1.32; 95% C.I 1.06- 1.65) and breach presentation (OR 2.37; 95% C.I. 1.63- 3.43). Our findings shows that CS births are nearly three times more in private as compared to public sector health facilities.The higher rates of CS births, especially in private sector, not only increase the cost of care but may pose unnecessary risks to women (when there is no indications for CS). The government of India need to take measures to strengthen existing public health facilities as well as ensure that cesarean sections are performed based upon medical indications in both public and private

Reference ranges for regional cerebral tissue oxygen saturation and fractional oxygen extraction in neonates during immediate transition after birth.

PubMed

Pichler, Gerhard; Binder, Corinna; Avian, Alexander; Beckenbach, Elisabeth; Schmölzer, Georg M; Urlesberger, Berndt

2013-12-01

To define reference ranges for regional cerebral tissue oxygen saturation (crSO2) and regional cerebral fractional tissue oxygen extraction (cFTOE) during the first 15 minutes after birth in neonates requiring no medical support. The crSO2 was measured using near infrared spectroscopy (Invos 5100 cerebral/somatic oximeter monitor; Somanetics Corp, Troy, Michigan) during the first 15 minutes after birth for term and preterm neonates. The near infrared spectroscopy sensor was placed on the left forehead. Peripheral oxygen saturation and heart rate were continuously measured by pulse oximetry, and cFTOE was calculated. Neonates were excluded if they required any medical support. A total of 381 neonates were included: 82 term neonates after vaginal delivery, 272 term neonates after cesarean delivery, and 27 preterm neonates after cesarean delivery. In all neonates, median (10th-90th percentiles) crSO2 was 41% (23-64) at 2 minutes, 68% (45-85) at 5 minutes, 79% (65-90) at 10 minutes, and 77% (63-89) at 15 minutes of age. In all neonates, median (10th-90th percentiles) cFTOE was 33% (11-70) at 2 minutes, 21% (6-45) at 5 minutes, 15% (5-31) at 10 minutes, and 18% (7-34) at 15 minutes of age. We report reference ranges of crSO2 and cFTOE in neonates requiring no medical support during transition immediately after birth. The use of cerebral oxygenation monitoring and use of these reference ranges in neonates during transition may help to guide oxygen delivery and avoid cerebral hypo-oxygenation and hyperoxygenation. Copyright © 2013 Mosby, Inc. All rights reserved.

Baby-friendly hospital practices and birth costs.

PubMed

Allen, Jessica A; Longenecker, Holly B; Perrine, Cria G; Scanlon, Kelley S

2013-12-01

Hospital practices supportive of breastfeeding can improve breastfeeding rates. There are limited data available on how improved hospital practices are associated with hospital costs. We describe the association between the number of breastfeeding supportive practices a hospital has in place and the cost of an uncomplicated birth. Data from hospitals in 20 states that participated in the 2007 Maternity Practices in Infant Nutrition and Care (mPINC) survey and Healthcare Cost and Utilization Project's (HCUP) State Inpatient Databases (SID) were merged to calculate the average median hospital cost of uncomplicated vaginal and cesarean section births by number of ideal practices from the Ten Steps to Successful Breastfeeding. Linear regression analyses were conducted to estimate change in birth cost for each additional ideal practice in place. Sixty-one percent of hospitals had ideal practice on 3-5 of the 10 steps, whereas 29 percent of hospitals had ideal practice on 6-8. Adjusted analyses of uncomplicated births revealed a higher but nonsignificant increase in any of the birth categories (all births, $19; vaginal, $15; cesarean section, $39) with each additional breastfeeding supportive maternity care practice in place. Our results revealed that the number of breastfeeding supportive practices a hospital has in place is not significantly associated with higher birth costs. Concern for higher birth costs should not be a barrier for improving maternity care practices that support women who choose to breastfeed. © 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.

Alternative Strategy to Decrease Cesarean Section: Support by Doulas During Labor

PubMed Central

Trueba, Guadalupe; Contreras, Carlos; Velazco, Maria Teresa; Lara, Enrique García; Martínez, Hugo B.

2000-01-01

This research was conducted in a public general hospital in Mexico City, Mexico. The objective was to evaluate efficacy of the support given by a doula during labor to reduce cesarean rate. From March 1997 to February 1998, a group of 100 pregnant women were studied. These women were at term, engaged in an active phase of labor, exhibited 3 cm. or more cervical dilatation, were nuliparous, had no previous uterine incision, and possessed adequate pelvises. The group was randomly divided into two subgroups comprising 50 women, each: The first subgroup had the support of a childbirth educator trained as a doula, while the second subgroup did not have doula support. Measurements were recorded on the duration of labor, the use of pitocin, and whether or not the birth was a vaginal birth or cesarean section. Characteristics and gestational age were similar in both groups. Results confirmed that support by doulas during labor was associated with a significant reduction in cesarean birth and pitocin administration. There was a trend toward shorter labors and less use of epidurals. The results of this study showed, as in other trials measuring the impact of a doula's presence during labor and birth, that doula support during labor is associated with positive outcomes that have physical, emotional, and economic implications. PMID:17273201

The effect of prepregnancy body mass index on birth weight, preterm birth, cesarean section, and preeclampsia in pregnant women.

PubMed

Mohammadi, Maryam; Maroufizadeh, Saman; Omani-Samani, Reza; Almasi-Hashiani, Amir; Amini, Payam

2018-05-17

The objective of this study is to determine the impact of maternal prepregnancy BMI on birth weight, preterm birth, cesarean section, and preeclampsia among pregnant women delivering singleton life birth. A cross-sectional study of 4397 women who gave singleton birth in Tehran, Iran from 6 to 21 July 2015, was conducted. Women were categorized into four groups: underweight (BMI < 18.5 kg/m 2 ), normal (BMI 18.5-25 kg/m 2 ), overweight (BMI 25-30 kg/m 2 ) and obese (BMI >30 kg/m 2 ), and their obstetric and infant outcomes were analyzed using both univariate and multivariate logistic regression. Prepregnancy BMI of women classified 198 women as underweight (4.5%), 2293 normal (52.1%), 1434 overweight (32.6%), and 472 as obese (10.7%). In comparison with women of normal weight, women who were overweight or obese were at increased risk of preeclampsia (odds ratio (OR) = 1.47, 95% CI = 1.06-2.02; OR = 3.67, 95% CI = 2.57-5.24, respectively) and cesarean section (OR = 1.21, 95% CI = 1.04-1.41; OR = 1.35, 95% CI = 1.06-1.72, respectively). Infants of obese women were more likely to be macrosomic (OR = 2.43, 95% CI = 1.55-3.82). Prepregnancy obesity is a risk factor for macrosomia, preeclampsia, and cesarean section and need for resuscitation.

Physical and Organizational Job Stressors in Pregnancy and Associations With Primary Cesarean Deliveries.

PubMed

Guendelman, Sylvia; Gemmill, Alison; Hosang, Nap; MacDonald, Leslie A

2017-06-01

The aim of this study was to assess the relationship between exposure to physical and organizational job stressors during pregnancy and cesarean delivery. We sampled 580 employed women in California who participated in a nested population-based case-control study of birth outcomes. Adjusted multivariate regression analyses estimated associations between heavy lifting, frequent bending, high noise, extreme temperature, prolonged standing and organizational stressors (shift work, inflexible schedules, effort-reward ratio), and primary cesarean (vs vaginal) delivery, controlling for covariates. Women occupationally exposed had higher odds of cesarean. Those exposed to daily manual lifting more than 15 pounds [adjusted odds ratio = 2.54; 95% confidence interval (95% CI) 1.21 to 5.32] and at least four physical job stressors (adjusted odds ratio = 3.49; 95% CI 1.21 to 10.09) had significantly elevated odds of cesarean delivery. Exposed morbid women experienced greater risk; risk was lower among those with schedule flexibility. Associations were found between modifiable exposure to physical job stressors during pregnancy and cesarean delivery.

It's about time: Cesarean sections and neonatal health.

PubMed

Costa-Ramón, Ana María; Rodríguez-González, Ana; Serra-Burriel, Miquel; Campillo-Artero, Carlos

2018-05-01

Cesarean sections have been associated in the literature with poorer newborn health, particularly with a higher incidence of respiratory morbidity. Most studies suffer, however, from potential omitted variable bias, as they are based on simple comparisons of mothers who give birth vaginally and those who give birth by cesarean section. We try to overcome this limitation and provide credible causal evidence by using variation in the probability of having a c-section that is arguably unrelated to maternal and fetal characteristics: variation by time of day. Previous literature documents that, while nature distributes births and associated problems uniformly, time-dependent variables related to physicians' demand for leisure are significant predictors of unplanned c-sections. Using a sample of public hospitals in Spain, we show that the rate of c-sections is higher during the early hours of the night compared to the rest of the day, while mothers giving birth at the different times are similar in observable characteristics. This exogenous variation provides us with a new instrument for type of birth: time of delivery. Our results suggest that non-medically indicated c-sections have a negative and significant impact on newborn health, as measured by Apgar scores, but that the effect is not severe enough to translate into more extreme outcomes. Copyright © 2018 Elsevier B.V. All rights reserved.

What is vaginal birth after cesarean (VBAC)?

MedlinePlus

... of the Scientific Director (OSD) Affinity Groups & Labs (AG&L) Scientists Emeriti National Center for Medical Rehabilitation ... base (called a low-transverse incision)—the most common type of incision. Note that the incision on ...

Induction of labor versus expectant management for women with a prior cesarean delivery.

PubMed

Palatnik, Anna; Grobman, William A

2015-03-01

Previous studies of induction of labor in the setting of trial of labor after cesarean have compared women undergoing trial of labor after cesarean to those undergoing spontaneous labor. However, the clinically relevant comparison is to those undergoing expectant management. The objective of this study was to compare obstetric outcomes between women undergoing induction of labor and those undergoing expectant management ≥39 weeks of gestation. This was a secondary analysis of data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Cesarean Registry that included women with singleton gestations at a gestational age of ≥39 weeks and a history of 1 low transverse cesarean delivery. Outcomes of induction at 39, 40, and 41 weeks were compared to expectant management beyond each gestational age period using univariable and multivariable analyses. Women with scheduled repeat cesarean deliveries done for the indication of prior cesarean delivery were excluded from the analysis. In all, 12,676 women were eligible for analysis. The rate of vaginal birth after cesarean (VBAC) was higher among women undergoing induction of labor at 39 weeks compared to expectant management (73.8% vs 61.3%, P < .001). The risk of uterine rupture also was higher among women undergoing induction of labor at 39 weeks compared to expectant management (1.4% vs 0.5%, P = .006, respectively). In multivariable analysis, induction of labor at 39 weeks remained associated with a significantly higher chance of VBAC and uterine rupture (odds ratio, 1.31; 95% confidence interval, 1.03-1.67; and odds ratio, 2.73; 95% confidence interval, 1.22-6.12, respectively). Induction of labor at 39 weeks, when compared to expectant management, was associated with a higher chance of VBAC but also of uterine rupture. Copyright © 2015 Elsevier Inc. All rights reserved.

Births: preliminary data for 2000.

PubMed

Martin, J A; Hamilton, B E; Ventura, S J

2001-07-24

rise in the rate of primary cesarean deliveries and a decline in the rate of vaginal births after previous cesarean delivery.

Fear of childbirth and risk of cesarean delivery: a cohort study in six European countries.

PubMed

Ryding, Elsa Lena; Lukasse, Mirjam; Parys, An-Sophie Van; Wangel, Anne-Marie; Karro, Helle; Kristjansdottir, Hildur; Schroll, Anne-Mette; Schei, Berit

2015-03-01

Few studies have examined the mode of birth among women with fear of childbirth, and the results are conflicting. The objective of this study was to assess the association between fear of childbirth and cesarean delivery in North European women. A longitudinal cohort study was conducted among 6,422 pregnant women from Belgium, Iceland, Denmark, Estonia, Norway, and Sweden. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire during pregnancy and linked to obstetric information from hospital records. Among 3,189 primiparous women, those reporting severe fear of childbirth were more likely to give birth by elective cesarean, (OR, 1.66 [95% CI 1.05-2.61]). Among 3,233 multiparous women, severe fear of childbirth increased the risk of elective cesarean (OR 1.87 [95% CI 1.30-2.69]). Reporting lack of positive anticipation, one of six dimensions of fear of childbirth, was most strongly associated with elective cesarean (OR 2.02 [95% CI 1.52-2.68]). A dose-effect pattern was observed between level of fear and risk of emergency cesarean in both primiparous and multiparous women. Indications for cesarean were more likely to be reported as "nonmedical" among those with severe fear of childbirth; 16.7 versus 4.6 percent in primiparous women, and 31.7 versus 17.5 percent in multiparous women. Having severe fear of childbirth increases the risk of elective cesarean, especially among multiparous women. Lack of positive anticipation of the upcoming childbirth seems to be an important dimension of fear associated with cesarean delivery. Counseling for women who do not look forward to vaginal birth should be further evaluated. © 2015 Wiley Periodicals, Inc.

Applying Lean Six Sigma methodology to reduce cesarean section rate.

PubMed

Chai, Ze-Ying; Hu, Hua-Min; Ren, Xiu-Ling; Zeng, Bao-Jin; Zheng, Ling-Zhi; Qi, Feng

2017-06-01

This study aims to reduce cesarean section rate and increase rate of vaginal delivery. By using Lean Six Sigma (LSS) methodology, the cesarean section rate was investigated and analyzed through a 5-phase roadmap consisting of Define, Measure, Analyze, Improve, and Control. The principal causes of cesarean section were identified, improvement measures were implemented, and the rate of cesarean section before and after intervention was compared. After patients with a valid medical reason for cesarean were excluded, the main causes of cesarean section were maternal request, labor pain, parturient women assessment, and labor observation. A series of measures was implemented, including an improved parturient women assessment system, strengthened pregnancy nutrition guidance, implementation of painless labor techniques, enhanced midwifery team building, and promotion of childbirth-assist skills. Ten months after introduction of the improvement measures, the cesarean section rate decreased from 41.83% to 32.00%, and the Six Sigma score (ie, Z value) increased from 1.706 to 1.967 (P < .001). LSS is an effective way to reduce the rate of cesarean section. © 2016 John Wiley & Sons, Ltd.

Vaginal Repair of Cesarean Section Scar Diverticula that Resulted in Improved Postoperative Menstruation.

PubMed

Zhou, Jieru; Yao, Min; Wang, Husheng; Tan, Weilin; Chen, Pin; Wang, Xipeng

2016-01-01

Owing to the increase in cesarean sections (C-sections) worldwide, long-term complications such as postmenstrual spotting, chronic pelvic pain, and C-section scar ectopic pregnancies have created a new medical era of gynecologic disease. A new type of vaginal repair is evaluated to repair C-section diverticulum (CSD) and rebuild the muscular layer to improve symptoms of abnormal uterine bleeding and decrease the risk of uterine rupture. Retrospective cohort study (Canadian Task Force classification II-2). University hospital. A total of 121 patients with CSD diagnoses by transvaginal ultrasound (TVU) presented with postmenstrual spotting between June 2012 and March 2015. All patients had undergone at least 1 C-section delivery and had no history of postmenstrual spotting before undergoing C-section. Vaginal excision and suture of CSD. The mean duration of menstruation was 14.87 ± 3.46 days preoperatively and decreased to 8.22 ± 2.73 days at 1 month after surgery, 8.89 ± 2.67 days at 3 months after surgery, and 9.02 ± 2.47 days at 6 months after surgery (p < .01). The length, width, depth, and thickness of the remaining muscular layer (TRM) at 1 month, 3 months, and 6 months assessed by TVU also improved significantly after surgery (p < .05). However, postoperative menstruation and imaging data did not differ markedly between 3 months and 6 months, suggesting that follow-up at 3 months represents an adequate endpoint for evaluating the effectiveness of surgery. At 6 months, 80.3% of patients (94 of 117) reached ≤10 days of menstruation. Further study revealed that a TRM at 6 months of ≥8.5 mm measured by TVU (relative risk [RR], 6.418; 95% confidence interval [CI], 1.478-28.443) and an interval between CS and vaginal repair of ≤2.5 years (RR, 12.0; 95% CI, 1.541- 93.454) were good prognostic factors associated with surgery. Vaginal repair of CSD improved the symptoms of postmenstrual spotting and anatomically corrected the

Cesarean section on request at 39 weeks: impact on shoulder dystocia, fetal trauma, neonatal encephalopathy, and intrauterine fetal demise.

PubMed

Hankins, Gary D V; Clark, Shannon M; Munn, Mary B

2006-10-01

The purpose of this analysis was to determine the impact on specific forms of neonatal morbidity and mortality by allowing women to opt for delivery by elective cesarean section at 39 weeks of gestation (EGA). According to the National Vital Statistics Reports, over 70% of deliveries in the U.S. annually are at gestational ages>or=39 weeks EGA. Estimating that over 4 million deliveries occur annually in the United States, this would yield approximately 3 million pregnancies wherein the woman may exercise her choice for either primary or repeat cesarean section at 39 weeks EGA or at the point when labor is established. A search was conducted using Ovid Medline spanning the past 10 years using the following key words: fetal trauma, shoulder dystocia, brachial plexus palsy, neonatal skull fracture, obstetrical trauma, traumatic delivery, intrauterine fetal demise, stillbirth, fetal demise, and neonatal encephalopathy. Using this search technique, over 2100 articles were identified. The abstracts were reviewed and pertinent articles were chosen for further consideration. The identified articles and their applicable references were obtained for inclusion in this review. Preference was given to publications on or after the year 2000 with the exception of classical or sentinel articles, which were included without regard to year of publication. Four major categories of neonatal morbidity and mortality are discussed: Shoulder dystocia: Accepting that we do not have a successful method for the prediction or prevention of shoulder dystocia, the question becomes, "What is the chance that a baby will sustain a permanent brachial plexus injury at delivery?" Additionally, is there a significant protective effect of cesarean section in reducing the risk of such injury? Currently, the occurrence rate of brachial plexus palsy at the time of vaginal delivery ranges from 0.047% to 0.6% and for cesarean section from 0.0042% to 0.095%. Using a composite estimate of the risk of 0

Childbirth Fear: Relation to Birth and Care Provider Preferences.

PubMed

Stoll, Kathrin; Fairbrother, Nichole; Thordarson, Dana S

2018-01-01

The purpose of this study was to assess how preferences for place of birth and mode of birth relate to different dimensions of childbirth fear and whether there is an association between Canadian women's prenatal fear of childbirth and the type and quality of prenatal care they received. A link to an online survey was posted on Canadian pregnancy and birth websites; 409 women completed the survey that included sociodemographic questions, questions about the current pregnancy and previous pregnancy experiences (if applicable), and the Childbirth Fear Questionnaire, a validated 40-item scale that measures 9 dimensions of childbirth fear. Women under physician care and those with a preference for cesarean birth were generally more fearful of pain associated with vaginal birth, fear of loss of sexual pleasure and attractiveness, and fear of harm to themselves or their infant. Conversely, women under the care of midwives and women who preferred to give birth vaginally were more fearful of interventions. Women who preferred a cesarean birth were significantly more likely to report that fear of childbirth interfered with daily functioning, compared to women who preferred a vaginal birth. Satisfaction with care was associated with lower scores on the Childbirth Fear Questionnaire full and subscales, especially among midwifery clients. At present there are no guidelines in Canada or the United States for the treatment and/or referral of pregnant women who suffer from childbirth fear. Until such guidelines are developed, findings from the current study can help maternity care providers identify and address specific fears among women in their care and understand how different fear domains relate to care provider choice, satisfaction with care, and women's preferences for place and mode of birth. © 2018 by the American College of Nurse-Midwives.

Intention for Cesarean Section Versus Vaginal Delivery Among Pregnant Women in Isfahan: Correlates and Determinants

PubMed Central

Shams-Ghahfarokhi, Zahra; Khalajabadi-Farahani, Farideh

2016-01-01

Background: Iran has the second highest rate of cesarean section in the world. the corresponding rate in the third metropolitan city of Iran, Isfahan, is even higher. This paper aimed to assess correlates and determinants of intention for cesarean section versus normal vaginal delivery (NVD) among pregnant women in Isfahan. Methods: A study was conducted among 400 pregnant women aged 18–38 years, with gestational age of 24–40 weeks who attended labor clinics of nine hospitals in Isfahan during June and July 2014. Probability proportional to size was used to estimate the number of cases required to be selected for each hospital. T-test, chi-square and logistic regression analysis were employed to analyze the data. Results: Mean age of women was 26.6±4.4 years. Multivariate analysis identified selected factors as determinants of intention for CS. These were “the role of physician” (OR=1.33, p<0.001), “subjective norms” (OR=1.19, p<0.01) and “body Image” (OR= 1.46, p<0.001) upon control of education, income and intended fertility (number of children intended). Moreover, path analysis showed that “attitude towards cesarean section” and “individualism” influence CS decision through subjective norm. Conclusion: Choosing cesarean section voluntarily is a multifaceted decision which is shaped by various factors; hence, comprehensive interventions are suggested to discourage voluntary cesarean section. These interventions need to encompass changes in physicians’ role, social norms, body image and correcting misperceptions among women towards CS and NVD during prenatal courses. PMID:27921002

Financial incentives and use of Cesarean delivery: Taiwan birth data 2003 to 2007.

PubMed

Hong, Yi-Chen; Linn, George Chinhung

2012-01-01

The Cesarean section (CS) rate in Taiwan has exceeded 30% since 2000. To lower the CS rate, the Bureau of National Health Insurance in Taiwan raised the payment for vaginal delivery (VD) in May 2005, and also increased the insured's copayment for elective CS in May 2006. This study clarifies the influences of these financial incentives, and explores whether the 2 policies lowered the CS rate. The materials used are birth cases obtained from a systematic sampling of the original inpatient claim data in the National Health Insurance research database between 2003 and 2007. The empirical analysis of this study groups the birth data into 4 types: VD, unplanned CS, planned CS, and elective CS. The 4 delivery types represent the dependent variable. A multinomial logistic regression model was adopted as the empirical method. The policy changes, hospital attributes, and insured status were considered independent variables. Results indicate that the supply-side policy change in May 2005 reduced the number of CS cases. However, the policy effect was not very significant, and the CS rate decreased mainly because of planned CS cases. The demand-side policy change in May 2006 did not lower the rate of elective CS. The results imply that the financial incentives were not the main consideration for both the demand and supply sides. To encourage more VDs and lower the CS rate, the authorities could consider mechanisms other than adjusting the payment or changing the copayment.

Characteristics in the first vaginal birth and their association with mode of delivery in the subsequent birth.

PubMed

Chen, Jian Sheng; Ford, Jane B; Ampt, Amanda; Simpson, Judy M; Roberts, Christine L

2013-03-01

The extent to which complications or adverse outcomes in a first vaginal birth may contribute to mode of delivery in the next birth remains unclear. This study examines the impact of the first birth on subsequent mode of delivery. The study population included women with a first vaginal birth and a consecutive second birth. Data were obtained from linked birth and hospital records for the state of New South Wales, Australia 2000-09. The primary outcome was the mode of delivery for the second birth. Planned caesarean was modelled using logistic regression; intrapartum caesarean and instrumental delivery were modelled using multinomial logistic regression. Of the 114 287 second births, 4.2% were planned caesarean, 3.0% were intrapartum caesarean and 4.8% were instrumental deliveries. Adjusted risk factors from the first birth for a planned second birth caesarean were third to fourth degree tear [odds ratio (OR) = 5.0 [95% confidence interval (CI) 4.6, 5.4

Cesarean delivery on maternal request: can the ethical problem be solved by the principlist approach?

PubMed

Nilstun, Tore; Habiba, Marwan; Lingman, Göran; Saracci, Rodolfo; Da Frè, Monica; Cuttini, Marina

2008-06-17

In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications. We use two different types of premises: factual (facts about cesarean delivery and specifically attitudes of obstetricians as derived from the EUROBS European study) and value premises (principles of beneficence and non-maleficence, respect for autonomy and justice).Beneficence/non-maleficence entails physicians' responsibility to minimise harms and maximise benefits. Avoiding its inherent risks makes a prima facie case against cesarean section without medical indication. However, as vaginal delivery can have unintended consequences, there is a need to balance the somewhat dissimilar risks and benefits. The principle of autonomy poses a challenge in case of disagreement between the pregnant woman and the physician. Improved communication aimed to enable better informed choice may overcome some instances of disagreement. The principle of justice prohibits unfair discrimination, and broadly favours optimising resource utilisation. Available evidence supports vaginal birth in uncomplicated term pregnancies as the standard of care. The principlist approach offered a useful framework for ethical analysis of cesarean delivery on maternal request, identified the rights and duties of those involved, and helped reach a conclusion, although conflict at the individual level may remain challenging.

Labor management evidence update: potential to minimize risk of cesarean birth in healthy women.

PubMed

Simpson, Kathleen Rice

2014-01-01

New evidence regarding normal parameters of labor progress for healthy women has the potential to minimize risk of cesarean birth and thereby enhance current and future maternal well-being if clinicians apply the research findings to obstetric practice. The economic and reproductive health consequences of the increasing cesarean birth rate in the United States are considerable; therefore, action on this issue by all stakeholders is necessary. Review and integration of the recent recommendations for labor management from experts convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine are required to make maternity care in the United States as safe as possible.

Vaginal breech delivery: results of a prospective registration study

PubMed Central

2013-01-01

Background Most countries recommend planned cesarean section in breech deliveries, which is considered safer than vaginal delivery. As one of few countries in the western world Norway has continued to practice planned vaginal delivery in selected women. The aim of this study is to evaluate prospectively registered neonatal and maternal outcomes in term singleton breech deliveries in a Norwegian hospital during a ten years period. We aim to compare maternal and neonatal outcomes in term breech pregnancies subjected either to planned vaginal or elective cesarean section. Methods A prospective registration study including 568 women with term breech deliveries (>37 weeks) consecutively registered at Sorlandet Hospital Kristiansand between 2001 and 2011. Fetal and maternal outcomes were compared according to delivery method; planned vaginal delivery versus planned cesarean section. Results Of 568 women, elective cesarean section was planned in 279 (49%) cases and vaginal delivery was planned in 289 (51%) cases. Acute cesarean section was performed in 104 of the planned vaginal deliveries (36.3%). There were no neonatal deaths. Two cases of serious neonatal morbidity were reported in the planned vaginal group. One infant had seizures, brachial plexus injury, and cephalhematoma. The other infant had 5-minutes Apgar < 4. Twenty-nine in the planned vaginal group (10.0%) and eight in the planned cesarean section group (2.9%) (p < 0.001) were transferred to the neonatal intensive care unit. However, only one infant was admitted for ≥4 days. According to follow-up data (median six years) none of these infants had long-term sequelae. Regarding maternal morbidity, blood loss was the only variable that was significantly higher in the planned cesarean section group versus in the vaginal delivery group (p < 0.001). Conclusions Strict guidelines were followed in all cases. There were no neonatal deaths. Two infants had serious neonatal morbidity in the planned

Hemoglobin Differences in Uncomplicated Monochorionic Twins in Relation to Birth Order and Mode of Delivery.

PubMed

Verbeek, Lianne; Zhao, Depeng P; Te Pas, Arjan B; Middeldorp, Johanna M; Hooper, Stuart B; Oepkes, Dick; Lopriore, Enrico

2016-06-01

To determine the differences in hemoglobin (Hb) levels in the first 2 days after birth in uncomplicated monochorionic twins in relation to birth order and mode of delivery. All consecutive uncomplicated monochorionic pregnancies with two live-born twins delivered at our center were included in this retrospective study. We recorded Hb levels at birth and on day 2, and analyzed Hb levels in association with birth order, mode of delivery, and time interval between delivery of twin 1 and 2. A total of 290 monochorionic twin pairs were analyzed, including 171 (59%) twins delivered vaginally and 119 (41%) twins born by cesarean section (CS). In twins delivered vaginally, mean Hb levels at birth and on day 2 were significantly higher in second-born twins compared to first-born twins: 17.8 versus 16.1 g/dL and 18.0 versus 14.8 g/dL, respectively (p < .01). Polycythemia was detected more often in second-born twins (12%, 20/166) compared to first-born twins (1%, 2/166; p < .01). Hb differences within twin pairs delivered by CS were not statistically or clinically significant. We found no association between inter-twin delivery time intervals and Hb differences. Second-born twins after vaginal delivery have higher Hb levels and more often polycythemia than their co-twin, but not when born by CS.

Mother-to-Infant Transmission of Intestinal Bifidobacterial Strains Has an Impact on the Early Development of Vaginally Delivered Infant's Microbiota

PubMed Central

Makino, Hiroshi; Kushiro, Akira; Ishikawa, Eiji; Kubota, Hiroyuki; Gawad, Agata; Sakai, Takafumi; Oishi, Kenji; Martin, Rocio; Ben-Amor, Kaouther; Knol, Jan; Tanaka, Ryuichiro

2013-01-01

Objectives Bifidobacterium species are one of the major components of the infant's intestine microbiota. Colonization with bifidobacteria in early infancy is suggested to be important for health in later life. However, information remains limited regarding the source of these microbes. Here, we investigated whether specific strains of bifidobacteria in the maternal intestinal flora are transmitted to their infant's intestine. Materials and Methods Fecal samples were collected from healthy 17 mother and infant pairs (Vaginal delivery: 12; Cesarean section delivery: 5). Mother's feces were collected twice before delivery. Infant's feces were collected at 0 (meconium), 3, 7, 30, 90 days after birth. Bifidobacteria isolated from feces were genotyped by multilocus sequencing typing, and the transitions of bifidobacteria counts in infant's feces were analyzed by quantitative real-time PCR. Results Stains belonging to Bifidobacterium adolescentis, Bifidobacterium bifidum, Bifidobacterium catenulatum, Bifidobacterium longum subsp. longum, and Bifidobacterium pseudocatenulatum, were identified to be monophyletic between mother's and infant's intestine. Eleven out of 12 vaginal delivered infants carried at least one monophyletic strain. The bifidobacterial counts of the species to which the monophyletic strains belong, increased predominantly in the infant's intestine within 3 days after birth. Among infants delivered by C-section, monophyletic strains were not observed. Moreover, the bifidobacterial counts were significantly lower than the vaginal delivered infants until 7 days of age. Conclusions Among infants born vaginally, several Bifidobacterium strains transmit from the mother and colonize the infant's intestine shortly after birth. Our data suggest that the mother's intestine is an important source for the vaginal delivered infant's intestinal microbiota. PMID:24244304

The vaginal microbiome, vaginal anti-microbial defence mechanisms and the clinical challenge of reducing infection-related preterm birth.

PubMed

Witkin, S S

2015-01-01

Ascending bacterial infection is implicated in about 40-50% of preterm births. The human vaginal microbiota in most women is dominated by lactobacilli. In women whose vaginal microbiota is not lactobacilli-dominated anti-bacterial defence mechanisms are reduced. The enhanced proliferation of pathogenic bacteria plus degradation of the cervical barrier increase bacterial passage into the endometrium and amniotic cavity and trigger preterm myometrial contractions. Evaluation of protocols to detect the absence of lactobaciili dominance in pregnant women by self-measuring vaginal pH, coupled with measures to promote growth of lactobacilli are novel prevention strategies that may reduce the occurrence of preterm birth in low-resource areas. © 2014 Royal College of Obstetricians and Gynaecologists.

Effects of maternal characteristics on cesarean delivery rates among U.S. Department of Defense healthcare beneficiaries, 1996-2002.

PubMed

Linton, Andrea; Peterson, Michael R; Williams, Thomas V

2004-03-01

National rates of cesarean birth continue a three decade-long escalation, despite widespread recognition that a reduction in the use of the procedure is a continuing appropriate public health goal, as evidenced by the Healthy People 2010 reduction targets. Nonclinical factors associated with cesarean delivery include maternal age, race, socioeconomic status, and insurance coverage. This study compared cesarean delivery rates and trends for the U.S. Department of Defense healthcare beneficiary population from 1996 to 2002 with those observed nationally, and assessed the association of these nonclinical factors with cesarean rate variation in the U.S. Department of Defense healthcare beneficiary population. Hospital discharge and claims records for babies born in the military and civilian hospitals that comprise the Department of Defense healthcare network were used to calculate total and primary cesarean delivery rates and vaginal birth after cesarean (VBAC) rates from 1996 to 2002. Annual cesarean rates for subgroups defined by maternal age, race, and socioeconomic status were calculated to examine rate variations and rate trends within the study population. Pooled data from 1999 to 2002 were used to compare rates across socioeconomic status, stratified by age and race. Statistical significance of the differences calculated for subgroups was assessed using chi-square. Total and primary cesarean delivery rates among the U.S. Department of Defense population were lower than those reported nationally for every year examined. Cesarean delivery and VBAC rate trends in the national and Department of Defense populations were similar. Within the Department of Defense population, total cesarean delivery increased with increasing maternal age and was more highly associated with racial minorities relative to white women. The higher socioeconomic subgroup (defined as active duty, retired, and warrant officers and their families in this study) was generally associated with

Risk of Autism Associated with General Anesthesia during Cesarean Delivery: A Population-Based Birth-Cohort Analysis

ERIC Educational Resources Information Center

Chien, Li-Nien; Lin, Hsiu-Chen; Shao, Yu-Hsuan Joni; Chiou, Shu-Ti; Chiou, Hung-Yi

2015-01-01

The rates of Cesarean delivery (C-section) have risen to >30 % in numerous countries. Increased risk of autism has been shown in neonates delivered by C-section. This study examined the incidence of autism in neonates delivered vaginally, by C-section with regional anesthesia (RA), and by C-section with general anesthesia (GA) to evaluate the…

Cesarean section and interferon-induced helicase gene polymorphisms combine to increase childhood type 1 diabetes risk.

PubMed

Bonifacio, Ezio; Warncke, Katharina; Winkler, Christiane; Wallner, Maike; Ziegler, Anette-G

2011-12-01

The incidence of type 1 diabetes is increasing. Delivery by cesarean section is also more prevalent, and it is suggested that cesarean section is associated with type 1 diabetes risk. We examine associations between cesarean delivery, islet autoimmunity and type 1 diabetes, and genes involved in type 1 diabetes susceptibility. Cesarean section was examined as a risk factor in 1,650 children born to a parent with type 1 diabetes and followed from birth for the development of islet autoantibodies and type 1 diabetes. Children delivered by cesarean section (n = 495) had more than twofold higher risk for type 1 diabetes than children born by vaginal delivery (hazard ratio [HR] 2.5; 95% CI 1.4-4.3; P = 0.001). Cesarean section did not increase the risk for islet autoantibodies (P = 0.6) but was associated with a faster progression to diabetes after the appearance of autoimmunity (P = 0.015). Cesarean section-associated risk was independent of potential confounder variables (adjusted HR 2.7;1.5-5.0; P = 0.001) and observed in children with and without high-risk HLA genotypes. Interestingly, cesarean section appeared to interact with immune response genes, including CD25 and in particular the interferon-induced helicase 1 gene, where increased risk for type 1 diabetes was only seen in children who were delivered by cesarean section and had type 1 diabetes-susceptible IFIH1 genotypes (12-year risk, 9.1 vs. <3% for all other combinations; P < 0.0001). These findings suggest that type 1 diabetes risk modification by cesarean section may be linked to viral responses in the preclinical autoantibody-positive disease phase.

Labor and birth care by nurse with midwifery skills in Brazil.

PubMed

Gama, Silvana Granado Nogueira da; Viellas, Elaine Fernandes; Torres, Jacqueline Alves; Bastos, Maria Helena; Brüggemann, Odaléa Maria; Theme Filha, Mariza Miranda; Schilithz, Arthur Orlando Correa; Leal, Maria do Carmo

2016-10-17

The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections. Birth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births. 16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower. The results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor

Invasive Obstetric Procedures and Cesarean Sections in Women With Known Herpes Simplex Virus Status During Pregnancy.

PubMed

Stankiewicz Karita, Helen C; Moss, Nicholas J; Laschansky, Ellen; Drolette, Linda; Magaret, Amalia S; Selke, Stacey; Gardella, Carolyn; Wald, Anna

2017-01-01

Neonatal herpes is a potentially devastating infection that results from acquisition of herpes simplex virus (HSV) type 1 or 2 from the maternal genital tract at the time of vaginal delivery. Current guidelines recommend (1) cesarean delivery if maternal genital HSV lesions are present at the time of labor and (2) antiviral suppressive therapy for women with known genital herpes to decrease HSV shedding from the genital tract at the time of vaginal delivery. However, most neonatal infections occur in infants born to women without a history of genital HSV, making current prevention efforts ineffective for this group. Although routine serologic HSV testing of women during pregnancy could identify women at higher risk of intrapartum viral shedding, it is uncertain how this knowledge might impact intrapartum management, and a potential concern is a higher rate of cesarean sections among women known to be HSV-2 seropositive. To assess the effects of prenatal HSV-2 antibody testing, history of genital herpes, and use of suppressive antiviral medication on the intrapartum management of women, we investigated the frequency of invasive obstetric procedures and cesarean deliveries. We conducted a retrospective cohort study of pregnant women delivering at the University of Washington Medical center in Seattle, Washington. We defined the exposure of interest as HSV-2 antibody positivity or known history of genital herpes noted in prenatal records. The primary outcome was intrapartum procedures including fetal scalp electrode, artificial rupture of membranes, intrauterine pressure catheter, or operative vaginal delivery (vacuum or forceps). The secondary outcome was incidence of cesarean birth. Univariate and multivariable logistic regressions were performed. From a total of 449 women included in the analysis, 97 (21.6%) were HSV-2 seropositive or had a history of genital herpes (HSV-2/GH). Herpes simplex virus-2/GH women not using suppressive antiviral therapy were less likely

Invasive Obstetric Procedures and Cesarean Sections in Women With Known Herpes Simplex Virus Status During Pregnancy

PubMed Central

Moss, Nicholas J; Laschansky, Ellen; Drolette, Linda; Magaret, Amalia S; Selke, Stacey; Gardella, Carolyn; Wald, Anna

2017-01-01

Abstract Background Neonatal herpes is a potentially devastating infection that results from acquisition of herpes simplex virus (HSV) type 1 or 2 from the maternal genital tract at the time of vaginal delivery. Current guidelines recommend (1) cesarean delivery if maternal genital HSV lesions are present at the time of labor and (2) antiviral suppressive therapy for women with known genital herpes to decrease HSV shedding from the genital tract at the time of vaginal delivery. However, most neonatal infections occur in infants born to women without a history of genital HSV, making current prevention efforts ineffective for this group. Although routine serologic HSV testing of women during pregnancy could identify women at higher risk of intrapartum viral shedding, it is uncertain how this knowledge might impact intrapartum management, and a potential concern is a higher rate of cesarean sections among women known to be HSV-2 seropositive. Methods To assess the effects of prenatal HSV-2 antibody testing, history of genital herpes, and use of suppressive antiviral medication on the intrapartum management of women, we investigated the frequency of invasive obstetric procedures and cesarean deliveries. We conducted a retrospective cohort study of pregnant women delivering at the University of Washington Medical center in Seattle, Washington. We defined the exposure of interest as HSV-2 antibody positivity or known history of genital herpes noted in prenatal records. The primary outcome was intrapartum procedures including fetal scalp electrode, artificial rupture of membranes, intrauterine pressure catheter, or operative vaginal delivery (vacuum or forceps). The secondary outcome was incidence of cesarean birth. Univariate and multivariable logistic regressions were performed. Results From a total of 449 women included in the analysis, 97 (21.6%) were HSV-2 seropositive or had a history of genital herpes (HSV-2/GH). Herpes simplex virus-2/GH women not using

Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Placenta Previa.

PubMed

Soyama, Hiroaki; Miyamoto, Morikazu; Ishibashi, Hiroki; Takano, Masashi; Sasa, Hidenori; Furuya, Kenichi

2016-01-01

Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa. We included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss). Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage. Of 256 pregnant women with placenta previa, 96 (38%) developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was -0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >-0.33 (odds ratio, 5.88; 95% confidence interval, 3.04-12.00), need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79-6.25), and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85-92.13) were independent risk of intraoperative massive hemorrhage. In patients with placenta previa, a birth weight >-0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on this result, further studies are required to investigate whether

The MFMU Cesarean Registry: uterine atony after primary cesarean delivery.

PubMed

Rouse, Dwight J; Leindecker, Sharon; Landon, Mark; Bloom, Steven L; Varner, Michael W; Moawad, Atef H; Spong, Catherine Y; Caritis, Steve N; Harper, Margaret; Wapner, Ronald J; Sorokin, Yoram; Miodovnik, Menachem; O'Sullivan, Mary Jo; Sibai, Baha M; Langer, Oded

2005-09-01

The purpose of this study was to define independent risk factors for uterine atony after primary cesarean delivery, and to assess their overall association with atony in the study cohort. This was a 13-university center prospective observational study. All women who underwent primary cesarean from January 1, 1999 to December 31, 2000 were eligible. Trained and certified research nurses performed systematic data abstraction. The definition of atony required both the clinical diagnosis and the use of methergine or a prostaglandin preparation. Risk factors for uterine atony were assessed in univariable and multivariable logistic regression analyses, and these analyses then used to inform an assessment of the association of the various risk factors with the occurrence of uterine atony in the overall cohort. Twenty-three thousand, three hundred and ninety pregnancies were analyzed. Uterine atony occurred in 1416 women (6%). Several variables were independently associated with atony in a multivariable model, including multiple gestation (odds ratio [OR] 2.40, 95% CI 1.95-2.93), maternal Hispanic race (2.21, 1.90-2.57), induced or augmented labor for >18 hours (2.23, 1.92-2.60), infant birth weight >4500 g (2.05, 1.53-2.69), and clinically diagnosed chorioamnionitis (1.80, 1.55-2.09). However, because the various risk factors were not very powerful, approximately half of the cases of atony were associated with the 2/3 of women lacking a given risk factor or combination of risk factors. Although certain risk factors and uterine atony were clearly associated, the associations are of limited practical clinical use.

Predictive model for risk of cesarean section in pregnant women after induction of labor.

PubMed

Hernández-Martínez, Antonio; Pascual-Pedreño, Ana I; Baño-Garnés, Ana B; Melero-Jiménez, María R; Tenías-Burillo, José M; Molina-Alarcón, Milagros

2016-03-01

To develop a predictive model for risk of cesarean section in pregnant women after induction of labor. A retrospective cohort study was conducted of 861 induced labors during 2009, 2010, and 2011 at Hospital "La Mancha-Centro" in Alcázar de San Juan, Spain. Multivariate analysis was used with binary logistic regression and areas under the ROC curves to determine predictive ability. Two predictive models were created: model A predicts the outcome at the time the woman is admitted to the hospital (before the decision to of the method of induction); and model B predicts the outcome at the time the woman is definitely admitted to the labor room. The predictive factors in the final model were: maternal height, body mass index, nulliparity, Bishop score, gestational age, macrosomia, gender of fetus, and the gynecologist's overall cesarean section rate. The predictive ability of model A was 0.77 [95% confidence interval (CI) 0.73-0.80] and model B was 0.79 (95% CI 0.76-0.83). The predictive ability for pregnant women with previous cesarean section with model A was 0.79 (95% CI 0.64-0.94) and with model B was 0.80 (95% CI 0.64-0.96). For a probability of estimated cesarean section ≥80%, the models A and B presented a positive likelihood ratio (+LR) for cesarean section of 22 and 20, respectively. Also, for a likelihood of estimated cesarean section ≤10%, the models A and B presented a +LR for vaginal delivery of 13 and 6, respectively. These predictive models have a good discriminative ability, both overall and for all subgroups studied. This tool can be useful in clinical practice, especially for pregnant women with previous cesarean section and diabetes.

First birth cesarean proportion: A missed indicator in controlling policies

PubMed Central

Safari-Faramani, Roya; Haghdoost, Ali Akbar; Nakhaei, Nouzar; Foroudnia, Shohreh; Mahmoodabadi, Zahra; Safizadeh, Mansooreh

2016-01-01

Background: Around one out of two mothers give births by cesarean section (CS) surgery in Iran and about half of this number is due to previous CS. Recently Health Sector Evolution (HSEP) program (started in April 2014) targets the high rate of CS in Iran. To assess the impact of the interventions, we emphasized that the First Birth Cesarean (FBC) proportion is one of the main indicators to assess the controlling programs. Methods: Data on the mode of delivery were collected in Kerman province between 21 March and 20 March 2015 classified by hospital ownership. FBC proportion is defined as the number of CS in the first pregnancies divided by the total number of first births. Chi-square test for trend was used to assess the trends. Results: Total number of births was around 34000. There were 8.9 and 13.1 percent reduction in CS and FBC proportion respectively. CS proportion was 54.5 at the end of the first quarter of the studied period and reached to 49.6 at the end of the period (p<0.0001). Also, FBC proportion was 54.1 percent at first and reached to 47 percent at the end of the study period. The main reason for CS was due to previous CS. At the hospital level, the highest reduction in CS and FBC proportion were in public hospitals. Conclusion: Results suggested more reduction in FBC proportion than the CS proportion, so this is a very good sign since more potential CS cases will be prevented. As repeated CS is one of the main indications for the operation, in the short term, even effective policies may change the overall proportion slightly, while the FBC proportion is more sensitive to reflect the impacts. Therefore, it is necessary to target the main fuel to reduce CS proportion effectively. PMID:27579285

Vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert: a retrospective study of 1656 women in China.

PubMed

Zhao, Lei; Lin, Ying; Jiang, Ting-Ting; Wang, Ling; Li, Min; Wang, Ying; Sun, Guo-Qiang; Xiao, Mei

2017-12-21

This study aimed to qualify relevant factors for vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert in a Chinese tertiary maternity hospital. A retrospective study was conducted in Hubei Maternal and Child Health Hospital. A total of 1656 pregnancies that underwent labor induction with vaginal dinoprostone insert between January and August 2016 were finally included in this study. Data were analyzed using univariate and multivariable regression modeling. Of 1656 women with PGE2-induced labor at term, 396 (23.91%) gave birth by cesarean section, 1260 (76.09%) had a vaginal delivery among which 921 (55.61%) delivered vaginally within 24 h. Multivariable regression analysis showed that maternal age (p < .001, OR = 0.89, 95%CI 0.85-0.93), parity (multiparous versus nulliparous, p < .001, OR = 8.74, 95%CI 4.36-17.50), baseline fetal heart rate (p = .009, OR = 0.98, 95%CI 0.96-0.99), and birth weight (p < .001, OR = 0.37, 95%CI 0.28-0.51) were significantly correlated with vaginal delivery. Moreover, body mass index (p < .001, OR = 1.11, 95%CI 1.05-1.19), parity (multiparous versus nulliparous, p < .001, OR = 6.57, 95%CI 2.37-18.23), baseline fetal heart rate (p = .004, OR = 0.96, 95%CI 0.94-0.99), and birth weight (p < .001, OR = 0.34, 95%CI 0.21-0.54) were independent predictors of vaginal delivery within 24-h. Our findings suggested a vaginal delivery rate of 76.09% when dinoprostone vaginal insert was used for labor induction, which was markedly higher than the overall annual vaginal delivery rate of 65.1% in China during 2014. Maternal age, parity, baseline fetal heart rate, and birth weight were significant factors for vaginal delivery. This study enables us to better understand the efficiency of dinoprostone and the potential predictors of vaginal delivery in dinoprostone-induced labor, which may be helpful to guide the clinical use of dinoprostone and therefore provide better

Cesarean delivery on maternal request: Can the ethical problem be solved by the principlist approach?

PubMed Central

Nilstun, Tore; Habiba, Marwan; Lingman, Göran; Saracci, Rodolfo; Da Frè, Monica; Cuttini, Marina

2008-01-01

In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications. We use two different types of premises: factual (facts about cesarean delivery and specifically attitudes of obstetricians as derived from the EUROBS European study) and value premises (principles of beneficence and non-maleficence, respect for autonomy and justice). Beneficence/non-maleficence entails physicians' responsibility to minimise harms and maximise benefits. Avoiding its inherent risks makes a prima facie case against cesarean section without medical indication. However, as vaginal delivery can have unintended consequences, there is a need to balance the somewhat dissimilar risks and benefits. The principle of autonomy poses a challenge in case of disagreement between the pregnant woman and the physician. Improved communication aimed to enable better informed choice may overcome some instances of disagreement. The principle of justice prohibits unfair discrimination, and broadly favours optimising resource utilisation. Available evidence supports vaginal birth in uncomplicated term pregnancies as the standard of care. The principlist approach offered a useful framework for ethical analysis of cesarean delivery on maternal request, identified the rights and duties of those involved, and helped reach a conclusion, although conflict at the individual level may remain challenging. PMID:18559083

A large head circumference is more strongly associated with unplanned cesarean or instrumental delivery and neonatal complications than high birthweight.

PubMed

Lipschuetz, Michal; Cohen, Sarah M; Ein-Mor, Eliana; Sapir, Hanna; Hochner-Celnikier, Drorith; Porat, Shay; Amsalem, Hagai; Valsky, Dan V; Ezra, Yossef; Elami-Suzin, Matan; Paltiel, Ora; Yagel, Simcha

2015-12-01

Fetal size impacts on perinatal outcomes. We queried whether the fetal head, as the fetal part interfacing with the birth canal, might impact on obstetric outcomes more than birthweight (BW). We examined associations between neonatal head circumference (HC) and delivery mode and risk of perinatal complications as compared to high BW. This was an electronic medical records-based study of term singleton births (37-42 weeks' gestation) from January 2010 through December 2012 (N = 24,780, 6343 primiparae). We assessed risks of unplanned cesarean or instrumental delivery and maternal and fetal complications in cases with HC or BW ≥95th centile (large HC, high BW) vs those with parameters <95th centile (normal). Newborns were stratified into 4 subgroups: normal HC/normal BW (reference, n = 22,548, primiparae 5862); normal HC/high BW (n = 817, P = 213); large HC/normal BW (n = 878, P = 265); and large HC/high BW (n = 537, P = 103). Multinomial multivariable regression provided adjusted odds ratio (aOR) while controlling for potential confounders. Infants with HC ≥95th centile (n = 1415) were delivered vaginally in 62% of cases, unplanned cesarean delivery 16%, and instrumental delivery 11.2%; 78.4% of infants with HC <95th centile were delivered vaginally, 7.8% unplanned cesarean, and 6.7% instrumental delivery. Odds ratio (OR) for unplanned cesarean was 2.58 (95% confidence interval [CI], 2.22-3.01) and for instrumental delivery OR was 2.13 (95% CI, 1.78-2.54). In contrast, in those with BW ≥95th centile (n = 1354) 80.3% delivered vaginally, 10.2% by unplanned cesarean (OR, 1.2; 95% CI, 1.01-1.44), and 3.4% instrumental delivery (OR, 0.46; 95% CI, 0.34-0.62) compared to infants with BW <95th centile: spontaneous vaginal delivery, 77.3%, unplanned cesarean 8.2%, instrumental 7.1%. Multinomial regression with normal HC/normal BW as reference group showed large HC/normal BW infants were more likely to be delivered by unplanned cesarean (aOR, 3.08; 95% CI, 2

'Stress, anger, fear and injustice': An international qualitative survey of women's experiences planning a vaginal breech birth.

PubMed

Petrovska, Karolina; Watts, Nicole P; Catling, Christine; Bisits, Andrew; Homer, Caroline Se

2017-01-01

the outcomes of the Term Breech Trial had a profound impact on women's options for breech birth, with caesarean section now seen as the default method for managing breech birth by many clinicians. Despite this, the demand for planned vaginal breech birth from women does exist. This study aimed to examine the experiences of women who sought a vaginal breech birth to increase understanding as to how to care for women seeking this birth option. an electronic survey was distributed to women online via social media. The survey consisted of qualitative and quantitative questions, with the qualitative data being the focus of this paper. Open ended questions sought information on the ways in which woman sourced a clinician skilled in vaginal breech birth and the level of support and quality of information provided from clinicians regarding vaginal breech birth. Thematic analysis was used to analyse and code the qualitative data into major themes. in total, 204 women from over seven countries responded to the survey. Written responses to the open ended questions were categorised into seven themes: Seeking the chance to try for a VBB; Encountering coercion and fear; Putting the birth before the baby?; Dealing with emotional wounds; Searching for information and support; Traveling across boundaries; Overcoming obstacles in the system. for women seeking vaginal breech birth, limited system and clinical support can impede access to balanced information and options for care. Recognition of existing evidence on the safety of vaginal breech birth, as well as the presence of clinical guidelines that support it, may assist in promoting vaginal breech birth as a legitimate option that should be available to women. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cesarean scar ectopic pregnancy in a patient with multiple prior cesarean sections: a case report.

PubMed

Kiley, Jessica; Shulman, Lee P

2009-04-01

Cesarean scar pregnancy, an abnormal gestation implanted in the hysterotomy site of a previous cesarean section, is a unique type of ectopic pregnancy. Once uncommon, these life-threatening gestations are increasing in frequency. Outcomes depend on a high index of suspicion and early diagnosis. A 39-year-old, gravida 9, para 5-0-3-5, with a history of 5 cesarean deliveries, presented with vaginal bleeding secondary to cesarean scar pregnancy at 8 weeks' gestation. The patient, who desired future fertillty, was successfully treated conservatively with methotrexate and uterine artery embolization. Reports of cesarean scar pregnancies are rising in the literature, and we describe a scar pregnancy in a woman with multiple prior cesareans. Although the relationship between cesarean scar pregnancy and the number of previous cesarean deliveries is unclear, rising cesarean section rates worldwide will further increase overall incidence. The optimal treatment modality remains uncertain, but conservative management is appropriate when desired by the patient and administered under close observation.

Population changes, racial/ethnic disparities, and birth outcomes in Louisiana after Hurricane Katrina.

PubMed

Harville, Emily W; Tran, Tri; Xiong, Xu; Buekens, Pierre

2010-09-01

To examine how the demographic and other population changes affected birth and obstetric outcomes in Louisiana, and the effect of the hurricane on racial disparities in these outcomes. Vital statistics data were used to compare the incidence of low birth weight (LBW) (<2500 g), preterm birth (PTB) (37 weeks' gestation), cesarean section, and inadequate prenatal care (as measured by the Kotelchuck index), in the 2 years after Katrina compared to the 2 years before, for the state as a whole, region 1 (the area around New Orleans), and Orleans Parish (New Orleans). Logistic models were used to adjust for covariates. After adjustment, rates of LBW rose for the state, but preterm birth did not. In region 1 and Orleans Parish, rates of LBW and PTB remained constant or fell. These patterns were all strongest in African American women. Rates of cesarean section and inadequate prenatal care rose. Racial disparities in birth outcomes remained constant or were reduced. Although risk of LBW/PTB remained higher in African Americans, the storm does not appear to have exacerbated health disparities, nor did population shifts explain the changes in birth and obstetric outcomes.

[Development of a scale to measure the self concept of cesarean section mothers].

PubMed

Lee, M L; Cho, J H

1990-08-01

Recently, the rate of cesarean section in Korea has been increasing. The results of several previous studies in foreign countries on the emotional responses of cesarean section mothers showed that they might experience difficulties in the mother-infant interaction due to fatigue, lack of early mother-infant interaction, disappointments, anger, feelings of loss of control, and other factors. Human behavior is said to be determined by one's self concept, and self concept is influenced by both internal and external environmental factors. A scale to measure the self concept of cesarean section mothers was needed in order to identify those who might have difficulties in the mother-infant interactions in future. The purposes of this study were to develop a measuring scale, and to test its reliability and validity. The process of this study was as follows. A structured interview was done with 50 cesarean section and vaginal delivery mothers to find their state of emotional reaction after giving birth to their babies. Based on the results of the interviews, a 50 items Likert scale was developed. The self concept of 268 cesarean section and vaginal delivery mothers who were hospitalized at six hospital in seoul were measured, during the period between Feb. 1 and April 30. Reviewing the discriminating power of each item by means of crosstabulation, ten items were selected for the final scale. The reliability and validity of this ten item scale were tested by Cronbach's alpha and t-test, using spss pc + package. The results of this study and recommendation are as follows. 1. The ten selected items were as follows. I feel pains in my breast. (-) I have a good appetite now. (+) I feel pains in my flank. (-) I feel fine now. (+) My body seems to have returned to its prepregnant state. (+) Thinking of the delivery process, I feel sorry. (-) I want to hold my baby in my arms. (+) I want to keep my own life, even if I became a mother. (-) I want to delegate the care of the baby to

Cesarean Section and Interferon-Induced Helicase Gene Polymorphisms Combine to Increase Childhood Type 1 Diabetes Risk

PubMed Central

Bonifacio, Ezio; Warncke, Katharina; Winkler, Christiane; Wallner, Maike; Ziegler, Anette-G.

2011-01-01

OBJECTIVE The incidence of type 1 diabetes is increasing. Delivery by cesarean section is also more prevalent, and it is suggested that cesarean section is associated with type 1 diabetes risk. We examine associations between cesarean delivery, islet autoimmunity and type 1 diabetes, and genes involved in type 1 diabetes susceptibility. RESEARCH DESIGN AND METHODS Cesarean section was examined as a risk factor in 1,650 children born to a parent with type 1 diabetes and followed from birth for the development of islet autoantibodies and type 1 diabetes. RESULTS Children delivered by cesarean section (n = 495) had more than twofold higher risk for type 1 diabetes than children born by vaginal delivery (hazard ratio [HR] 2.5; 95% CI 1.4–4.3; P = 0.001). Cesarean section did not increase the risk for islet autoantibodies (P = 0.6) but was associated with a faster progression to diabetes after the appearance of autoimmunity (P = 0.015). Cesarean section–associated risk was independent of potential confounder variables (adjusted HR 2.7;1.5–5.0; P = 0.001) and observed in children with and without high-risk HLA genotypes. Interestingly, cesarean section appeared to interact with immune response genes, including CD25 and in particular the interferon-induced helicase 1 gene, where increased risk for type 1 diabetes was only seen in children who were delivered by cesarean section and had type 1 diabetes–susceptible IFIH1 genotypes (12-year risk, 9.1 vs. <3% for all other combinations; P < 0.0001). CONCLUSIONS These findings suggest that type 1 diabetes risk modification by cesarean section may be linked to viral responses in the preclinical autoantibody-positive disease phase. PMID:22110093

Selective versus routine use of episiotomy for vaginal birth

PubMed Central

Jiang, Hong; Qian, Xu; Carroli, Guillermo; Garner, Paul

2017-01-01

between the groups. One study reported genital prolapse three years after the birth and there was no clear difference between groups (low-certainty evidence). Other important outcomes relating to long-term effects were not reported in these trials (urinary fistula, rectal fistula, and faecal incontinence). One trial examined selective episiotomy compared with routine episiotomy in women for whom an operative vaginal birth was intended. The results showed no clear difference in severe perineal trauma between the restrictive and routine use of episiotomy. Women's views on the different policies were not reported. What does this mean? Overall, the findings show that selective use of episiotomy in women (where a normal delivery without forceps is anticipated) means that fewer women have severe perineal trauma. Thus the rationale for conducting routine episiotomies to prevent severe perineal trauma is not justified by current evidence, and we could not identify any benefits of routine episiotomy for the baby or the mother. More research is needed in order to inform policy in women where an instrumental birth is planned and episiotomy is often advocated. Outcomes could be better standardised and measured. PMID:28176333

Complication of cesarean section: pregnancy on the cicatrix of a previous cesarean section.

PubMed

Wang, Weimin; Long, Wenqing; Yu, Qunhuan

2002-02-01

To probe into the clinical manifestation, diagnosis, as well as treatment of pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester. Analysis of 14 patients with pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester was made after conservative treatment by drugs from January 1996 to December 1999. The 14 patients with a pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester were painless, had slight vaginal bleeding, and concurrently had increased serum beta-subunit human chorionic gonadotropin (beta-HCG). Doppler ultrasonic examination revealed an obvious enlargement of the previous cesarean section cicatrix in the uterine isthmus, and found a gestational sac or mixed mass attached to the cicatrice, with a very thin myometrium between the gestational sac and bladder walls. Among the 14 patients, 12 patients had crystalline trichosanthes injected into the cervix, mifepristone taken orally, or methotrexate in the form of intramuscular injection. Following this procedure, their serum beta-HCG dropped to normal. The other 2 patients had a total hysterectomy. Pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester is a complication of cesarean section. Early diagnosis and effective conservative treatment by drugs are instrumental in decreasing the potential occurrence of uterine rupture, which is also conducive to preserving the patient's future fertility.

Elevated vaginal pH in the absence of current vaginal infection, still a challenging obstetrical problem.

PubMed

Hantoushzadeh, Sedigheh; Sheikh, Mahdi; Javadian, Pouya; Shariat, Mamak; Amini, Elaheh; Abdollahi, Alireza; Kashanian, Maryam

2014-04-01

To assess the association of vaginal pH ≥ 5 in the absence of vaginal infection with systemic inflammation and adverse pregnancy outcome. Four-hundred sixty pregnant women completed the study, upon enrollment Vaginal pH was measured for all women, maternal and umbilical sera were obtained for determining C-reactive protein (CRP) and uric acid levels. Umbilical blood was tested for gas parameters, 1 and 5 min Apgar scores, the need for neonatal resuscitation and neonatal intensive care unit (NICU) admission were recorded. Elevated vaginal pH was significantly associated with preterm birth (odds ratio (OR), 2.23; 95% confidence interval (CI), 1.04-4.76), emergency cesarean section (OR 2.57; 95% CI 1.32-5), neonatal resuscitation in the delivery room (OR 2.85; 95% CI 1.1-7.38), elevated cord base deficit (OR 8.01; 95% CI 1.61-39.81), low cord bicarbonate (OR 4.16, 95% CI 1.33-12.92) and NICU admission (OR 2.02; 95% CI 1.12-3.66). Increased vaginal pH was also significantly associated with maternal leukocytosis, hyperuricemia and elevated CRP levels in maternal and umbilical sera. Elevated vaginal pH in the absence of current vaginal infection still constitutes a risk for adverse pregnancy outcome which is mediated by systemic inflammatory response.

The fact and the fiction: A prospective study of internet forum discussions on vaginal breech birth.

PubMed

Petrovska, Karolina; Sheehan, Athena; Homer, Caroline S E

2017-04-01

Women with a breech baby late in pregnancy may use the internet to gather information to assist in decision-making for birth. The aim of this study was to examine how women use English language internet discussion forums to find out information about vaginal breech birth and to increase understanding of how vaginal breech birth is perceived among women. A descriptive qualitative study of internet discussion forums was undertaken. Google alerts were created with the search terms "breech birth" and "breech". Alerts were collected for a one-year period (January 2013-December 2013). The content of forum discussions was analysed using thematic analysis. A total of 50 forum discussions containing 382 comments were collected. Themes that arose from the data were: Testing the waters-which way should I go?; Losing hope for the chance of a normal birth; Seeking support for options-who will listen to me?; Considering vaginal breech birth-a risky choice?; Staying on the 'safe side'-caesarean section as a guarantee; Exploring the positive potential for vaginal breech birth. Women search online for information about vaginal breech birth in an attempt to come to a place in their decision-making where they feel comfortable with their birth plan. This study highlights the need for clinicians to provide comprehensive, unbiased information on the risks and benefits of all options for breech birth to facilitate informed decision-making for the woman. This will contribute to improving the woman's confidence in distinguishing between "the fact and the fiction" of breech birth discussions online. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Reverse Vesicouterine Fold Dissection for Laparoscopic Hysterectomy After Prior Cesarean Deliveries.

PubMed

Nezhat, Camran; Grace, Lindsey A; Razavi, Gity M; Mihailide, Catalina; Bamford, Holden

2016-09-01

Cesarean delivery adhesions, during laparoscopic hysterectomy, can present surgical challenges, including distortion of anatomy, prolonged operating time, and inadvertent injury to nearby structures. At the time of laparoscopic hysterectomy, in patients with significant adhesions from prior cesarean deliveries, we use a reverse inferior to superior vesicouterine fold dissection to mobilize the scarred bladder. We use this as an alternative to the commonly practiced technique of mobilizing the bladder in a superior to inferior fashion at the time of laparoscopic hysterectomy. Fifty-two patients with a median age of 42.5 years are presented. Forty-eight patients were discharged within 3-6 hours postoperatively. Sixteen patients were discharged with Foley catheters, because they were unable to void within the protocol for a fast-track discharge. The catheters were removed between postoperative days 1 and 5. There were no gastrointestinal or genitourinary complications. One patient experienced a delayed vaginal cuff abscess and bleeding, which were managed conservatively. Reverse vesicouterine fold dissection is a useful alternative technique for laparoscopic hysterectomy in women with a history of prior cesarean deliveries.

Trial of labour and vaginal birth after previous caesarean section: A population based study of Eastern African immigrants in Victoria, Australia.

PubMed

Belihu, Fetene B; Small, Rhonda; Davey, Mary-Ann

2017-03-01

Variations in caesarean section (CS) between some immigrant groups and receiving country populations have been widely reported. Often, African immigrant women are at higher risk of CS than the receiving population in developed countries. However, evidence about subsequent mode of birth following CS for African women post-migration is lacking. The objective of this study was to examine differences in attempted and successful vaginal birth after previous caesarean (VBAC) for Eastern African immigrants (Eritrea, Ethiopia, Somalia and Sudan) compared with Australian-born women. A population-based observational study was conducted using the Victorian Perinatal Data Collection. Pearson's chi-square test and logistic regression analysis were performed to generate adjusted odds ratios for attempted and successful VBAC. Victoria, Australia. 554 Eastern African immigrants and 24,587 Australian-born eligible women with previous CS having singleton births in public care. 41.5% of Eastern African immigrant women and 26.1% Australian-born women attempted a VBAC with 50.9% of Eastern African immigrants and 60.5% of Australian-born women being successful. After adjusting for maternal demographic characteristics and available clinical confounding factors, Eastern African immigrants were more likely to attempt (OR adj 1.94, 95% CI 1.57-2.47) but less likely to succeed (OR adj 0.54 95% CI 0.41-0.71) in having a VBAC. There are disparities in attempted and successful VBAC between Eastern African origin and Australian-born women. Unsuccessful VBAC attempt is more common among Eastern African immigrants, suggesting the need for improved strategies to select and support potential candidates for vaginal birth among these immigrants to enhance success and reduce potential complications associated with failed VBAC attempt. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Births: final data for 2004.

PubMed

Martin, Joyce A; Hamilton, Brady E; Sutton, Paul D; Ventura, Stephanie J; Menacker, Fay; Kirmeyer, Sharon

2006-09-29

This report presents 2004 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Descriptive tabulations of data reported on the birth certificates of the 4.1 million births that occurred in 2004 are presented. Denominators for population-based rates are post-censal estimates derived from the U.S. 2000 census. In 2004, 4,112,052 births were registered in the United States, less than 1 percent more than the number in 2003. The crude birth rate declined slightly; the general fertility rate increased by less than 1 percent. Childbearing among teenagers and women aged 20-24 years declined to record lows. Rates for women aged 25-34 and 45-49 years were unchanged, whereas rates for women aged 35-44 years increased. All measures of unmarried childbearing rose in 2004. Smoking during pregnancy continued to decline. No improvement was seen in the timely initiation of prenatal care. The cesarean delivery rate jumped 6 percent to another all-time high, whereas the rate of vaginal birth after previous cesarean fell by 13 percent. Preterm and low birthweight rates continued their steady rise

Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Placenta Previa

PubMed Central

Ishibashi, Hiroki; Takano, Masashi; Sasa, Hidenori; Furuya, Kenichi

2016-01-01

Background Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa. Materials and Methods We included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss). Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage. Results Of 256 pregnant women with placenta previa, 96 (38%) developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was −0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >−0.33 (odds ratio, 5.88; 95% confidence interval, 3.04–12.00), need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79–6.25), and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85–92.13) were independent risk of intraoperative massive hemorrhage. Conclusion In patients with placenta previa, a birth weight >−0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on

New Views on Cesarean Section, its Possible Complications and Long-Term Consequences for Children’s Health

PubMed Central

Kulas, Tomislav; Bursac, Danijel; Zegarac, Zana; Planinic-Rados, Gordana; Hrgovic, Zlatko

2013-01-01

Historical developments and advancements in cesarean section techniques and logistics have reduced the maternal and neonatal risks associated with the procedure, while increasing the number of operatively completed pregnancies for medically unjustifiable reasons. The uncritical attitude towards cesarean section and the fast emergence of ‘modern’ diseases such as obesity at a young age, asthma, type 1 diabetes mellitus and various forms of dermatitis have stimulated researches associating cesarean section with these diseases. Intestinal flora of the children born by cesarean section contains less bifidobacteria, i.e. their intestinal flora is similar to the intestinal flora in diabetic individuals. In children born by cesarean section, the ‘good’ maternal bacterial that are normally found in the maternal birth canal and rectum are lacking, while the ‘bad’ bacteria that may endanger the child’s immune system are frequently present. In children born by vaginal delivery, the ‘good’ maternal bacteria stimulate the newborn’s white blood cells and other components of the immune system, which has been taken as a basis for the hypotheses explaining the evident association of the above morbidities and delivery by cesarean section. PMID:25568522

The Costs and Their Determinant of Cesarean Section and Vaginal Delivery: An Exploratory Study in Chongqing Municipality, China

PubMed Central

He, Zhifei; Cheng, Zhaohui; Wu, Tailai; Zhou, Yan; Chen, Junguo; Fu, Qian

2016-01-01

Objectives. This study aims to analyze the cesarean section (CS) rates and vaginal delivery rates in tertiary hospitals of China, explore the costs of two different deliveries, and examine the relative influencing factors of the costs in both CS and vaginal deliveries. Methods. 30,168 anonymized obstetric medical cases were selected from three sample tertiary hospitals in Chongqing Municipality from 2011 to 2013. Chi-square test was used to compare the distributions of CS and vaginal deliveries under different indicators. Mann–Whitney test and Kruskal-Wallis test were adopted to analyze the differences under different items. Multiple linear regression was used to determine the influencing factors of the costs of different delivery modes. Results. (1) The rates of CS were 69%, 65.5%, and 59.2% in the three sample tertiary hospitals in Chongqing from 2011 to 2013. (2) The costs and the length of stay of CS were greater than those of vaginal delivery, which had significant differences (P < 0.005). (3) The areas, length of stay, age, medical insurance, and modes of delivery were the influencing factors of both CS and vaginal delivery costs. Discussion. The high CS rates in China must be paid significant attention. The indicators of two modes of delivery should be regulated strictly. CS rate reduction and saving medical resources will be the benefits if vaginal delivery is chosen by pregnant women. PMID:27995142

Exploring Women's Preferences for the Mode of Delivery in Twin Gestations: Results of the Twin Birth Study.

PubMed

Murray-Davis, Beth; McVittie, Jennifer; Barrett, Jon F; Hutton, Eileen K

2016-12-01

The Twin Birth Study, an international, multi-center randomized controlled trial was conducted to compare the risks of planned cesarean with planned vaginal delivery for twin pregnancies. The aim of this component of the trial was to understand participants' perspectives of study participation and preferences for the mode of delivery. A mixed-methods questionnaire was distributed to study participants 3 months after giving birth. The questionnaire contained Likert scales and open-ended questions about the experience of being enrolled in a clinical trial and of childbirth, including the mode of delivery. Quantitative data were analyzed using SAS to generate descriptive statistics. Qualitative data were analyzed to identify categories and themes. Ninety-one percent of trial participants completed the questionnaire. Across all groups, the majority of women would participate in a study like this one again if given the opportunity. Main benefits of participating were as follows: benefits to one and one's babies, altruism, and receiving quality care. Randomization for the mode of delivery was challenging for women because of the desire to be involved in decision-making. Findings related to childbirth experience and the mode of delivery demonstrated a preference for vaginal birth across all groups. Those who had a vaginal birth were more satisfied with their birth experience. This study provides evidence to inform practitioners about what women who have twin pregnancies like or dislike about birth and their desire for involvement in decision-making. Vaginal birth was preferred across all study groups and was associated with greater satisfaction with childbirth experience. © 2016 Wiley Periodicals, Inc.

Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network.

PubMed

Humberg, Alexander; Härtel, Christoph; Paul, Pia; Hanke, Kathrin; Bossung, Verena; Hartz, Annika; Fasel, Laura; Rausch, Tanja K; Rody, Achim; Herting, Egbert; Göpel, Wolfgang

2017-05-01

Very-low-birth-weight infants (VLBWI) are frequently delivered by cesarean section (CS). However, it is unclear at what gestational age the benefits of spontaneous delivery outweigh the perinatal risks, i.e. intraventricular hemorrhage (IVH) or death. To assess the short-term outcome of VLBWI on IVH according to mode of delivery in a population-based cohort of the German Neonatal Network (GNN). A total cohort of 2203 singleton VLBWI with a birth weight <1500g and gestational age between 22 0/7 and 36 6/7 weeks born and discharged between 1st of January 2009 and 31st of December 2015 was available for analysis. VLBWI were stratified into three categories according to mode of delivery: (1) planned cesarean section (n=1381), (2) vaginal delivery (n=632) and (3) emergency cesarean section (n=190). Outcome was assessed in univariate and logistic regression analyses. Prevalence of IVH was significantly higher in the vaginal delivery (VD) (26.6%) and emergency CS group (31.1%) as compared to planned CS (17.2%), respectively. In a logistic regression analysis including known risk factors for IVH, vaginal delivery (OR 1.725 [1.325-2.202], p≤0.001) and emergency cesarean section (OR 1.916 [1.338-2.746], p≤0.001) were independently associated with IVH risk. In the subgroup of infants >30 weeks of gestation prevalence for IVH was not significantly different in VD and planned CS (5.3% vs. 4.4%). Our observational data demonstrate that elective cesarean section is associated with a reduced risk of IVH in preterm infants <30 weeks gestational age when presenting with preterm labor. Copyright © 2017 Elsevier B.V. All rights reserved.

Efficacy of Warm Showers on Postpartum Fatigue Among Vaginal-Birth Taiwanese Women: A Quasi-Experimental Design.

PubMed

Hsieh, Ching-Hsing; Chen, Chien-Lan; Chung, Feng-Fang; Lin, Su-Ying

2017-05-01

Postpartum fatigue is one of the most common complaints among women following childbirth. As a postpartum ritual practice, Taiwanese women refrain from taking showers while "doing the month." However, warm showers are the systemic application of moist heat, and they maintain physical hygiene, stimulate blood circulation, mitigate discomfort, and provide relaxation. As Taiwanese society becomes increasingly receptive to scientific and contemporary health care practice, more and more women choose to take warm showers after childbirth. The purpose of this study was to evaluate the efficacy of warm showers on postpartum fatigue among vaginal-birth women in Taiwan. This was a two-group quasi-experimental design. Women took showers in warm water with temperatures ranging between 40 °C and 43 °C for approximately 20 minutes. Postpartum women's fatigue is measured using the 10-item Postpartum Fatigue Scale (PFS). The intervention effect was analyzed using a generalized estimating equation (GEE) model. The study population consisted of 358 vaginal-birth postpartum Taiwanese women aged 20-43 years. Postpartum women who took warm showers showed improvements from their pretest to posttest mean scores of postpartum fatigue compared to postpartum women who did not take warm showers. Warm showers helped to reduce postpartum fatigue among vaginal-birth women during the study period. Nurses have the unique opportunity to provide the intervention to Taiwanese women who have vaginal birth to help them relieve postpartum fatigue with warm showers while "doing the month" without the taboo of no-showering customary practices in the early postpartum period.

Antibiotic prophylaxis for episiotomy repair following vaginal birth.

PubMed

Bonet, Mercedes; Ota, Erika; Chibueze, Chioma E; Oladapo, Olufemi T

2017-11-02

Bacterial infections occurring during labour, childbirth, and the puerperium may be associated with considerable maternal and perinatal morbidity and mortality. Antibiotic prophylaxis might reduce wound infection incidence after an episiotomy, particularly in situations associated with a higher risk of postpartum perineal infection, such as midline episiotomy, extension of the incision, or in settings where the baseline risk of infection after vaginal birth is high. However, available evidence is unclear concerning the role of prophylactic antibiotics in preventing infections after an episiotomy. To assess whether routine antibiotic prophylaxis before or immediately after incision or repair of episiotomy for women with an uncomplicated vaginal birth, compared with either placebo or no antibiotic prophylaxis, prevents maternal infectious morbidities and improves outcomes. We searched the Cochrane Pregnancy and Childbirth's Trials Register, LILACS, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) on 24 July 2017, and screened reference lists of retrieved studies. We considered randomised controlled trials, quasi-randomised trials, and cluster-randomised trials that compared the use of routine antibiotic prophylaxis for incision or repair of an episiotomy for women with otherwise normal vaginal births, compared with either placebo or no antibiotic prophylaxis. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy. We only found one quasi-randomised trial that met the inclusion criteria and was included in the analysis, therefore, we did not perform a meta-analysis. We included one quasi-RCT (with data from 73 women) in the review. The trial, which was conducted in a public hospital in Brazil, compared oral chloramphenicol 500 mg four times daily for 72 hours after episiotomy repair (N = 34) and no treatment (N = 39). We assessed most of the domains at high

The effect of increased number of cesarean on maternal and fetal outcomes.

PubMed

Çintesun, Ersin; Al, Ragıp Atakan

2017-01-01

The aim of this study was to evaluate the effects of multiple cesarean deliveries (CDs) on maternal-fetal mor-bidity and mortality rates. This retrospective study included a total of 1,506 patients who underwent multiple CDs between January 2006 and May 2014. The patients were divided into two groups. One group consisted of patients with four or more CDs (n = 444) and a control group of patients with three CDs (n=1,062). Both groups were analyzed for demographics, complications from multiple cesarean deliveries and perinatal outcomes. The mean age was higher in the study group (p < 0.001). Dense adhesion (p < 0.001), demand for tubal ligation (p < 0.001), the requirement of pelvic drainage (p < 0.001), duration of hospitalization (p < 0.001) and the requirement for blood transfusion (p=0.03) was also significantly higher in the study group. Hemoglobin levels (p = 0.002) were signifi-cantly higher in the control group on the second postoperative day. Regarding perinatal morbidity; umbilical artery pH results (p = 0.003) were significantly lower in the study group. There was no significant difference in the maternal and fetal mortality rates between both groups. According to our study results, an increase in the number of cesarean sections increases maternal and fetal morbidity rates significantly. Therefore, we recommend decreasing the rate of primary cesarean deliveries by encouraging vaginal birth after CD. We also advocate the use of permanent contraceptive methods in patients with a high number of CD's. Further large-scale prospective results are required to establish a definitive conclusion.

Quality Improvement Initiatives Lead to Reduction in Nulliparous Term Singleton Vertex Cesarean Delivery Rate

PubMed Central

Vadnais, Mary A.; Hacker, Michele R.; Shah, Neel T.; Jordan, JoAnn; Modest, Anna M.; Siegel, Molly; Golen, Toni H.

2018-01-01

Background The nulliparous term singleton vertex (NTSV) cesarean delivery rate has been recognized as a meaningful benchmark. Variation in the NTSV cesarean delivery rate among hospitals and providers suggests many hospitals may be able to safely improve their rates. The NTSV cesarean delivery rate at the authors’ institution was higher than state and national averages. This study was conducted to determine the influence of a set of quality improvement interventions on the NTSV cesarean delivery rate. Methods From 2008 through 2015, at a single tertiary care academic medical center, a multi-strategy approach that included provider education, provider feedback, and implementation of new policies was used to target evidence-based and inferred factors that influence the NTSV cesarean delivery rate. Data on mode of delivery, maternal outcomes, and neonatal outcomes were collected from birth certificates and administrative claims data. The Cochran-Armitage test and linear regression were used to calculate the p-trend for categorical and continuous variables, respectively. Results More than 20,000 NTSV deliveries were analyzed, including more than 15,000 during the intervention period. The NTSV cesarean delivery rate declined from 35% to 21% over eight years. The total cesarean delivery rate declined as well. Increase in meconium aspiration syndrome and maternal transfusion were observed. Conclusion Quality improvement initiatives can decrease the NTSV cesarean delivery rate. Any increased incidence of fetal or maternal complications associated with decreased NTSV cesarean delivery rate should be considered in the context of the risks and benefits of vaginal delivery compared to cesarean delivery. PMID:28334563

Fetal presentation and successful twin vaginal delivery.

PubMed

Easter, Sarah Rae; Lieberman, Ellice; Carusi, Daniela

2016-01-01

Despite the demonstrated safety of a trial of labor for pregnancies with a vertex-presenting twin and clinical guidelines in support of this plan, the rate of planned cesarean delivery for twin pregnancies remains high. This high rate, as well as variation in cesarean rates for twin pregnancies across providers, may be influenced strongly by concern about delivery of the second twin, particularly when it is in a nonvertex presentation. There are limited data in the literature that has examined the impact of the position of the nonpresenting twin on successful vaginal delivery or maternal/neonatal morbidity. We hypothesized that nonvertex presentation of the second twin would be associated with lower rates of successful vaginal birth for those patients attempting labor. This institutional review board-approved, retrospective cohort study of women who labored with twin pregnancies in a single urban hospital from 2007-2011. We included women with vertex-presenting first twins at >32 weeks gestation without a contraindication to labor and excluded those with uterine scar or lethal fetal anomaly. Vaginal delivery rates were evaluated according to vertex or nonvertex presentation of the second twin at admission and again at delivery. Maternal and neonatal morbidities were evaluated separately. Logistic regression was used to control for multiple confounders. Seven hundred sixteen patients met the inclusion criteria; 349 patients (49%) underwent a trial of labor. This included 73% (296/406) of eligible vertex/vertex twins and 17% (53/310) eligible vertex/nonvertex twins (P < .01). When compared with laboring patients with vertex/vertex-presenting twins, those with vertex/nonvertex twins were younger (median age, 32 vs 33 years; P = .05), were more often multiparous (60% vs 43%; P = .02), and were less likely to have hypertension (13% vs 27%; P = .03). Eighty-five percent of patients with nonvertex second twins at admission delivered vaginally, compared with 70% of

Mode of delivery preferences in a diverse population of pregnant women.

PubMed

Yee, Lynn M; Kaimal, Anjali J; Houston, Kathryn A; Wu, Erica; Thiet, Mari-Paule; Nakagawa, Sanae; Caughey, Aaron B; Firouzian, Atoosa; Kuppermann, Miriam

2015-03-01

The objective of the study was to assess women's preferences for vaginal vs cesarean delivery in 4 contexts: prior cesarean delivery, twins, breech presentation, and absent indication for cesarean. This was a cross-sectional study of pregnant women at 24-40 weeks' gestation. After assessing stated preferences for vaginal or cesarean delivery, we used the standard gamble metric to measure the strength of these preferences and the time tradeoff metric to determine how women value the potential processes and outcomes associated with these 2 delivery approaches. Among the 240 participants, 90.8% had a stated preference for vaginal delivery. Across the 4 contexts, these women indicated that, on average, they would accept a 59-75% chance of an attempted vaginal birth ending in a cesarean delivery before choosing a planned cesarean delivery, indicating strong preferences for spontaneous, uncomplicated vaginal delivery. Variations in preferences for labor processes emerged. Although uncomplicated labor ending in vaginal birth was assigned mean utilities of 0.993 or higher (on a 0-1 scale, with higher scores indicating more preferred outcomes), the need for oxytocin, antibiotics, or operative vaginal delivery resulted in lower mean scores, comparable with those assigned to uncomplicated cesarean delivery. Substantially lower scores (ranging from 0.432 to 0.598) were obtained for scenarios ending in severe maternal or neonatal morbidity. Although most women expressed strong preferences for vaginal delivery, their preferences regarding interventions frequently used to achieve that goal varied. These data underscore the importance of educating patients about the process of labor and delivery to facilitate incorporation of informed patient preferences in shared decision making regarding delivery approach. Copyright © 2015 Elsevier Inc. All rights reserved.

A cluster-randomized trial to reduce major perinatal morbidity among women with one prior cesarean delivery in Québec (PRISMA trial): study protocol for a randomized controlled trial.

PubMed

Chaillet, N; Bujold, E; Masse, B; Grobman, W A; Rozenberg, P; Pasquier, J C; Shorten, A; Johri, M; Beaudoin, F; Abenhaim, H; Demers, S; Fraser, W; Dugas, M; Blouin, S; Dubé, E; Gauthier, R

2017-09-20

Rates of cesarean delivery are continuously increasing in industrialized countries, with repeated cesarean accounting for about a third of all cesareans. Women who have undergone a first cesarean are facing a difficult choice for their next pregnancy, i.e.: (1) to plan for a second cesarean delivery, associated with higher risk of maternal complications than vaginal delivery; or (b) to have a trial of labor (TOL) with the aim to achieve a vaginal birth after cesarean (VBAC) and to accept a significant, but rare, risk of uterine rupture and its related maternal and neonatal complications. The objective of this trial is to assess whether a multifaceted intervention would reduce the rate of major perinatal morbidity among women with one prior cesarean. The study is a stratified, non-blinded, cluster-randomized, parallel-group trial of a multifaceted intervention. Hospitals in Quebec are the units of randomization and women are the units of analysis. As depicted in Figure 1, the study includes a 1-year pre-intervention period (baseline), a 5-month implementation period, and a 2-year intervention period. At the end of the baseline period, 20 hospitals will be allocated to the intervention group and 20 to the control group, using a randomization stratified by level of care. Medical records will be used to collect data before and during the intervention period. Primary outcome is the rate of a composite of major perinatal morbidities measured during the intervention period. Secondary outcomes include major and minor maternal morbidity; minor perinatal morbidity; and TOL and VBAC rate. The effect of the intervention will be assessed using the multivariable generalized-estimating-equations extension of logistic regression. The evaluation will include subgroup analyses for preterm and term birth, and a cost-effectiveness analysis. The intervention is designed to facilitate: (1) women's decision-making process, using a decision analysis tool (DAT), (2) an estimate of uterine

Doula care, birth outcomes, and costs among Medicaid beneficiaries.

PubMed

Kozhimannil, Katy Backes; Hardeman, Rachel R; Attanasio, Laura B; Blauer-Peterson, Cori; O'Brien, Michelle

2013-04-01

We compared childbirth-related outcomes for Medicaid recipients who received prenatal education and childbirth support from trained doulas with outcomes from a national sample of similar women and estimated potential cost savings. We calculated descriptive statistics for Medicaid-funded births nationally (from the 2009 Nationwide Inpatient Sample; n = 279,008) and births supported by doula care (n = 1079) in Minneapolis, Minnesota, in 2010 to 2012; used multivariate regression to estimate impacts of doula care; and modeled potential cost savings associated with reductions in cesarean delivery for doula-supported births. The cesarean rate was 22.3% among doula-supported births and 31.5% among Medicaid beneficiaries nationally. The corresponding preterm birth rates were 6.1% and 7.3%, respectively. After control for clinical and sociodemographic factors, odds of cesarean delivery were 40.9% lower for doula-supported births (adjusted odds ratio = 0.59; P < .001). Potential cost savings to Medicaid programs associated with such cesarean rate reductions are substantial but depend on states' reimbursement rates, birth volume, and current cesarean rates. State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.

Types of pelvic floor dysfunctions in nulliparous, vaginal delivery, and cesarean section female patients with obstructed defecation syndrome identified by echodefecography.

PubMed

Murad-Regadas, Sthela M; Regadas, Francisco Sérgio P; Rodrigues, Lusmar V; Oliveira, Leticia; Barreto, Rosilma G L; de Souza, Marcellus H L P; Silva, Flavio Roberto S

2009-10-01

This study aims to show pelvic floor dysfunctions in women with obstructed defecation syndrome (ODS), comparing nulliparous to those with vaginal delivery or cesarean section using the echodefecography (ECD). Three hundred seventy female patients with ODS were reviewed retrospectively and were divided in Group I-105 nulliparous, Group II-165 had at least one vaginal delivery, and Group III-comprised of 100 patients delivered only by cesarean section. All patients had been submitted to ECD to identify pelvic floor dysfunctions. No statistical significance was found between the groups with regard to anorectocele grade. Intussusception was identified in 40% from G I, 55.0% from G II, and 30.0% from G III, with statistical significance between Groups I and II. Intussusception was associated with significant anorectocele in 24.8%, 36.3%, and 18% patients from G I, II, and III, respectively. Anismus was identified in 39.0% from G I, 28.5% from G II, and 60% from G III, with statistical significance between Groups I and III. Anismus was associated with significant anorectocele in 22.8%, 15.7%, and 24% patients from G I, II, and III, respectively. Sigmoidocele/enterocele was identified in 7.6% from G I, 10.9% G II, and was associated with significant rectocele in 3.8% and 7.3% patients from G I and II, respectively. The distribution of pelvic floor dysfunctions showed no specific pattern across the groups, suggesting the absence of a correlation between these dysfunctions and vaginal delivery.

True vaginal prolapse in a bitch.

PubMed

Alan, M; Cetin, Y; Sendag, S; Eski, F

2007-08-01

Frequently, vaginal fold prolapse is the protrusion of edematous vaginal tissue into and through the opening of the vulva occurring during proestrus and estrus stages of the sexual cycle. True vaginal prolapse may occur near parturition, as the concentration of serum progesterone declines and the concentration of serum oestrogen increases. In the bitch, this type of true vaginal prolapse is a very rare condition. This short communication describes a 5-year-old female, cross-breed dog in moderate condition, weighing 33 kg, with distocia and true vaginal prolapse. Abdominal palpation and transabdominal ultrasonography revealed live and dead foetuses in the uterine horns. One dead and four live fetuses were removed from uterus by cesarean section. The ovariohysterectomy was performed after repositioning the vaginal wall with a combination of traction from within the abdomen and external manipulation through the vulva. Re-occurrence of a vaginal prolapse was not observed and the bitch recovered completely after the surgical therapy. Compared to other vaginal disorders, vaginal prolapse is an uncommon condition in the bitch. In the present case, extreme tenesmus arising from distocia may have predisposed to the vaginal prolapse. The cause of dystocia was probably the disposition of the first foetus. We concluded that the vaginal prolapse was the result of dystocia in the present case.

Parent-Infant Skin-to-Skin Contact Following Birth: History, Benefits, and Challenges.

PubMed

Hubbard, Jessie Marie; Gattman, Kindsey Rae

2017-03-01

It is a practice with strong roots in nature and has a significant influence on health outcomes, particularly for at-risk newborns in low-resource settings. In this comprehensive review, benefits of SSC for newborns, mothers, and fathers after vaginal and cesarean births are discussed as well as the benefits of SSC observed for infants in the NICU. Barriers to SSC practice implementation are discussed, and proposed solutions and recommendations are offered. By understanding the many benefits of SSC and strategies for implementation, health care providers can best support and promote this high-quality, evidence-based practice with mothers, newborns, and their families.

Administration of oral and vaginal prebiotic lactoferrin for a woman with a refractory vaginitis recurring preterm delivery: appearance of lactobacillus in vaginal flora followed by term delivery.

PubMed

Otsuki, Katsufumi; Tokunaka, Mayumi; Oba, Tomohiro; Nakamura, Masamitsu; Shirato, Nahoko; Okai, Takashi

2014-02-01

Lactoferrin (LF) is one of the prebiotics present in the human body. A 38-year-old multiparous woman with poor obstetrical histories, three consecutive preterm premature rupture of membrane at the 19th, 23rd and 25th week of pregnancy, was referred to our hospital. She was diagnosed as having refractory vaginitis. Although estriol vaginal tablets were used for 4 months, the vaginitis was not cured. We administrated vaginal tablets and oral agents of prebiotic LF, resulting in a Lactobacillus predominant vaginal flora. When she was pregnant, she continued to use the LF, and the Lactobacillus in the vaginal flora was continuously observed during pregnancy. An elective cesarean section was performed at the 38th week of pregnancy. When the administration of LF was discontinued after the delivery, Lactobacillus in the vaginal flora was disappeared. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

On the Biomechanics of Vaginal Birth and Common Sequelae

PubMed Central

Ashton-Miller, James A.; DeLancey, John O.L.

2010-01-01

Approximately 11% of U.S. women undergo surgery for pelvic floor dysfunction, including genital organ prolapse and urinary and fecal incontinence. The major risk factor for developing these conditions is giving vaginal birth. Vaginal birth is a remarkable event about which little is known from a biomechanical perspective. We first review the functional anatomy of the female pelvic floor, the normal loads acting on the pelvic floor in activities of daily living, and the functional capacity of the pelvic floor muscles. Computer models show that the stretch ratio in the pelvic floor muscles can reach an extraordinary 3.26 by the end of the second stage of labor. Magnetic resonance images provide evidence that show that the pelvic floor regions experiencing the most stretch are at the greatest risk for injury, especially in forceps deliveries. A conceptual model suggests how these injuries may lead to the most common form of pelvic organ prolapse, a cystocele. PMID:19591614

Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop.

PubMed

Spong, Catherine Y; Berghella, Vincenzo; Wenstrom, Katharine D; Mercer, Brian M; Saade, George R

2012-11-01

With more than one third of pregnancies in the United States being delivered by cesarean and the growing knowledge of morbidities associated with repeat cesarean deliveries, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists convened a workshop to address the concept of preventing the first cesarean delivery. The available information on maternal and fetal factors, labor management and induction, and nonmedical factors leading to the first cesarean delivery was reviewed as well as the implications of the first cesarean delivery on future reproductive health. Key points were identified to assist with reduction in cesarean delivery rates including that labor induction should be performed primarily for medical indication; if done for nonmedical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient. Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress. The diagnosis of "failed induction" should only be made after an adequate attempt. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed as long as the maternal and fetal conditions permit. The adequate time for each of these stages appears to be longer than traditionally estimated. Operative vaginal delivery is an acceptable birth method when indicated and can safely prevent cesarean delivery. Given the progressively declining use, it is critical that training and experience in operative vaginal delivery are facilitated and encouraged. When discussing the first cesarean delivery with a patient, counseling should include its effect on future reproductive health.

Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop

PubMed Central

Spong, Catherine Y.; Berghella, Vincenzo; Wenstrom, Katharine D.; Mercer, Brian M.; Saade, George R.

2012-01-01

With over one-third of pregnancies in the United States being delivered by cesarean and the growing knowledge of morbidities associated with repeat cesarean deliveries, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists convened a workshop to address the concept of preventing the first cesarean. The available information on maternal and fetal factors, labor management and induction, and non-medical factors leading to the first cesarean were reviewed as well as the implications of the first cesarean on future reproductive health. Key points were identified to assist with reduction in cesarean rates including that labor induction should be performed primarily for medical indication; if done for non-medical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient. Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress. The diagnosis of “failed induction” should only be made after an adequate attempt. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed, as long as the maternal and fetal conditions permit. The adequate time for each of these stages appears to be longer than traditionally estimated. Operative vaginal delivery is an acceptable birth method when indicated, and can safely prevent cesarean delivery. Given the progressively declining use, it is critical that training and experience in operative vaginal delivery is facilitated and encouraged. When discussing the first cesarean with a patient, counseling should include its effect on future reproductive health. PMID:23090537

A Native American Community with a 7% Cesarean Delivery Rate: Does Case Mix, Ethnicity, or Labor Management Explain the Low Rate?

PubMed Central

Leeman, Lawrence; Leeman, Rebecca

2003-01-01

PURPOSE Cesarean delivery rates vary widely across populations. Studying communities with low rates of cesarean delivery may identify practices that can lower the cesarean rate. METHODS A population-based historical cohort study included all pregnant women (N = 1132) from 1992 through 1996 in a predominantly Native American region of northwestern New Mexico known to have a high prevalence of gestational diabetes and preeclampsia. The outcomes studied included delivery type (eg, cesarean, operative vaginal, spontaneous vaginal), indication for cesarean delivery, presence of obstetrical risk factors, and use of labor induction or augmentation. RESULTS The cesarean delivery rate of the study group (7.3%) was only 35% of the 1996 US rate of 20.7%. Among study participants, the relative risk of a primary cesarean delivery for dystocia was 0.22 (95% CI, 0.14, 0.35). Trial of labor after cesarean delivery was attempted by 93% of study participants compared with 42% of women nationwide in 1994. The cesarean delivery rates for women with diabetes in pregnancy (11.5% versus 35.4%) and preeclampsia (14.8% versus 37.4%) were significantly lower than nationwide rates. Case-mix analysis comparison with a standardized population and comparison of standard (ie, term, singleton, vertex) primiparous women demonstrate that the low rate of cesarean delivery was not because of a lower prevalence of risk factors. CONCLUSIONS The community’s low rate of cesarean delivery is primarily the result of a decreased use of cesarean delivery for labor dystocia and an almost universal acceptance of trial of labor after cesarean delivery. Cultural attitudes toward childbirth, design of the perinatal system, and genetic factors also may explain the low rate of cesarean delivery. PMID:15043178

A Native American community with a 7% cesarean delivery rate: does case mix, ethnicity, or labor management explain the low rate?

PubMed

Leeman, Lawrence; Leeman, Rebecca

2003-01-01

Cesarean delivery rates vary widely across populations. Studying communities with low rates of cesarean delivery may identify practices that can lower the cesarean rate. A population-based historical cohort study included all pregnant women (N = 1132) from 1992 through 1996 in a predominantly Native American region of northwestern New Mexico known to have a high prevalence of gestational diabetes and preeclampsia. The outcomes studied included delivery type (eg, cesarean, operative vaginal, spontaneous vaginal), indication for cesarean delivery, presence of obstetrical risk factors, and use of labor induction or augmentation. The cesarean delivery rate of the study group (7.3%) was only 35% of the 1996 US rate of 20.7%. Among study participants, the relative risk of a primary cesarean delivery for dystocia was 0.22 (95% CI, 0.14, 0.35). Trial of labor after cesarean delivery was attempted by 93% of study participants compared with 42% of women nationwide in 1994. The cesarean delivery rates for women with diabetes in pregnancy (11.5% versus 35.4%) and preeclampsia (14.8% versus 37.4%) were significantly lower than nationwide rates. Case-mix analysis comparison with a standardized population and comparison of standard (ie, term, singleton, vertex) primiparous women demonstrate that the low rate of cesarean delivery was not because of a lower prevalence of risk factors. The community's low rate of cesarean delivery is primarily the result of a decreased use of cesarean delivery for labor dystocia and an almost universal acceptance of trial of labor after cesarean delivery. Cultural attitudes toward childbirth, design of the perinatal system, and genetic factors also may explain the low rate of cesarean delivery.

Matched cohort study of external cephalic version in women with previous cesarean delivery.

PubMed

Keepanasseril, Anish; Anand, Keerthana; Soundara Raghavan, Subrahmanian

2017-07-01

To evaluate the efficacy and safety of external cephalic version (ECV) among women with previous cesarean delivery. A retrospective study was conducted using data for women with previous cesarean delivery and breech presentation who underwent ECV at or after 36 weeks of pregnancy during 2011-2016. For every case, two multiparous women without previous cesarean delivery who underwent ECV and were matched for age and pregnancy duration were included. Characteristics and outcomes were compared between groups. ECV was successful for 32 (84.2%) of 38 women with previous cesarean delivery and 62 (81.6%) in the control group (P=0.728). Multivariate regression analysis confirmed that previous cesarean was not associated with ECV success (odds ratio 1.89, 95% confidence interval 0.19-18.47; P=0.244). Successful vaginal delivery after successful ECV was reported for 19 (59.4%) women in the previous cesarean delivery group and 52 (83.9%) in the control group (P<0.001). No ECV-associated complications occurred in women with previous cesarean delivery. To avoid a repeat cesarean delivery, ECV can be offered to women with breech presentation and previous cesarean delivery who are otherwise eligible for a trial of labor. © 2017 International Federation of Gynecology and Obstetrics.

A Rare Case of Transvesical Cesarean Section

PubMed Central

Juneja, Sunil Kumar; Tandon, Pooja; Kochhar, Bakul; Singh, Harman Deep; Sharma, Bhanupriya

2017-01-01

Cesarean section, also commonly known as C-section, is a surgical procedure in which incision is made through a mother's abdomen and uterus to deliver one or more babies. According to urgency, they are classified either as elective or emergency. According to technique, they have been classified as classical, lower uterine segment and cesarean hysterectomy. Intentional transvesical cesarean though not a routinely practiced technique is used for delivery in women born with imperforate anus, ectopic intravaginal urethra, vaginal and urethral strictures, and bladder adherent completely over the uterus. Since such cases are very rare, we are reporting one such case of transvesical cesarean section. PMID:28904925

Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain.

PubMed

Doğan, Bülent; Gün, İsmet; Özdamar, Özkan; Yılmaz, Ali; Muhçu, Murat

2017-02-01

To investigate whether spontaneous vaginal birth with mediolateral episiotomy has any long-term impact on urinary and/or fecal incontinence, sexual dysfunction and perineal pain in primiparous women. This matched case-control study included 150 women between 25 and 35 years old who had a singleton childbirth at least five years previously. Patients were grouped as; women who had a spontaneous vaginal delivery with mediolateral episiotomy (Group 1), an elective cesarean delivery (Group 2), and who had no delivery (Group 3). Controls were matched for age and delivery time. Urinary/fecal incontinence were questioned and Female Sexual Function Index (FSFI) questionnaire was completed. Total FSFI and domain scores were compared. Statistical evaluation was performed using One-way ANOVA test or χ 2 test. Statistical significance was defined as p < 0.05. No women had urinary/fecal incontinence nor sexual dysfunction. Mean total FSFI points in Group 1 were significantly lower than in Groups 2 and 3 (p = 0.001). There were significant differences in sexual desire between groups 1 and 3 (p = 0.005), in arousal and in orgasm between both groups 1 and 2 (p = 0.001 and p = 0.038, respectively) and groups 1 and 3 (p = 0.001 and p = 0.001, respectively). There was no significant difference between groups 2 and 3 in any parameters or total points. Vaginal delivery with mediolateral episiotomy is not associated with urinary and/or fecal incontinence and sexual dysfunction but associated with a decreased sexual functioning as well as sexual desire, arousal and orgasm within postpartum five years.

Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study.

PubMed

Owe, Katrine Mari; Nystad, Wenche; Stigum, Hein; Vangen, Siri; Bø, Kari

2016-12-01

Vaginal delivery for the first birth is of great importance for further obstetric performance for the individual woman. Given the rising cesarean delivery rates worldwide over the past decades, a search for modifiable factors that are associated with cesarean delivery is needed. Exercise may be a modifiable factor that is associated with type of delivery, but the results of previous studies are not conclusive. The purpose of this study was to investigate the association between exercise during pregnancy and cesarean delivery, both acute and elective, in nulliparous women. We conducted a population-based cohort study that involved 39,187 nulliparous women with a singleton pregnancy who were enrolled in the Norwegian Mother and Child Cohort Study between 2000 and 2009. All women answered 2 questionnaires in pregnancy weeks 17 and 30. Acute and elective cesarean delivery data were obtained from the Medical Birth Registry of Norway. Information on exercise frequency and type was assessed prospectively by questionnaires in pregnancy weeks 17 and 30. Generalized linear models estimated risk differences of acute and elective cesarean delivery for different frequencies and types of exercise during pregnancy weeks 17 and 30. We used restricted cubic splines to examine dose-response associations of exercise frequency and acute cesarean delivery. A test for nonlinearity was also conducted. The total cesarean delivery rate was 15.4% (n=6030), of which 77.8% (n=4689) was acute cesarean delivery. Exercise during pregnancy was associated with a reduced risk of cesarean delivery, particularly for acute cesarean delivery. A nonlinear association was observed for exercise frequency in weeks 17 and 30 and risk of acute cesarean delivery (test for nonlinearity, P=.003 and P=.027, respectively). The largest risk reduction was observed for acute cesarean delivery among women who exercised >5 times weekly during weeks 17 (-2.2%) and 30 (-3.6%) compared with nonexercisers (test for trend

Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth.

PubMed

Nakamura-Pereira, Marcos; do Carmo Leal, Maria; Esteves-Pereira, Ana Paula; Domingues, Rosa Maria Soares Madeira; Torres, Jacqueline Alves; Dias, Marcos Augusto Bastos; Moreira, Maria Elisabeth

2016-10-17

Cesarean section (CS) rates are increasing worldwide but there is some concern with this trend because of potential maternal and perinatal risks. The Robson classification is the standard method to monitor and compare CS rates. Our objective was to analyze CS rates in Brazil according to source of payment for childbirth (public or private) using the Robson classification. Data are from the 2011-2012 "Birth in Brazil" study, which used a national hospital-based sample of 23,940 women. We categorized all women into Robson groups and reported the relative size of each Robson group, the CS rate in each group and the absolute and relative contributions made by each to the overall CS rate. Differences were analyzed through chi-square and Z-test with a significance level of < 0.05. The overall CS rate in Brazil was 51.9 % (42.9 % in the public and 87.9 % in the private health sector). The Robson groups with the highest impact on Brazil's CS rate in both public and private sectors were group 2 (nulliparous, term, cephalic with induced or cesarean delivery before labor), group 5 (multiparous, term, cephalic presentation and previous cesarean section) and group 10 (cephalic preterm pregnancies), which accounted for more than 70 % of CS carried out in the country. High-risk women had significantly greater CS rates compared with low-risk women in almost all Robson groups in the public sector only. Public policies should be directed at reducing CS in nulliparous women, particularly by reducing the number of elective CS in these women, and encouraging vaginal birth after cesarean to reduce repeat CS in multiparous women.

Early elective cesarean delivery before 36 weeks vs late spontaneous delivery in infants with gastroschisis.

PubMed

Hadidi, Ahmed; Subotic, Ulrike; Goeppl, Maximilian; Waag, Karl-L

2008-07-01

The aim of this study is to assess the value of early elective cesarean delivery for patients with gastroschisis in comparison with late spontaneous delivery. Analysis of infants with gastroschisis admitted between 1986 and 2006 at a tertiary care center was performed. The findings were analyzed statistically. Eighty-six patients were involved in the study. This included 15 patients who underwent emergency cesarean delivery (EM CD group) because of fetal distress and/or bowel ischemia. The remaining 71 patients born electively were stratified into 4 groups. The early elective cesarean delivery (ECD) group included 23 patients born by ECD before 36 weeks; late vaginal delivery (LVD) group included 23 patients who had LVD after 36 weeks; 24 patients had LCD after 36 weeks because of delayed diagnosis that resulted in late referral; and 1 patient had early spontaneous vaginal delivery (EVD group) before 36 weeks. The mean time to start oral feeding, incidence of complications, and primary closure were significantly better in the ECD group than in the LVD group. The duration of ventilation and the length of stay were shorter in ECD group, but the difference was not statistically significant. Elective cesarean delivery before 36 weeks allows earlier enteral feeding and is associated with less complications and higher incidence of primary closure (statistically significant).

Complications and outcomes of repeat cesarean section in adolescent women

PubMed Central

Kaplanoglu, Mustafa; Karateke, Atilla; Un, Burak; Akgor, Utku; Baloğlu, Ali

2014-01-01

Aim: The evaluation of the effect of repeat cesarean sections in adolescent pregnancies on the morbidity, obstetric and perinatal results. Materials and methods: We reviewed the patient file and hospital records of patients who underwent at least one cesarean section among adolescent age group pregnant women who gave birth at our clinic between January 2010 and May 2013. The patients were divided into two groups as the patients who underwent the second cesarean section (116 patients) and those who underwent the third cesarean section (36 patients). The demographic data, maternal data and obstetric and perinatal results of the patients were evaluated. Results: A significant difference was present between the patients in the evaluation of the total number of examinations during pregnancy (P = 0.001), total maternal weight gain during pregnancy (P = 0.006), and the first examination gestational age (P = 0.006) and all values were less favorable in the third cesarean group. The gestational week at birth (P < 0.001), birth weight (P < 0.001), and APGAR score (P < 0.001) in the group with the third cesarean section were statistically significantly lower than the second cesarean section. The third cesarean cesarean was found to cause a significant risk increase for placenta accreta risk in adolescent pregnancies (P = 0.042). Conclusion: The increasing number of cesarean sections in the adolescent group is seen to be a significant risk factor for low gestational week of birth, low birth weight and related morbidities. The most important reason for the increased morbidity with increasing cesarean sections in the adolescent age has been defined as placenta accreta. PMID:25664081

The Brazilian Preference: Cesarean Delivery among Immigrants in Portugal

PubMed Central

Teixeira, Cristina; Correia, Sofia; Victora, César G.; Barros, Henrique

2013-01-01

Objective To evaluate how the country of origin affects the probability of being delivered by cesarean section when giving birth at public Portuguese hospitals. Study Design Women delivered of a singleton birth (n = 8228), recruited from five public level III maternities (April 2005–August 2006) during the procedure of assembling a birth cohort, were classified according to the country of origin and her migration status as Portuguese (n = 7908), non-Portuguese European (n = 84), African (n = 77) and Brazilian (n = 159). A Poisson model was used to evaluate the association between country of birth and cesarean section that was measured by adjusted prevalence ratio (PR) and respective 95% confidence intervals (95%CI). Results The cesarean section rate varied from 32.1% in non-Portuguese European to 48.4% in Brazilian women (p = 0.008). After adjustment for potential confounders and compared to Portuguese women as a reference, Brazilian women presented significantly higher prevalence of cesarean section (PR = 1.26; 95%CI: 1.08–1.47). The effect was more evident among multiparous women (PR = 1.39; 95%CI: 1.12–1.73) and it was observed when cesarean section was performed either before labor (PR = 1.43; 95%CI: 0.99–2.06) or during labor (PR = 1.30; 95%CI: 1.07–1.58). Conclusions The rate of cesarean section was significantly higher among Brazilian women and it was independent of the presence of any known risk factors or usual clinical indications, suggesting that cultural background influences the mode of delivery overcoming the expected standard of care and outcomes in public health services. PMID:23555912

Care during the decision-making phase for women who want a vaginal breech birth: Experiences from the field.

PubMed

Catling, C; Petrovska, K; Watts, N P; Bisits, A; Homer, C S E

2016-03-01

few women are given the option of a vaginal breech birth in Australia, unless the clinicians feel confident and have the skills to facilitate this mode of birth. Few studies describe how clinicians provide care during the decision-making phase for women who choose a vaginal breech birth. The aim of this study was to explore how experienced clinicians facilitated decisions about external cephalic version and mode of birth for women who have a breech presentation. a descriptive exploratory design was undertaken with nine experienced clinicians (obstetricians and midwives) from two tertiary hospitals in Australia. Data were collected through face to face interviews and analysed thematically. five obstetricians and four midwives participated in this study. All were experienced in caring for women having a vaginal breech birth and were currently involved in providing such a service. The themes that arose from the data were: Pitching the discussion, Discussing safety and risk, Being calm and Providing continuity of care. caring for women who seek a vaginal breech birth includes careful selection of appropriate women, full discussions outlining the risks involved, and undertaking care with a calm manner, ensuring continuity of care. Health services considering establishing a vaginal breech service should consider that these elements are included in the establishment and implementation processes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Vaginal birth after caesarean section prediction models: a UK comparative observational study.

PubMed

Mone, Fionnuala; Harrity, Conor; Mackie, Adam; Segurado, Ricardo; Toner, Brenda; McCormick, Timothy R; Currie, Aoife; McAuliffe, Fionnuala M

2015-10-01

Primarily, to assess the performance of three statistical models in predicting successful vaginal birth in patients attempting a trial of labour after one previous lower segment caesarean section (TOLAC). The statistically most reliable models were subsequently subjected to validation testing in a local antenatal population. A retrospective observational study was performed with study data collected from the Northern Ireland Maternity Service Database (NIMATs). The study population included all women that underwent a TOLAC (n=385) from 2010 to 2012 in a regional UK obstetric unit. Data was collected from the Northern Ireland Maternity Service Database (NIMATs). Area under the curve (AUC) and correlation analysis was performed. Of the three prediction models evaluated, AUC calculations for the Smith et al., Grobman et al. and Troyer and Parisi Models were 0.74, 0.72 and 0.65, respectively. Using the Smith et al. model, 52% of women had a low risk of caesarean section (CS) (predicted VBAC >72%) and 20% had a high risk of CS (predicted VBAC <60%), of whom 20% and 63% had delivery by CS. The fit between observed and predicted outcome in this study cohort using the Smith et al. and Grobman et al. models were greatest (Chi-square test, p=0.228 and 0.904), validating both within the population. The Smith et al. and Grobman et al. models could potentially be utilized within the UK to provide women with an informed choice when deciding on mode of delivery after a previous CS. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

Effectiveness of vaginal breech birth training strategies: An integrative review of the literature.

PubMed

Walker, Shawn; Breslin, Eamonn; Scamell, Mandie; Parker, Pam

2017-06-01

The safety of vaginal breech birth depends on the skill of the attendant. The objective of this review was to identify, synthesize, and report the findings of evaluated breech birth training strategies. A systematic search of the following on-line databases: Medline, CINAHL Plus, PsychINFO, EBM Reviews/Cochrane Library, EMBASE, Maternity and Infant Care, and Pubmed, using a structured search strategy. Studies were included in the review if they evaluated the efficacy of a breech birth training program or particular strategies, including obstetric emergency training evaluations that reported differentiated outcomes for breech. Out of 1040 original citings, 303 full-text articles were assessed for eligibility, and 17 methodologically diverse studies met the inclusion criteria. A data collection form was used to extract relevant information. Data were synthesized, using an evaluation levels framework, including reaction, learning (subjective and objective assessment), and behavioral change. No evaluations included clinical outcome data. Improvements in self-assessed skill and confidence were not associated with improvements in objective assessments or behavioral change. Inclusion of breech birth as part of an obstetric emergencies training package without support in practice was negatively associated with subsequent attendance at vaginal breech births. As a result of the heterogeneity of the studies available, and the lack of evidence concerning neonatal or maternal outcomes, no conclusive practice recommendations can be made. However, the studies reviewed suggest that vaginal breech birth training may be enhanced by reflection, repetition, and experienced clinical support in practice. Further evaluation studies should prioritize clinical outcome data. © 2017 Wiley Periodicals, Inc.

Changes in Cesarean Delivery Rates by Gestational Age: United States, 1996-2011

MedlinePlus

... cesarean delivery rate : Number of births in multiple pregnancies delivered by cesarean per 100 multiple births. Gestational age categories Early preterm : Births prior to 34 completed weeks of ...

[Prevention of gastroesophageal reflux and aspiration in neonates by holding with hands immediately after delivery by cesarean section].

PubMed

Guo, Hui-Ping; Li, Hui; Guo, Jing; Li, Yan-Wen

2002-04-01

To evaluate the clinical effect of preventing gastroesophageal reflux (GER) and aspiration in neonates delivered by elective cesarean section with hand immediately after birth. On the basis of the principles for drowning resuscitation and evaluation of the principal factors causing GER and aspiration, the author adopted immediate manual management to promote emptying of gastroesophageal and airway contents in 496 newborns delivered by elective cesarean section. No GER and aspiration occurred in the babies receiving the management, and no complication was recorded. As an early preventive measure, manual management is effective in clearing gastroesophageal and airway contents against GER and aspiration, and Apgar scoring can be readily conducted.

Trends in Maternity Care Practice Skin-to-Skin Contact Indicators: United States, 2007-2015.

PubMed

Boundy, Ellen O; Perrine, Cria G; Barrera, Chloe M; Li, Ruowei; Hamner, Heather C

2018-05-21

Mother-infant skin-to-skin contact (SSC) immediately after birth helps transition infants to the post-uterine environment and increases the likelihood of breastfeeding initiation and duration. This study examines trends in U.S. maternity practices related to SSC, and variations by facility demographics. Data were from the Maternity Practices in Infant Nutrition and Care (mPINC) surveys (2007-2015), a biennial assessment of all U.S. maternity facilities. Facilities reported how often patients were encouraged to practice mother-infant SSC for ≥30 minutes within 1 hour of uncomplicated vaginal birth and 2 hours of uncomplicated cesarean birth, and how often routine infant procedures are performed while in SSC. We calculated the percentage of maternity facilities reporting these indicators for ≥90% of patients across the United States for each survey year. Estimates by facility characteristics (size, type, and state) were calculated for 2015 only. The percentage of facilities reporting "Most (≥90%)" women, which were encouraged to practice early SSC, increased from 2007 to 2015 following both vaginal (40.4% to 83.0%) and cesarean (29.3% to 69.9%) births. The percentage of facilities reporting routine infant procedures were performed "Almost always (≥90%)," while mother and infant were SSC increased from 16.6% to 49.5% (2007 to 2015) for vaginal births and from 2.2% to 10.7% (2009 to 2015) for cesarean births. Variations in SSC practice by facility type, size, and state were noted. Significant progress has been made in increasing hospital encouragement of early SSC for both vaginal and cesarean births. Continued efforts to support evidence-based maternity practices are needed.

Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities.

PubMed

Flick, Randall P; Lee, Kunmoo; Hofer, Ryan E; Beinborn, Charles W; Hambel, Ellen M; Klein, Melissa K; Gunn, Paul W; Wilder, Robert T; Katusic, Slavica K; Schroeder, Darrell R; Warner, David O; Sprung, Juraj

2011-06-01

In prior work, children born to mothers who received neuraxial anesthesia for cesarean delivery had a lower incidence of subsequent learning disabilities compared with vaginal delivery. The authors speculated that neuraxial anesthesia may reduce stress responses to delivery, which could affect subsequent neurodevelopmental outcomes. To further explore this possibility, we examined the association between the use of neuraxial labor analgesia and development of childhood learning disabilities in a population-based birth cohort of children delivered vaginally. The educational and medical records of all children born to mothers residing in the area of 5 townships of Olmsted County, Minnesota from 1976 to 1982 and remaining in the community at age 5 years were reviewed to identify those with learning disabilities. Cox proportional hazards regression was used to compare the incidence of learning disabilities between children delivered vaginally with and without neuraxial labor analgesia, including analyses adjusted for factors of either potential clinical relevance or that differed between the 2 groups in univariate analysis. Of the study cohort, 4684 mothers delivered children vaginally, with 1495 receiving neuraxial labor analgesia. The presence of childhood learning disabilities in the cohort was not associated with use of labor neuraxial analgesia (adjusted hazard ratio, 1.05; 95%confidence interval, 0.85-1.31; P = 0.63). The use of neuraxial analgesia during labor and vaginal delivery was not independently associated with learning disabilities diagnosed before age 19 years. Future studies are needed to evaluate potential mechanisms of the previous finding indicating that the incidence of learning disabilities is lower in children born to mothers via cesarean delivery under neuraxial anesthesia compared with vaginal delivery.

Caesarean section on demand: influence of personal birth experience and working environment on attitude of German gynaecologists.

PubMed

Faas-Fehervary, Patricia; Schwarz, Kai; Bauer, Lelia; Melchert, Frank

2005-10-01

We performed a survey among German obstetricians and gynecologists in order to evaluate the influence of biographic data, working environment and personal birth experience on the attitude towards Cesarean Section on demand. All 2106 board-certified gynecologists in Baden-Württemberg received an anonymous questionnaire in 2002-2003 concerning attitude towards C-section on demand, biographical data, personal birth experience and working environment. Seven hundred and nineteen questionnaires were returned and entered into statistical analysis. General approval of C-section was in 59% of all participants, with huge statistically significant variations according to age, personal birth experience and working field. When asked for their preferred way of delivery for themselves or their partner after a low-risk pregnancy, 90% of the responding gynecologists opted for vaginal delivery. The approval depended statistically significant on parenthood, personal birth experience and working environment. Biographical data, personal birth experience and working environment influence the attitude towards elective Cesaran section. Although 90% would chose vaginal delivery for themselves or their partner as best medical practice, 59% of the physicians approve of the general opportunity of C-section on demand. This shows, that not only best medical practice, but also patient autonomy and forensic aspects seem to play an important role.

What about the Misgav-Ladach surgical technique in patients with previous cesarean sections?

PubMed

Bolze, Pierre-Adrien; Massoud, Mona; Gaucherand, Pascal; Doret, Muriel

2013-03-01

The Misgav-Ladach technique is recommended worldwide to perform cesarean sections but there is no consensus about the appropriate technique to use in patients with previous cesarean sections. This study evaluated the feasibility of the Misgav-Ladach technique in patients with previous cesarean sections. This prospective cohort study included all women undergoing cesarean section after 36 weeks of gestation over a 5-month period, with the Misgav-Ladach technique as first choice, whatever the previous number of cesarean sections. Among the 204 patients included, the Misgav-Ladach technique was successful in 100%, 80%, and 65.6% of patients with no, one, and multiple previous cesarean sections, respectively. When successful, the Misgav-Ladach technique was associated with a shorter incision to birth interval in patients with no previous cesarean section compared with patients with one or multiple previous cesarean sections. Anterior rectus aponeurosis fibrosis and severe peritoneal adherences were the two main reasons explaining the Misgav-Ladach technique failure. The Misgav-Ladach technique is possible in over three-fourths of patients with previous cesarean sections with a slight increase in incision to birth interval compared with patients without previous cesarean section. Further studies comparing the Misgav-Ladach and the Pfannenstiel techniques in women with previous cesarean should be done. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Neonatal Microbiome and Its Partial Role in Mediating the Association between Birth by Cesarean Section and Adverse Pediatric Outcomes.

PubMed

Montoya-Williams, Diana; Lemas, Dominick J; Spiryda, Lisa; Patel, Keval; Carney, O'neshia Olivia; Neu, Josef; Carson, Tiffany L

2018-05-22

Cesarean sections (CS) are among the most commonly performed surgical procedures in the world. Epidemiologic data has associated delivery by CS with an increased risk of certain adverse health outcomes in children, such as asthma and obesity. To explore what is known about the effect of mode of delivery on the development of the infant microbiome and discuss the potentially mediating role of CS-related microbial dysbiosis in the development of adverse pediatric health outcomes. Recommendations for future inquiry are also provided. This study provides a narrative overview of the literature synthesizing the findings of literature retrieved from searches of PubMed and other computerized databases and authoritative texts. Emerging evidence suggests that mode of delivery is involved in the development of the neonatal microbiome and may partially explain pediatric health outcomes associated with birth by CS. Specifically, the gut microbiome of vaginally delivered infants more closely resembles their mothers' vaginal microbiome and thus more commonly consists of potentially beneficial microbiota such as Lactobacillus, Bifidobacterium, and Bacteroides. Conversely, the microbiome of infants born via CS shows an increased prevalence of either skin flora or potentially pathogenic microbial communities such as Klebsiella, Enterococcus, and Clostridium. Mode of delivery plays an important role in the development of the postnatal microbiome but likely tells only part of the story. More comprehensive investigations into all the pre- and perinatal factors that have the potential to contribute to the neonatal microbiome are warranted. © 2018 S. Karger AG, Basel.

Perinatal mortality in second- vs firstborn twins: a matter of birth size or birth order?

PubMed

Luo, Zhong-Cheng; Ouyang, Fengxiu; Zhang, Jun; Klebanoff, Mark

2014-08-01

Second-born twins on average weigh less than first-born twins and have been reported at an elevated risk of perinatal mortality. Whether the risk differences depend on their relative birth size is unknown. The present study aimed to evaluate the association of birth order with perinatal mortality by birth order-specific weight difference in twin pregnancies. In a retrospective cohort study of 258,800 twin pregnancies without reported congenital anomalies using the US matched multiple birth data 1995-2000 (the available largest multiple birth dataset), conditional logistic regression was applied to estimate the odds ratio (OR) of perinatal death adjusted for fetus-specific characteristics (sex, presentation, and birthweight for gestational age). Comparing second vs first twins, the risks of perinatal death were similar if they had similar birthweights (within 5%) and were increasingly higher if second twins weighed progressively less (adjusted ORs were 1.37, 1.90, and 3.94 if weighed 5.0-14.9%, 15.0-24.9%, and ≥25.0% less, respectively), and progressively lower if they weighed increasingly more (adjusted ORs were 0.67, 0.63, and 0.36 if weighed 5.0-14.9%, 15.0-24.9%, and ≥25.0% more, respectively) (all P < .001). The perinatal mortality rates were not significantly different in cesarean deliveries or preterm (<37 weeks) vaginal deliveries but were significantly higher in second twins in term vaginal deliveries (3.1 vs 1.8 per 1000; adjusted OR, 2.15; P < .001). Perinatal mortality risk differences in second vs first twins depend on their relative birth size. Vaginal delivery at term is associated with a substantially greater risk of perinatal mortality in second twins. Copyright © 2014 Mosby, Inc. All rights reserved.

[Quality of birth care in maternity hospitals of Rio de Janeiro, Brazil].

PubMed

d'Orsi, Eleonora; Chor, Dóra; Giffin, Karen; Angulo-Tuesta, Antonia; Barbosa, Gisele Peixoto; Gama, Andrea de Souza; Reis, Ana Cristina; Hartz, Zulmira

2005-08-01

To evaluate the quality of birth care based on the World Health Organization guidelines. A case-control study was carried out in a public and a private maternity hospitals contracted by the Brazilian Health System in the city of Rio de Janeiro, Brazil, from October 1998 to March 1999. The sample comprised 461 women in the public maternity hospital (230 vaginal deliveries and 231 Cesarean sections) and 448 women in the private one (224 vaginal deliveries and 224 Cesarean sections). Data was collected through interviews with puerperal women and review of medical records. A summarization score of quality of delivery care was constructed. There was low frequency of practices that should be encouraged, such as having an accompanying person (1% in the private hospital for both vaginal delivery and C-sections), freedom of movements throughout labor (9.6% of C-sections in the public hospital and 9.9% of vaginal deliveries in the private hospital) and breastfeeding in the delivery room (6.9% of C-sections in the public hospital and 8.0% of C-sections in the private hospital). There was a high frequency of known harmful practices such as enema administration (38.4%); routine pubic shaving; routine intravenous infusion (88.8%); routine use of oxytocin (64.4%), strict bed rest throughout labor (90.1%) and routine supine position in labor (98.7%) in vaginal deliveries. The best summarizing scores were seen in the public maternity hospital. The two maternity hospitals have a high frequency of interventions during birth care. In spite of providing care to higher risk pregnant women, the public maternity hospital has a less interventionist profile than the private one. Procedures carried out on a routine basis should be pondered based on evidence of their benefits.

Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography.

PubMed

Thurmond, A S; Harvey, W J; Smith, S A

1999-01-01

A previously undescribed cause of abnormal uterine bleeding is presented. Nine of 310 women evaluated by sonohysterography for abnormal bleeding demonstrated an 8 to 17 mm gap in the anterior lower uterine segment myometrium at the site of prior cesarean deliveries. All women were premenopausal and had a history of 2 to 12 days of postmenstrual spotting. Presumably a lack of coordinated muscular contractions occurs around the cesarean scar, allowing the defect to collect menstrual debris. Subsequently, the debris leaches out through the cervix for several days after the majority of menstrual flow has ceased.

Low birth weight,very low birth weight rates and gestational age-specific birth weight distribution of korean newborn infants.

PubMed

Shin, Son-Moon; Chang, Young-Pyo; Lee, Eun-Sil; Lee, Young-Ah; Son, Dong-Woo; Kim, Min-Hee; Choi, Young-Ryoon

2005-04-01

To obtain the low birth weight (LBW) rate, the very low birth weight (VLBW) rate, and gestational age (GA)-specific birth weight distribution based on a large population in Korea, we collected and analyzed the birth data of 108,486 live births with GA greater than 23 weeks for 1 yr from 1 January to 31 December 2001, from 75 hospitals and clinics located in Korea. These data included birth weight, GA, gender of the infants, delivery type, maternal age, and the presence of multiple pregnancy. The mean birth weight and GA of a crude population are 3,188 +/-518 g and 38.7+/-2.1 weeks, respectively. The LBW and the VLBW rates are 7.2% and 1.4%, respectively. The preterm birth rate (less than 37 completed weeks of gestation) is 8.4% and the very preterm birth rate (less than 32 completed weeks of gestation) is 0.7%. The mean birth weights for female infants, multiple births, and births delivered by cesarean section were lower than those for male, singletons, and births delivered vaginally. The risk of delivering LBW or VLBW infant was higher for the teenagers and the older women (aged 35 yr and more). We have also obtained the percentile distribution of GA-specific birth weight in infants over 23 weeks of gestation.

Risk of vaginal bleeding and postpartum hemorrhage after use of antidepressants in pregnancy: a study from the Norwegian Mother and Child Cohort Study.

PubMed

Lupattelli, Angela; Spigset, Olav; Koren, Gideon; Nordeng, Hedvig

2014-02-01

This study aimed to examine obstetric bleeding outcomes after exposure during pregnancy to selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic (TCAs), and other antidepressants (OADs).The Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway constituted the data source for the present study. We included 57,279 pregnant women, of which 1.02% reported use of antidepressants during pregnancy, mostly SSRIs/SNRIs (0.92%). We categorized exposure according to antidepressant use in pregnancy (SSRIs/SNRIs, n = 527; TCAs/OADs, n = 59; nonexposed, nondepressed, n = 55,411) with inclusion of a disease comparison group (nonexposed, depressed, n = 1282). We used logistic regression to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI) for vaginal bleeding outcomes in pregnancy and postpartum hemorrhage.Compared with nonexposed subjects, first trimester exposure to SSRIs/SNRIs or TCAs/OADs did not confer any increased risk of vaginal bleeding in early pregnancy (aOR, 0.91; 95% CI, 0.72-1.16 and aOR, 0.83; 95% CI, 0.36-1.92, respectively). No increased risk for vaginal bleeding in midpregnancy was observed among users of SSRIs/SNRIs (aOR, 0.81; 95% CI, 0.50-1.31) or TCAs/OADs (aOR, 0.96; 95% CI, 0.26-3.53) in second trimester. Exposure to SSRIs/SNRIs during gestational week 30 to childbirth did not confer any increased risk of postpartum hemorrhage after vaginal (aOR, 0.90; 95% CI, 0.47-1.74) or cesarean (aOR, 1.47; 95% CI, 0.51-4.22) delivery. Women in the disease comparison group presented a significant moderate increased risk of vaginal bleeding in early pregnancy (aOR, 1.22; 95% CI, 1.06-1.39) and midpregnancy (aOR, 1.28; 95% CI, 1.07-1.55) but not postpartum.Among this Norwegian cohort of pregnant women, use of antidepressants in pregnancy was not associated with any obstetrical bleeding outcome.

Levator Ani Muscle Stretch Induced by Simulated Vaginal Birth

PubMed Central

Lien, Kuo-Cheng; Mooney, Brian; DeLancey, John O. L.; Ashton-Miller, James A.

2005-01-01

OBJECTIVE: To develop a three-dimensional computer model to predict levator ani muscle stretch during vaginal birth. METHODS: Serial magnetic resonance images from a healthy nulliparous 34-year-old woman, published anatomic data, and engineering graphics software were used to construct a structural model of the levator ani muscles along with related passive tissues. The model was used to quantify pelvic floor muscle stretch induced during the second stage of labor as a model fetal head progressively engaged and then stretched the iliococcygeus, pubococcygeus, and puborectalis muscles. RESULTS: The largest tissue strain reached a stretch ratio (tissue length under stretch/original tissue length) of 3.26 in medial pubococcygeus muscle, the shortest, most medial and ventral levator ani muscle. Regions of the ileococcygeus, pubococcygeus, and puborectalis muscles reached maximal stretch ratios of 2.73, 2.50, and 2.28, respectively. Tissue stretch ratios were proportional to fetal head size: For example, increasing fetal head diameter by 9% increased medial pubococcygeus stretch by the same amount. CONCLUSION: The medial pubococcygeus muscles undergo the largest stretch of any levator ani muscles during vaginal birth. They are therefore at the greatest risk for stretch-related injury. PMID:14704241

Episiotomy for vaginal birth

PubMed Central

Carroli, Guillermo; Mignini, Luciano

2014-01-01

Background Episiotomy is done to prevent severe perineal tears, but its routine use has been questioned. The relative effects of midline compared with midlateral episiotomy are unclear. Objectives The objective of this review was to assess the effects of restrictive use of episiotomy compared with routine episiotomy during vaginal birth. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (March 2008). Selection criteria Randomized trials comparing restrictive use of episiotomy with routine use of episiotomy; restrictive use of mediolateral episiotomy versus routine mediolateral episiotomy; restrictive use of midline episiotomy versus routine midline episiotomy; and use of midline episiotomy versus mediolateral episiotomy. Data collection and analysis The two review authors independently assessed trial quality and extracted the data. Main results We included eight studies (5541 women). In the routine episiotomy group, 75.15% (2035/2708) of women had episiotomies, while the rate in the restrictive episiotomy group was 28.40% (776/2733). Compared with routine use, restrictive episiotomy resulted in less severe perineal trauma (relative risk (RR) 0.67, 95% confidence interval (CI) 0.49 to 0.91), less suturing (RR 0.71, 95% CI 0.61 to 0.81) and fewer healing complications (RR 0.69, 95% CI 0.56 to 0.85). Restrictive episiotomy was associated with more anterior perineal trauma (RR 1.84, 95% CI 1.61 to 2.10). There was no difference in severe vaginal/perineal trauma (RR 0.92, 95% CI 0.72 to 1.18); dyspareunia (RR 1.02, 95% CI 0.90 to 1.16); urinary incontinence (RR 0.98, 95% CI 0.79 to 1.20) or several pain measures. Results for restrictive versus routine mediolateral versus midline episiotomy were similar to the overall comparison. Authors’ conclusions Restrictive episiotomy policies appear to have a number of benefits compared to policies based on routine episiotomy. There is less posterior perineal trauma, less suturing and

The differences between pregnant women who request elective caesarean and those who plan for vaginal birth based on Health Belief Model.

PubMed

Darsareh, Fatemeh; Aghamolaei, Teamur; Rajaei, Minoo; Madani, Abdoulhossain; Zare, Shahram

2016-12-01

Although vaginal birth is the safest type of childbirth, sometimes caesarean is necessary for the safety of the mother or the infant. The problem is that low-risk, healthy women are choosing caesarean as a birth option despite the fact that it is fraught with possible complications. To determine the differences and identify the predictors for the way women plan their childbirth based on Health Belief Model. A cross-sectional study was conducted in Bandar abbas city, Iran, from May to October 2015. The study recruited eligible women who self identified themselves as requesting a caesarean or vaginal birth in their response to a questionnaire. Of 470 recruited women, 183 (38.9%) planned to have a caesarean without medical indication. Maternal characteristics (age, level of education, occupational status, involvement in a medical profession, and household income) and obstetric variables (health provider type, place of prenatal care, and the number of children planned for the future) influenced the decisions made by the women. There was a significant difference between women planning a caesarean and those planning vaginal birth in terms of childbirth knowledge. Significant differences were observed regarding maternal self-efficacy, with women planning a caesarean reporting significantly lower self-efficacy than women planning a vaginal birth. Women planning a caesarean birth were also significantly less likely to perceive themselves as being at risk for caesarean-related side effects than women planning a vaginal birth. Comprehensive childbirth knowledge can lead to positive maternal attitude towards vaginal birth and may improve birth confidence. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Mode of Delivery in Previable Births.

PubMed

Rossi, Robert M; DeFranco, Emily A

2018-06-08

 Preterm birth before 23 weeks of gestation typically results in neonatal death (5% survival). Society for Maternal-Fetal Medicine and American College of Obstetricians and Gynecologists published consensus guidelines recommending cesarean delivery (CD) not be performed for fetal indications between 20 and 22 6/7 weeks given the lack of proven benefit. We sought to quantify the previable CD rate and identify characteristics associated with previable CD.  We performed a population-based retrospective cohort study of all live births in Ohio (2006-2015). Frequency of previable CD was stratified by week of gestation, defined as delivery between 16 and < 23 weeks of gestation. Maternal, obstetric, and neonatal characteristics were compared between women who underwent vaginal delivery versus CD. Multivariable logistic regression estimated the relative influence of maternal and fetal factors on the outcome of CD among previable live births.  Of 1,463,506 live births in Ohio during the 10-year study period, 2,865 births (0.2%) occurred during the previable period of 16 to 22 weeks. Nearly 1 in 10 live births at less than 23 weeks was delivered by cesarean ( n  = 273/2,865), CD rate 9.5% (95% confidence interval, 8.5-10.7). At 16 to 22 weeks of gestation, the CD rates were 0, 5.5, 7.6, 3.5, 5.4, 10.1, and 15.1%, respectively. Factors associated with CD included increasing parity, increasing birth weight, maternal corticosteroid administration, and fetal malpresentation. Previable neonates born by CD were more likely to be admitted to the NICU, receive ventilator support, and more likely to be living at the time of birth certificate filing.  Nearly 1 out of 10 births during the previable period was delivered via cesarean. Factors associated with previable CD suggest intent for neonatal interventions, such as NICU admission and supportive therapies. Our findings support that education and adherence with guidelines for care of previable births are a potential

Evaluating the content and quality of intrapartum care in vaginal births: An example of a state hospital.

PubMed

Karaçam, Zekiye; Arslan Kurnaz, Döndü; Güneş, Gizem

2017-03-01

The purpose of the research was to assess the content and quality of the intrapartum care offered in vaginal births in Turkey, based on the example of a state hospital. This cross-sectional study was conducted between January 1 st , 2013 and December 31 st , 2014 at Aydın Maternity and Children's Hospital. The study sample consisted of 303 women giving vaginal birth, who were recruited into the study using the method of convenience sampling. Research data were collected with a questionnaire created by the researchers and assessed using the Bologna score. Numbers and percentages were assessed in the data analysis. The mean age of the women was 25.14±5.37 years and 40.5% had given one live birth. Of the women, 45.2% were admitted to hospital in the latent phase, 76.6% were administered an enema, 3.3% had epidural anesthesia, 2.6% delivered using vacuum extraction, and 54.1% underwent an episiotomy. Some 23.8% of the women experienced spontaneous laceration that needed sutures. The babies of two women exhibited an Apgar score below 7 in the fifth minute. When the quality of the intrapartum care given to the women was assessed with the Bologna score, it was found that 92.7% went into labor spontaneously, 100% of the births were supervised by midwives and doctors, 97.7% of the women had no supporting companion, and the nonsupine position was only used in 0.3% of the women. A partogram was used to follow up on the birth process in 72.6% of the women, and 82.5% achieved contact with their babies within the first hour after birth. Induction was applied in 76.6% of the women and fundal pressure in 27.4%. The study revealed that the quality of intrapartum care in vaginal births was inadequate. Reformulating the guidelines regarding intrapartum care in accordance with World Health Organization recommendations and evidence-based practices may contribute to improving mother and infant health.

VAGINAL PROGESTERONE VERSUS CERVICAL CERCLAGE FOR THE PREVENTION OF PRETERM BIRTH IN WOMEN WITH A SONOGRAPHIC SHORT CERVIX, SINGLETON GESTATION, AND PREVIOUS PRETERM BIRTH: A SYSTEMATIC REVIEW AND INDIRECT COMPARISON META-ANALYSIS

PubMed Central

CONDE-AGUDELO, Agustin; ROMERO, Roberto; NICOLAIDES, Kypros; CHAIWORAPONGSA, Tinnakorn; O'BRIEN, John M.; CETINGOZ, Elcin; DA FONSECA, Eduardo; CREASY, George; SOMA-PILLAY, Priya; FUSEY, Shalini; CAM, Cetin; ALFIREVIC, Zarko; HASSAN, Sonia S.

2012-01-01

OBJECTIVE No randomized controlled trial has directly compared vaginal progesterone and cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix in the midtrimester, singleton gestation, and previous spontaneous preterm birth. We performed an indirect comparison of vaginal progesterone versus cerclage, using placebo/no cerclage as the common comparator. STUDY DESIGN Adjusted indirect meta-analysis of randomized controlled trials. RESULTS Four studies evaluating vaginal progesterone versus placebo (158 patients) and five evaluating cerclage versus no cerclage (504 patients) were included. Both interventions were associated with a statistically significant reduction in the risk of preterm birth <32 weeks of gestation and composite perinatal morbidity and mortality compared with placebo/no cerclage. Adjusted indirect meta-analyses did not show statistically significant differences between vaginal progesterone and cerclage in reducing preterm birth or adverse perinatal outcomes. CONCLUSION Based on state-of-the-art methodology for indirect comparisons, either vaginal progesterone or cerclage are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the midtrimester, singleton gestation, and previous preterm birth. The selection of the optimal treatment may depend upon adverse events, cost and patient/clinician preferences. PMID:23157855

Uteroabdominal Wall Fistula After Cesarean Section in a Patient With Prior Colorectal Resection for Endometriosis: A Case Report and Systematic Review.

PubMed

Chattot, Chloé; Aristizabal, Patrick; Bendifallah, Sofiane; Daraï, Emile

Uteroabdominal wall fistula (UAWF) is a very rare complication of cesarean section. We report an unusual case of a UAWF occurring in a 37-year-old woman 4 years after a cesarean section and previous radical surgery for deep infiltrating endometriosis with bowel resection. The patient presented with persistent purulent discharge of the Pfannenstiel scar and noted that the discharge was blood stained during menstruation. Magnetic resonance imaging confirmed the diagnosis of UAWF. Surgery was performed by laparotomy and was complicated by a postoperative rectovaginal fistula, which was successfully treated by the placement of a biological mesh via the vagina route. The postoperative course was favorable at 6 months with disappearance of painful symptoms and good quality of the colorectal anastomosis. A systematic review was conducted, and 18 case reports were found from 1939 to 2016. This case report highlights the risk of postdelivery complications in women with deep infiltrating endometriosis and colorectal involvement, especially after cesarean section. Persistent abdominal discharge in this context should suggest a diagnosis of UAWF despite its low incidence. Finally, the vaginal route for rectovaginal fistula might be considered an option for patients with prior multiple laparotomies. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

Misrecognition of need: women's experiences of and explanations for undergoing cesarean delivery.

PubMed

Tully, Kristin P; Ball, Helen L

2013-05-01

providers in a variety of vaginal delivery scenarios (non-progressive labor, breech presentation, and/or after previous cesarean). Copyright © 2013 Elsevier Ltd. All rights reserved.

Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review.

PubMed

Lundgren, Ingela; Smith, Valerie; Nilsson, Christina; Vehvilainen-Julkunen, Katri; Nicoletti, Jane; Devane, Declan; Bernloehr, Annette; van Limbeek, Evelien; Lalor, Joan; Begley, Cecily

2015-02-05

The number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC. The bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, 'Effective Public Health Practice Project'. The primary outcome measure was VBAC rates. 238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates. This systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were

The effect of delaying childbirth on primary cesarean section rates.

PubMed

Smith, Gordon C S; Cordeaux, Yolande; White, Ian R; Pasupathy, Dharmintra; Missfelder-Lobos, Hannah; Pell, Jill P; Charnock-Jones, D Stephen; Fleming, Michael

2008-07-01

The relationship between population trends in delaying childbirth and rising rates of primary cesarean delivery is unclear. The aims of the present study were (1) to characterize the association between maternal age and the outcome of labor, (2) to determine the proportion of the increase in primary cesarean rates that could be attributed to changes in maternal age distribution, and (3) to determine whether the contractility of uterine smooth muscle (myometrium) varied with maternal age. We utilized nationally collected data from Scotland, from 1980 to 2005, and modeled the risk of emergency cesarean section among women delivering a liveborn infant in a cephalic presentation at term. We also studied isolated myometrial strips obtained from 62 women attending for planned cesarean delivery in Cambridge, England, from 2005 to 2007. Among 583,843 eligible nulliparous women, there was a linear increase in the log odds of cesarean delivery with advancing maternal age from 16 y upwards, and this increase was unaffected by adjustment for a range of maternal characteristics (adjusted odds ratio for a 5-y increase 1.49, 95% confidence interval [CI] 1.48-1.51). Increasing maternal age was also associated with a longer duration of labor (0.49 h longer for a 5-y increase in age, 95% CI 0.46-0.51) and an increased risk of operative vaginal birth (adjusted odds ratio for a 5-y increase 1.49, 95% CI 1.48-1.50). Over the period from 1980 to 2005, the cesarean delivery rate among nulliparous women more than doubled and the proportion of women aged 30-34 y increased 3-fold, the proportion aged 35-39 y increased 7-fold, and the proportion aged > or =40 y increased 10-fold. Modeling indicated that if the age distribution had stayed the same over the period of study, 38% of the additional cesarean deliveries would have been avoided. Similar associations were observed in multiparous women. When studied in vitro, increasing maternal age was associated with reduced spontaneous activity and

Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys

PubMed Central

Campbell, Oona M. R.; Cegolon, Luca; Macleod, David; Benova, Lenka

2016-01-01

Background Following childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants. Methods and Findings We described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” (<24 h for vaginal deliveries and <72 h for cesarean-section deliveries). Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries. Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation. Conclusions Length of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough

Changes in the cesarean section rate in Korea (1982-2012) and a review of the associated factors.

PubMed

Chung, Sung-Hoon; Seol, Hyun-Joo; Choi, Yong-Sung; Oh, Soo-Young; Kim, Ahm; Bae, Chong-Woo

2014-10-01

Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary.

Delivery modes and pregnancy outcomes of low birth weight infants in China.

PubMed

Chen, Y; Wu, L; Zhang, W; Zou, L; Li, G; Fan, L

2016-01-01

To investigate and analyze the perinatal outcomes of low birth weight (LBW) infants, thereby selecting the appropriate mode and suitable time of delivery to improve the adverse pregnancy outcomes. A retrospective analysis of 112,441 deliveries (from 39 hospitals of different levels in 14 provinces and autonomous regions in China throughout 2011) were performed in this study to further evaluate the modes of delivery and pregnancy outcomes of LBW infants. The rate of cesarean section, stillbirth, neonatal asphyxia and mortality of LBW were significantly higher than those of normal birth weight (NBW) infants (odds ratio, 1.24, 56.56, 57.27 and 10.40 times higher, respectively). Stratified analysis showed that adverse events were reduced with the increase in gestational weeks, especially at 34 to 36(+6) weeks. However, LBW infants still had higher risks of adverse events as compared with NBW infants. In particular, full-term LBW babies had a 23.81- and 26.06-fold higher risk of stillbirth and neonatal death as compared with term babies with NBW. In addition, the cesarean delivery rate was 1.24-fold higher for LBW babies than for NBW babies. With an increase in gestational age in LBW infants, the rate of cesarean section was also increased. The rates of stillbirth and neonatal mortality of full-term LBW infants who were delivered via cesarean section (0.5% and 1.0%, respectively) were significantly lower than in the vaginal-delivery group (5.2% and 6.9%, respectively). LBW is one of the causes of perinatal death and other adverse pregnancy outcomes and increases the rate of cesarean section. Individualized analysis according to gestational age and intrauterine fetal condition should be performed to extend the gestational age to at least 34 weeks before delivery, cesarean section is a relatively safe mode of delivery, but cannot completely eliminate complications. The key to improving mother and child outcomes is to strengthen pregnancy care and reduce low birth weight

[Breech presentation and vaginal delivery: evolution of acceptability by obstetricians and patients].

PubMed

Lagrange, E; Ab der Halden, M; Ughetto, S; Boda, C; Accoceberry, M; Neyrat, C; Houlle, C; Vendittelli, F; Laurichesse-Delmas, H; Jacquetin, B; Lémery, D; Gallot, D

2007-09-01

To investigate the influence of obstetrician and patient respectively on mode of delivery in case of breech presentation at term. This retrospective study included all women with a singleton pregnancy in a breech presentation delivered at term in a tertiary care maternity unit from January 1998 to December 2004. Mode of delivery was suggested by a score based on maternal age, parity, obstetrical past history, radiopelvimetry and cephalopelvic confrontation. The obstetrician was free to follow or not the score indication and patient's informed consent was required concerning the mode of delivery. Our main outcome measurements were mode of delivery and neonatal parameters. Two hundred cases were identified. Elective cesarean section increased progressively (from 52% in 1998 to 80% in 2004 [P=0,002]). Neonatal status and proportion of score in favour of vaginal birth remained stable during the study period. The rise in cesarean section rate was mainly due to patient's request (P=0,001) whereas the trend of obstetrician in favour of cesarean did not reach significance (P=0,3). The rise of elective cesarean section for term breech delivery in a maternity unit using a predefinite score is mainly induced by patient's request. This evolution has no effect on neonatal status.

Labor induction just after external cephalic version with epidural analgesia at term.

PubMed

Cuerva, Marcos J; Piñel, Carlos S; Caceres, Javier; Espinosa, Jose A

2017-06-01

To analyze the benefits of external cephalic version (ECV) with epidural analgesia at term and labor induction just after the procedure. This is a retrospective observational study with patients who did not want trying a breech vaginal delivery and decided trying an ECV with epidural analgesia at term and wanted labor induction or cesarean section after the procedure. We present the results of 40 ECV with epidural analgesia at term and labor induction or cesarean section just after the ECV. ECV succeeded in 26 out of 40 (65%) patients. Among the 26 successful ECV, 6 delivered by cesarean (23.1%). 20 patients delivered vaginally (76.9%; 50% of all patients). Considering that a high number of cesarean deliveries can be avoided, induction of labor after ECV with epidural analgesia at term can be considered after being discussed in selected patient. Copyright © 2017. Published by Elsevier B.V.

[The effect of breast massage at different time in the early period after cesarean section].

PubMed

Chu, J Y; Zhang, L; Zhang, Y J; Yang, M J; Li, X W; Sun, L L

2017-11-06

Objective: To evaluate the effect of breast massage at different time in the early period on maternal lactation after cesarean section. Methods: 80 women delivered by cesarean section were randomly selected from maternity ward of a hospital in Shandong province during Jan. 2013 to Jan. 2015; which were divided into four groups, with 20 patients in each. Three groups received 3 times of breast massage every 24 hoursbeginning from 2, 12 and 24 h after cesarean section, respectively. The control group didn't receive any breast massage. The starting time and status of lactation were observed and recorded after cesarean section. 5 ml venous blood sample was drawn from each patient respectively at 2 h before cesarean, 6, 12, 24, 48 and 72 h after cesarean to test the level of serum prolactin. The lactation status of each group was compared. Results: The P (50) ( P (25)- P (75)) of starting time of lactation of the three massage groups and control group were 3 (2-6) h, 4 (2-8) h, 4 (3-12) h and 4 (2-12) h, respectively, whose differences showed no statistical significance ( H =3.32, P= 0.345).The number of delivered women with adequate lactation 24 hours after cesarean was 10 in the group who received massage beginning from 2 h after cesarean; while the number was only 2 in the control group. The number of delivered women with adequate lactation 48 hours after cesarean was 18 in the group who received massage beginning from 2 h after cesarean; while the number was 8 in the control group. The differences showed statistical significances ( P values were 0.021 and 0.008, respectively). The serum prolactin level in the group of delivered women who received massage from 2 h after cesarean was separately (195.9±78.5), (176.0±96.5), (216.4±110.0), (190.0±56.8) and (184.8±69.6) μg/L at 2, 12, 24, 48 and 72 h after cesarean, which were significantly higher than those in the control group (which were (128.8±40.6), (127.3±66.8), (162.2±58.8), (145.1±64.7) and (141.7±49

Prevention of the first cesarean delivery.

PubMed

Spong, Catherine Y

2015-06-01

Education of providers and patients on the importance of vaginal delivery, for the current pregnancy as well as future pregnancies, is essential to reverse the current trend of primary cesareans. When discussing cesarean with patients, counseling should include the effect on subsequent pregnancy risks including the possibility of uterine rupture and placentation abnormalities. In addition, counseling must include the concept that normal labor takes time. Re-education on the natural process of labor, the importance of allowing the time needed, and patience with the duration of pregnancy and process of labor is essential. Published by Elsevier Inc.

Factors associated with cesarean delivery during labor in primiparous women assisted in the Brazilian Public Health System: data from a National Survey.

PubMed

Dias, Marcos Augusto Bastos; Domingues, Rosa Maria Soares Madeira; Schilithz, Arthur Orlando Corrêa; Nakamura-Pereira, Marcos; do Carmo Leal, Maria

2016-10-17

The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals. The analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with < 4 cm of dilatation, a decision late in pregnancy for CD, and the use of analgesia were associated with a greater risk for CD. Favorable advice for vaginal birth during antenatal care, induction of labor, and the use of any good practices during labor were protective factors for CD. The type of professional who attended birth was not significant in the final analyses, but bivariate analysis showed a higher use of good practices and a smaller proportion of epidural analgesia in women cared for by at least one nurse midwife. The CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns. Information and support for vaginal birth during antenatal care, avoiding

Antenatal use of a novel vaginal birth training device by term primiparous women in Singapore.

PubMed

Kok, J; Tan, K H; Koh, S; Cheng, P S; Lim, W Y; Yew, M L; Yeo, G S H

2004-07-01

To study the use, safety and effectiveness of a novel antenatal vaginal birth training device (EPI-NO) in primiparous women. Antenatal use of the EPI-NO vaginal birth trainer was prospectively studied in 31 primiparous booked patients who were delivered by obstetricians from July to December 2002 at the KK Women's and Children's Hospital. This was studied in relation to episiotomy rate, perineal trauma and analgesic requirements during the postpartum period. A patient questionnaire form was used to assess their perception of pain and how well they coped with its use. For comparison, perineal trauma was also studied retrospectively in 60 consecutive obstetrician-booked primiparous term patients who had normal vaginal delivery (NVD) and who did not use EPI-NO during the same study period. The mean length of usage was for 2.1 weeks (standard deviation [sd] 1.2 weeks). The mean frequency of use was 5.3 episodes per week (sd 2.1, range 1 to 7). There was no laceration and vaginal infection arising from its usage. There was a case of minimal bleeding post-usage. There were 20 (64.5 percent) NVDs, four (12.9 percent) forceps deliveries, five vacuum deliveries (16.1 percent) and two (6.5 percent) Caesarean sections. Of the 29 vaginal delivery cases, 19 (65.5 percent) had episiotomy, eight (27.6 percent) had lacerations, and two (6.9 percent) did not sustain laceration. The reasons for episiotomy in the 19 cases were nine cases of pending tearing of vagina/perineum, nine cases of instrumental vaginal deliveries, and one to shorten second stage. There was no third degree tear. 21 (67.7 percent) out of 30 required a painkiller. The majority of patients (17; 54.8 percent) appeared to be comfortable with the use of EPI-NO. All coped well with vaginal examination after using EPI-NO perineal training. Comparing among term primiparous NVD cases with (n value equals 20) and without (n value equals 60) EPI-NO, the perineal trauma rate (90.0 percent vs 96.6 percent, p value equals 0

Spontaneous vaginal delivery in the birth-chair versus in the conventional dorsal position: a matched controlled comparison.

PubMed

Scholz, H S; Benedicic, C; Arikan, M G; Haas, J; Petru, E

2001-09-17

The aim of the study was to assess the effect of a birth-chair on obstetric outcome. We reviewed the hospital records of 220 consecutive pregnant women who gave birth on a birth-chair at our institution. The control group consisted of 440 pregnant women who preceded and followed the index cases and who had spontaneous vaginal deliveries in the conventional dorsal supine position. The controls were matched for parity and for the attending mid-wife. Patients who delivered in the birth-chair had significantly lower rates of episiotomy and manual separation of the placenta. The umbilical blood cord pH was significantly higher in neonates of the birth-chair group. The duration of labour, rate of perineal and vaginal injury, Apgar scores and rate of admission to a neonatal intermediate care unit were not influenced by the mode of delivery. Our data support previous studies that a birth-chair delivery may be a safe alternative to conventional delivery in the supine position.

Trends in characteristics of women choosing contraindicated home births.

PubMed

Zafman, Kelly B; Stone, Joanne L; Factor, Stephanie H

2018-04-12

To characterize the American College of Obstetricians and Gynecologists (ACOG) contraindicated home births and the women who are receiving these births in hopes of identifying venues for intervention. The National Center for Health Statistics (NCHS) birth certificate records from 1990 to 2015 were used. "Planned home births" were defined as those births in which birthplace was coded as "residence" and birth attendant was coded as "certified nurse midwife (CNM)" or "other midwife". Contraindicated home births were defined as "planned home births" from 1990 to 2015 that had one or more of the ACOG risk factors for home births, which include vaginal birth after prior cesarean delivery (VBAC), breech presentation and multiple gestations. A review of trends in contraindicated home births from 1990 to 2015 suggests that they are increasing in number (481-1396) and as a percentage of total births (0.01%-0.04%, P<0.001). There has been an increase in the proportion of college-educated women (31%-51%, P<0.001). Most women receive prenatal care (>95%), which is most frequently initiated in the first trimester. The majority of home births were paid out-of-pocket (65%-69%). The increasing number of contraindicated home births in the United States requires public health action. Home births are likely a matter of choice rather than a lack of resources. It is unclear if women choose home births while knowing the risk or due to a lack of information. Prenatal education about contraindicated home births is possible, as almost all women receive prenatal care.

Induction of labor in grand multiparous women with previous cesarean delivery: how safe is this?

PubMed

Chibber, Rachana; Al-Harmi, Jehad; Foda, Mohamed; Mohammed K, Zeinab; Al-Saleh, Eyad; Mohammed, Asiya Tasneem

2015-02-01

To compare the outcome of induced and spontaneous labor in grand multiparous women with one previous lower segment cesarean section (CS), so that the safety of labor induction could be assessed. In 102 women (study group), labor was induced and the outcome was compared with 280 women (control group) who went into spontaneous labor. All 382 women were grand multiparous and had one previous CS. There were no significant difference in oxytocin augmentation, CS, scar dehiscence, fetal birth weight or apgar scores between groups. There was one neonatal death, two still births, one early neonatal death and one congenital malformation in the study group and this was not significant. There was no significant difference in vaginal birth in the study (80.9%) and the control group (83.8%). In this moderate-sized study, induction of labor may be a safe option in grand multiparous women, if there is no absolute induction for repeating CS.

Rational dissection of a high institutional cesarean section rate: an analysis using the Robson Ten Group Classification System.

PubMed

Tan, Jarrod K H; Tan, Eng Loy; Kanagalingan, Devendra; Tan, Lay Kok

2015-04-01

Cesarean section (CS) rates have risen far in excess of the optimal 15% recommended by the World Health Organization. The Robson Ten Group Classification System (TGCS) allows meaningful analysis of a CS rate. The aim of this study is to identify the leading patient categories contributing to our institution's CS rate. Prospective study of all women who delivered at the Singapore General Hospital from January 2008 to December 2011. The following data was recorded: parity, singleton/multiple pregnancy, previous CS, mode of labor onset and gestational age at delivery. CS rates were computed for each group, as well as their relative contribution to the overall CS rate. There were 6074 deliveries, in which 2011 (33.1%) women had CS delivery. Group 5 was the largest contributor to the overall CS rate (25.9%). Of the patients in this group, 18.8% had a successful vaginal birth after cesarean (VBAC). Group 2 was the second largest contributor to the overall CS rate at 18.0%. Group 10 had a high contribution of 16.1%. The TGCS allows easy identification of the leading contributing patient groups. The surprisingly high contribution of group 10 suggests that our institution, a tertiary multidisciplinary teaching hospital, manages a sizeable group of high-risk patients in its obstetric case mix accounting for the high CS rate. Almost one in five term pregnancies with one previous CS had a successful vaginal delivery, suggesting that the institutional attempted VBAC rate is higher than 20%. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Step 6: Does Not Routinely Employ Practices, Procedures Unsupported by Scientific Evidence

PubMed Central

Goer, Henci; Sagady Leslie, Mayri; Romano, Amy

2007-01-01

Step 6 of the Ten Steps of Mother-Friendly Care addresses two issues: 1) the routine use of interventions (shaving, enemas, intravenous drips, withholding food and fluids, early rupture of membranes, and continuous electronic fetal monitoring; and 2) the optimal rates of induction, episiotomy, cesareans, and vaginal births after cesarean. Rationales for compliance and systematic reviews are presented. PMID:18523680

Safety of vaginal delivery among dichorionic diamniotic twins over 10 years in a UK teaching hospital.

PubMed

Rzyska, Ewelina; Ajay, Bini; Chandraharan, Edwin

2017-01-01

To determine whether vaginal delivery among dichorionic diamniotic twins remains a safe option following full implementation of the European Working Time Directive in the UK. A retrospective study was conducted using data for women with dichorionic diamniotic twin pregnancies who attended a teaching hospital in London, UK, for delivery between January 4, 2000, and December 23, 2010. Among 892 women, 474 (53.1%) attempted vaginal delivery, 220 (46.4%) of whom achieved spontaneous vaginal delivery of both twins. Instrumental vaginal delivery was performed among 89 women (18.8%), and 165 (34.8%) women underwent emergency cesarean delivery. Delivery of the second twin by emergency cesarean (n=31) was predominantly for fetal distress (13 [41.9%]) or abnormal lie (10 [32.3%]). A 5-minute Apgar score of 9 or 10 was recorded for 384 (83.7%) of 459 first twins and 369 (82.9%) of 445 second twins, irrespective of the mode of delivery. Vaginal delivery among dichorionic diamniotic twins had a good success rate and a low intrapartum emergency cesarean delivery rate. Training in cardiotocography and intrapartum procedures might further reduce the need for emergency cesarean delivery. © 2016 International Federation of Gynecology and Obstetrics.

Neonatal morbidity associated with vaginal delivery of noncephalic second twins.

PubMed

Schmitz, Thomas; Korb, Diane; Battie, Catherine; Cordier, Anne-Gaël; de Carne Carnavalet, Céline; Chauleur, Céline; Equy, Véronique; Haddad, Bassam; Lemercier, Delphine; Poncelet, Christophe; Rigonnot, Luc; Goffinet, François

2018-04-01

Management of noncephalic second twin delivery rests on the results of population-based retrospective studies of twin births that have shown higher neonatal mortality and morbidity for second twins with noncephalic, compared with cephalic, presentations after vaginal delivery of the first twin. Because these studies are flawed by data of questionable validity, do not report the obstetrical practices at delivery, and do not allow collection of potential confounding variables, we performed a national prospective study specially designed to evaluate the management of twins' delivery. We sought to assess neonatal mortality and morbidity according to second twin presentation after vaginal birth of the first twin. The Jumeaux Mode d'Accouchement study was a nationwide prospective population-based cohort study of twin deliveries performed in 176 maternity units in France from February 2014 through March 2015. The primary outcome was a composite of intrapartum mortality and neonatal mortality and morbidity. Neonatal outcomes of second twins born ≥32 weeks of gestation after vaginal delivery of the first cephalic or breech twin were compared according to the noncephalic or cephalic second twin presentation. Multivariable logistic regression models controlled for potential confounders. Subgroup analyses were conducted according to the breech or transverse presentation of the noncephalic second twin, and gestational age at delivery, before or after 37 weeks of gestation. Among 3903 second twins enrolled in the study, 2384 (61.1%) were in cephalic and 1519 (38.9%) in noncephalic presentations, of whom 999 (25.6%) were in breech and 520 (13.3%) in transverse presentation. Composite neonatal mortality and morbidity did not differ between the noncephalic and cephalic group (47/1519 [3.1%] vs 59/2384 [2.5%]; adjusted odds ratio, 1.23; 95% confidence interval, 0.81-1.85). No significant difference between groups was shown for the primary outcome in subgroup analyses according to

Vaginal progesterone to prevent preterm birth in pregnant women with a sonographic short cervix: clinical and public health implications.

PubMed

Conde-Agudelo, Agustin; Romero, Roberto

2016-02-01

Vaginal progesterone administration to women with a sonographic short cervix is an efficacious and safe intervention used to prevent preterm birth and neonatal morbidity and mortality. The clinical and public health implications of this approach in the United States have been critically appraised and compared to other therapeutic interventions in obstetrics. Vaginal progesterone administration to women with a transvaginal sonographic cervical length (CL) ≤25 mm before 25 weeks of gestation is associated with a significant and substantial reduction of the risk for preterm birth from <28 to <35 weeks of gestation, respiratory distress syndrome, composite neonatal morbidity and mortality, admission to the neonatal intensive care unit, and mechanical ventilation. These beneficial effects have been achieved in women with a singleton gestation, with or without a history of spontaneous preterm birth, and did not differ significantly as a function of CL (<10 mm, 10-20 mm, or 21-25 mm). The number of patients required for treatment to prevent 1 case of preterm birth or adverse neonatal outcomes ranges from 10-19 women. The number needed to screen for the prevention of 1 case of preterm birth before 34 weeks of gestation is 125 women, and 225 for the prevention of 1 case of major neonatal morbidity or neonatal mortality. Several cost-effectiveness and decision analyses have shown that the combination of universal transvaginal CL screening and vaginal progesterone administration to women with a short cervix is a cost-effective intervention that prevents preterm birth and associated perinatal morbidity and mortality. Universal assessment of CL and treatment with vaginal progesterone for singleton gestations in the United States would result in an annual reduction of approximately 30,000 preterm births before 34 weeks of gestation and of 17,500 cases of major neonatal morbidity or neonatal mortality. In summary, there is compelling evidence to recommend universal transvaginal

Skin Preparation for Prevention of Surgical Site Infection After Cesarean Delivery: A Randomized Controlled Trial.

PubMed

Ngai, Ivan M; Van Arsdale, Anne; Govindappagari, Shravya; Judge, Nancy E; Neto, Nicole K; Bernstein, Jeffrey; Bernstein, Peter S; Garry, David J

2015-12-01

To compare chlorhexidine with alcohol, povidone-iodine with alcohol, and both applied sequentially to estimate their relative effectiveness in prevention of surgical site infections after cesarean delivery. Women undergoing nonemergent cesarean birth at greater than 37 0/7 weeks of gestation were randomly allocated to one of three antiseptic skin preparations: povidone-iodine with alcohol, chlorhexidine with alcohol, or the sequential combination of both solutions. The primary outcome was surgical site infection reported within the first 30 days postpartum. Based on a surgical site infection rate of 12%, an anticipated 50% reduction for the combination group relative to either single skin preparation group, with a power of 0.90 and an α of 0.05, 430 women per group were needed to detect a difference. From January 2013 to July 2014, 1,404 women were randomly assigned to one of three groups: povidone-iodine with alcohol (n=463), chlorhexidine with alcohol (n=474), or both (n=467). The groups were similar with respect to demographics, medical disorders, indication for cesarean delivery, operative time, and blood loss. The overall rate of surgical site infection-4.3%-was lower than anticipated. The skin preparation groups had similar surgical site infection rates: povidone-iodine 4.6%, chlorhexidine with alcohol 4.5%, and sequential 3.9% (P=.85). The skin preparation techniques resulted in similar rates of surgical site infections. Our study provides no support for any particular method of skin preparation before cesarean delivery. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01870583. I.

The Effect of Delaying Childbirth on Primary Cesarean Section Rates

PubMed Central

Smith, Gordon C. S; Cordeaux, Yolande; White, Ian R; Pasupathy, Dharmintra; Missfelder-Lobos, Hannah; Pell, Jill P; Charnock-Jones, D. Stephen; Fleming, Michael

2008-01-01

Background The relationship between population trends in delaying childbirth and rising rates of primary cesarean delivery is unclear. The aims of the present study were (1) to characterize the association between maternal age and the outcome of labor, (2) to determine the proportion of the increase in primary cesarean rates that could be attributed to changes in maternal age distribution, and (3) to determine whether the contractility of uterine smooth muscle (myometrium) varied with maternal age. Methods and Findings We utilized nationally collected data from Scotland, from 1980 to 2005, and modeled the risk of emergency cesarean section among women delivering a liveborn infant in a cephalic presentation at term. We also studied isolated myometrial strips obtained from 62 women attending for planned cesarean delivery in Cambridge, England, from 2005 to 2007. Among 583,843 eligible nulliparous women, there was a linear increase in the log odds of cesarean delivery with advancing maternal age from 16 y upwards, and this increase was unaffected by adjustment for a range of maternal characteristics (adjusted odds ratio for a 5-y increase 1.49, 95% confidence interval [CI] 1.48–1.51). Increasing maternal age was also associated with a longer duration of labor (0.49 h longer for a 5-y increase in age, 95% CI 0.46–0.51) and an increased risk of operative vaginal birth (adjusted odds ratio for a 5-y increase 1.49, 95% CI 1.48–1.50). Over the period from 1980 to 2005, the cesarean delivery rate among nulliparous women more than doubled and the proportion of women aged 30–34 y increased 3-fold, the proportion aged 35–39 y increased 7-fold, and the proportion aged ≥40 y increased 10-fold. Modeling indicated that if the age distribution had stayed the same over the period of study, 38% of the additional cesarean deliveries would have been avoided. Similar associations were observed in multiparous women. When studied in vitro, increasing maternal age was

Uterine massage for preventing postpartum hemorrhage at cesarean delivery: Which evidence?

PubMed

Saccone, Gabriele; Caissutti, Claudia; Ciardulli, Andrea; Berghella, Vincenzo

2018-04-01

Cesarean delivery could be complicated by postpartum hemorrhage (PPH), the first cause of maternal death. To evaluate the efficacy of uterine massage in preventing postpartum hemorrhage at cesarean delivery. Electronic databases from their inception until October 2017. We included all RCTs comparing uterine massage alone or as part of the active management of labor before or after delivery of the placenta, or both, with non-massage in the setting of cesarean delivery. The primary outcome was PPH, defined as blood loss >1000 mL. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) or relative risk (RR) with 95% confidence interval (CI). Only 3 RCTs comparing uterine massage vs no uterine massage were found. The quality of these 3 trials in general was very low with high or unclear risk of bias. All of them included only women in the setting of spontaneous vaginal delivery and none of them included cesarean delivery, and therefore the meta-analysis was not feasible. There is not enough evidence to determine if uterine massage prevents postpartum hemorrhage at cesarean delivery. Copyright © 2018 Elsevier B.V. All rights reserved.

Maternal Asian ethnicity and obstetric intrapartum intervention: a retrospective cohort study.

PubMed

Reddy, Maya; Wallace, Euan M; Mockler, Joanne C; Stewart, Lynne; Knight, Michelle; Hodges, Ryan; Skinner, Sasha; Davies-Tuck, Miranda

2017-01-05

Maternal ethnicity is a recognized risk factor for stillbirth, such that South Asian women have higher rates than their Caucasian counterparts. However, whether maternal ethnicity is a risk factor for intrapartum outcomes is less clear. The aim of this study is to explore associations between maternal country of birth, operative vaginal delivery and emergency cesarean section, and to identify possible mechanisms underlying any such associations. We performed a retrospective cohort study of singleton term births among South Asian, South East/East Asian and Australian/New Zealand born women at an Australian tertiary hospital in 2009-2013. The association between maternal country of birth, operative vaginal birth and emergency cesarean was assessed using multivariate logistic regression. Of the 31,932 births, 54% (17,149) were to Australian/New Zealand-born women, 25% (7874) to South Asian, and 22% (6879) to South East/East Asian born women. Compared to Australian/New Zealand women, South Asian and South East/East Asian women had an increased rate of both operative vaginal birth (OR 1.43 [1.30-1.57] and 1.22 [1.11-1.35] respectively, p < 0.001 for both) and emergency cesarean section (OR 1.67 [1.53-1.82] and 1.16 [1.04-1.26] respectively, p < 0.001 and p = 0.007 respectively). While prolonged labor was the predominant reason for cesarean section among Australian/New Zealand and South East/East Asian women, fetal compromise accounted for the majority of operative births in South Asian women. South Asian and South East/East Asian women experience higher rates of both operative vaginal birth and cesarean section in comparison to Australian/New Zealand women, independent of other risk factors for intrapartum interventions.

The influence of women's preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study.

PubMed

Garthus-Niegel, Susan; von Soest, Tilmann; Knoph, Cecilie; Simonsen, Tone Breines; Torgersen, Leila; Eberhard-Gran, Malin

2014-06-05

This study aimed to examine whether a mismatch between a woman's preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth. The study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women's preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups. Examining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p < 0.001). However, Bonferroni post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety. The results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms. These women, who often fear childbirth, may

[Transverse vaginal septum in the upper part of the vagina and pregnancy].

PubMed

Bautista Gómez, Esperanza; Morales-García, Victor; Flores-Romero, Ana Luisa; Pizarro Osorno, Noel; Velásquez-Valdivia, Abner

2012-07-01

Transverse vaginal septum is a congenital Mullerian malformation resulting from a failure of the fusion or canalization of the urogenital sinus and the Müllerian ducts. It may cause hematocolpos, dyspareunia and infertility in adult patients. In some cases, it is associated with congenital malformations such as coarctation of the aorta or atrial septal defects. A case of a transverse vaginal septum identified during a vaginal check-up of a 39-week pregnant patient during labour is reported. A cesarean surgery was performed with no complications. Septal defect was diagnosed due to heart murmur. It was decided to treat the transverse vaginal septum as soon as the puerperium was over. The patient left the hospital after proper response to treatment.

Prophylactic antibiotics for manual removal of retained placenta during vaginal birth: a systematic review of observational studies and meta-analysis.

PubMed

Chibueze, Ezinne C; Parsons, Alexander J Q; Ota, Erika; Swa, Toshiyuki; Oladapo, Olufemi T; Mori, Rintaro

2015-11-26

Manual removal of the placenta is an invasive obstetric procedure commonly used for the management of retained placenta. However, it is unclear whether antibiotic prophylaxis is beneficial in preventing infectious morbidity. We conducted a systematic review to determine the efficacy and safety of routine use of antibiotics for preventing adverse maternal outcomes related to manual placenta removal following vaginal birth. A detailed search of MEDLINE, EMBASE, Cochrane library and the CINAHL databases was conducted for non-randomized studies involving women undergoing manual placenta delivery after vaginal births and where antibiotic prophylaxis use was compared with no treatment or placebo to prevent maternal infection. Search terms including 'delivery, obstetric', 'placenta, retained', 'anti-infective agents', and 'chemoprevention' were used. Of the 407 citations that resulted after elimination of duplicates, 81 full texts were potentially eligible after independent assessment of the title and abstracts. Independent review of the full texts identified three eligible cohort studies which were retrospective in design. These studies contained data on two of the pre-specified outcomes, endometritis and puerperal fever. Other secondary outcomes such as perineal infection and/or any infection, hospital stay duration, sepsis, hemorrhage >1000 ml or hospital readmissions were not reported on excluding puerperal fever. A meta-analysis showed no significant reduction in the incidence of endometritis (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.38 to 1.85, three studies, 567 women) and puerperal fever (OR 0.99, 95% CI 0.38 to 2.27, one study, 302 women). There is currently no evidence to suggest beneficial effects for routine antibiotic use in women undergoing manual placental removal following vaginal birth. In appropriate settings, further research is required to determine whether a policy of routine antibiotic prophylaxis for the procedure should be maintained or

Vaginal sponge and spermicides

MedlinePlus

Birth control - over the counter; Contraceptives - over the counter; Family planning - vaginal sponge; Contraception - vaginal sponge ... preventing pregnancy as some other forms of birth control. However, using a spermicide or sponge is much ...

Effect of Formula Containing Lactobacillus reuteri DSM 17938 on Fecal Microbiota of Infants Born by Cesarean-Section.

PubMed

Garcia Rodenas, Clara L; Lepage, Melissa; Ngom-Bru, Catherine; Fotiou, Aikaterini; Papagaroufalis, Konstantinos; Berger, Bernard

2016-12-01

Microbiota modulation by probiotics in infants born by cesarean (C)-section is poorly understood. We aimed at assessing the response of C-section-delivered infant microbiota to a formula containing Lactobacillus reuteri Deutsche Sammlung von Mikroorganismen und Zellkulturen GmbH (DSM) 17938 and comparing it with that of vaginally delivered infants. Infants delivered by C-section (C) and vaginally (V) were randomized to receive either control formula (CCt, n = 10; VCt, n = 10) or the same formula containing L reuteri (CLr, n = 11; VLr, n = 9) within 72 hours following birth. Stool samples were collected at 2 weeks and 4 months of age. Microbial DNA was extracted, amplified, and pyrosequenced. The phylogenetic profiles of the CLr, VCt, and VLr microbiota were not significantly different at any age but diverged from that of CCt at 2 weeks. Compared with VCt, CCt displayed lower Bifidobacterium and higher Enterobacter, unclassified Enterobacteriaceae, Enterococcus, Clostridium, and unclassified Clostridiaceae relative abundance at 2 weeks, as well as lower Collinsella and higher Enterococcus and Coprococcus abundance at 4 months. The level of most of these taxa was not significantly different between the CLr and the vaginal-delivery groups. Compared with VCt, the only difference observed in VLr microbiota was higher Lactobacillus at the 2 study ages and Coprococcus at 4 months. Our results show that a formula containing L reuteri DSM 17938 does not essentially alter the microbiota in vaginally born infants. In C-section-delivered infants, however, this strain seems to play the role of keystone species by modulating the early development of the microbiota toward the composition found after vaginal delivery.

Successful External Cephalic Version: Factors Predicting Vaginal Birth

PubMed Central

Lim, Pei Shan; Ng, Beng Kwang; Ali, Anizah; Shafiee, Mohamad Nasir; Kampan, Nirmala Chandralega; Mohamed Ismail, Nor Azlin; Omar, Mohd Hashim; Abdullah Mahdy, Zaleha

2014-01-01

Purpose. To determine the maternal and fetal outcomes of successful external cephalic version (ECV) as well as factors predicting vaginal birth. Methods. The ECV data over a period of three years at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 1 September 2008 and 30 September 2010 was reviewed. Sixty-seven patients who had successful ECV were studied and reviewed for maternal, fetal, and labour outcomes. The control group comprised patients with cephalic singletons of matching parity who delivered following the index cases. Results. The mean gestational age at ECV was 263 ± 6.52 days (37.5 weeks ± 6.52 days). Spontaneous labour and transient cardiotocographic (CTG) changes were the commonest early adverse effects following ECV. The reversion rate was 7.46%. The mean gestational age at delivery of the two groups was significantly different (P = 0.000) with 277.9 ± 8.91 days and 269.9 ± 9.68 days in the study group and control groups, respectively. The study group needed significantly more inductions of labour. They required more operative deliveries, had more blood loss at delivery, a higher incidence of meconium-stained liquor, and more cord around the neck. Previous flexed breeches had a threefold increase in caesarean section rate compared to previous extended breeches (44.1% versus 15.2%, P = 0.010). On the contrary, an amniotic fluid index (AFI) of 13 or more is significantly associated with a higher rate of vaginal birth (86.8% versus 48.3%, P = 0.001). Conclusions. Patients with successful ECV were at higher risk of carrying the pregnancy beyond 40 weeks and needing induction of labour, with a higher rate of caesarean section and higher rates of obstetrics complications. Extended breech and AFI 13 or more were significantly more likely to deliver vaginally postsuccessful ECV. This additional information may be useful to caution a patient with breech that ECV does not bring them to behave exactly like a normal cephalic, so that they

Treatment of abnormal vaginal flora in early pregnancy with clindamycin for the prevention of spontaneous preterm birth: a systematic review and metaanalysis

PubMed Central

Lamont, Ronald F.; Nhan-Chang, Chia-Ling; Sobel, Jack D.; Workowski, Kimberly; Conde-Agudelo, Agustin; Romero, Roberto

2011-01-01

The purpose of this study was to determine whether the administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation reduces the risk of preterm birth and late miscarriage. We conducted a systematic review and metaanalysis of randomized controlled trials of the early administration of clindamycin to women with abnormal vaginal flora at <22 weeks of gestation. Five trials that comprised 2346 women were included. Clindamycin that was administered at <22 weeks of gestation was associated with a significantly reduced risk of preterm birth at <37 weeks of gestation and late miscarriage. There were no overall differences in the risk of preterm birth at <33 weeks of gestation, low birthweight, very low birthweight, admission to neonatal intensive care unit, stillbirth, peripartum infection, and adverse effects. Clindamycin in early pregnancy in women with abnormal vaginal flora reduces the risk of spontaneous preterm birth at <37 weeks of gestation and late miscarriage. There is evidence to justify further randomized controlled trials of clindamycin for the prevention of preterm birth. However, a deeper understanding of the vaginal microbiome, mucosal immunity, and the biology of bacterial vaginosis will be needed to inform the design of such trials. PMID:22071048

[Water birthing: retrospective review of 2625 water births. Contamination of birth pool water and risk of microbial cross-infection].

PubMed

Thöni, A; Mussner, K; Ploner, F

2010-06-01

The aim of this study was to document the practice of 2625 water births at Vipiteno over the period 1997-2009 and compare outcome and safety with normal vaginal delivery. The microbial load of the birth pool water was analyzed, and neonatal infection rates after water birth and after land delivery were compared. Methods. The variables analyzed in the 1152 primiparae were: length of labor; incidence of episiotomies and tears; arterial cord blood pH and base excess values; percentage of pH<7.10 and base excess values >/=12 mmol/L. In all 2625 water births, the variables were: analgesic requirements; shoulder dystocia/ neonatal complications; and deliveries after a previous caesarean section. Bacterial cultures of water samples obtained from the bath after filling (sample A) and after delivery (sample B) were analyzed in 300 cases. The pediatricians recorded signs of suspected neonatal infection after water birth and after conventional vaginal delivery. There was a marked reduction in labor duration in the primiparae who birthed in water; the episiotomy rate was 0.46%. Owing to the pain relieving effect of the warm birth pool water, pain relievers (opiates) were required in only 12.9% of water births. Arterial cord blood pH and base excess values were comparable in both groups. Shoulder dystocia/neonatal complications were managed in 4 water births; 105 women with a previous caesarean section had a water birth. In sample A, the isolated micro-organisms were Legionella spp. and Pseudomonas aeruginosa; in sample B, there was elevated colonization of birth pool water by total coliform bacilli and Escherichia coli. Despite microbial contamination of birth pool water during delivery, antibiotic prophylaxis, as indicated by clinical and laboratory suspicion of infection, was administered to only 0.98% of babies after water birth versus 1.64% of those after land delivery. Results suggest clear medical advantages of water birthing: significantly shorter labor duration among

Laceration injury at cesarean section.

PubMed

Haas, D M; Ayres, A W

2002-03-01

To determine the infant laceration injury rate during Cesarean sections at Naval Medical Center, San Diego and to describe risk factors associated with this complication. Retrospective chart review of all infants born between 1 January 1996 and 31 December, 1999 identified by computer coding as having sustained a birth injury. Fifty randomly selected maternal records of Cesarean sections without infant lacerations were reviewed and analyzed as a control group. Our Cesarean section rate during the time was 16.5% with a laceration injury rate of 0.74%. When compared to controls, there was no difference in operative indication, type of Cesarean section, or any demographic information between the two groups. Male infant gender (p = 0.027) and ruptured membranes (p = 0.019) showed a statistically significant difference between the two groups. Laceration injury to the infant during Cesarean section is associated with a laboring uterus. This is an important complication that should be part of preoperative counselling and should be documented appropriately when it occurs.

Arterial hemorrhage from cesarean scar: a rare cause of recurring massive uterine bleeding and successful surgical management.

PubMed

Wang, Chun-Feng; Hu, Min

2015-02-01

Abnormal uterine bleeding and other gynecologic complications associated with a previous cesarean section scar are only recently being identified and described. Herein we report a rare case of a woman with recurring massive uterine bleeding after 2 cesarean sections. Curettage and hormone therapy were unsuccessfully used in an attempt to control the bleeding. After she was transferred to our hospital, she had another episode of vaginal bleeding that was successfully managed with oxytocin and hemostatic. Diagnostic hysteroscopy performed under anesthesia revealed an abnormal transected artery in the cesarean section scar with a thrombus visible. In the treatment at the beginning of laparoscopic management, we adopted temporary bilateral uterine artery occlusion with titanium clips to prevent massive hemorrhage. Secondly, with the aid of hysteroscopy, the bleeding site was opened, and then the cesarean scar was wedge resected and stitched interruptedly with 1-0 absorbable sutures. The postoperative recovery was uneventful. It would seem that the worldwide use of cesarean section delivery may contribute to the risk of gynecologic disturbances including some unrecognized and complex conditions as seen in this case. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Cesarean section among immigrants in Norway.

PubMed

Vangen, S; Stoltenberg, C; Skrondal, A; Magnus, P; Stray-Pedersen, B

2000-07-01

We studied prevalences and risk factors for cesarean section among different groups of immigrants from countries outside Western Europe and North America in comparison to ethnic Norwegians. The study is population based using data from the Medical Birth Registry of Norway. A total of 553,491 live births during the period 1986-1995 were studied, including 17,891 births to immigrant mothers. The prevalences of cesarean section ranged from 10.1% among women from Vietnam to 25.8% in the group of Filipino origin. The use of abdominal delivery was also high in the groups from Sri Lanka/India (21.3%), Somalia/Eritrea/Ethiopia (20.5%) and Chile/Brazil (24.3%), while the frequency among women from Turkey/Morocco (12.6%) and Pakistan (13.2%) was approximately the same as among ethnic Norwegians (12.4%). Feto-pelvic disproportion, fetal distress and prolonged labor were the most important diagnoses associated with the high prevalences, but the significance of these diagnoses differed among the groups. Other unknown factors come into play, particularly among women from Somalia/Eritrea/Ethiopia and Chile/Brazil. There was substantial variation in the use of cesarean section among ethnic groups in Norway. The diagnoses feto-pelvic disproportion, fetal distress and prolonged labor may be confounded by a number of factors including maternal request for cesarean section and difficulties in handling the delivery. Further research is needed to explain the observed differences.

Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial

PubMed Central

HASSAN, S. S.; ROMERO, R.; VIDYADHARI, D.; FUSEY, S.; BAXTER, J. K.; KHANDELWAL, M.; VIJAYARAGHAVAN, J.; TRIVEDI, Y.; SOMA-PILLAY, P.; SAMBAREY, P.; DAYAL, A.; POTAPOV, V.; O’BRIEN, J.; ASTAKHOV, V.; YUZKO, O.; KINZLER, W.; DATTEL, B.; SEHDEV, H.; MAZHEIKA, L.; MANCHULENKO, D.; GERVASI, M. T.; SULLIVAN, L.; CONDE-AGUDELO, A.; PHILLIPS, J. A.; CREASY, G. W.

2012-01-01

Objectives Women with a sonographic short cervix in the mid-trimester are at increased risk for preterm delivery. This study was undertaken to determine the ef cacy and safety of using micronized vaginal progesterone gel to reduce the risk of preterm birth and associated neonatal complications in women with a sonographic short cervix. Methods This was a multicenter, randomized, double-blind, placebo-controlled trial that enrolled asymptomatic women with a singleton pregnancy and a sonographic short cervix (10–20 mm) at 19 + 0to23 + 6 weeks of gestation. Women were allocated randomly to receive vaginal progesterone gel or placebo daily starting from 20 to 23 + 6 weeks until 36 + 6 weeks, rupture of membranes or delivery, whichever occurred rst. Randomization sequence was strati ed by center and history of a previous preterm birth. The primary endpoint was preterm birth before 33 weeks of gestation. Analysis was by intention to treat. Results Of 465 women randomized, seven were lost to follow-up and 458 (vaginal progesterone gel, n = 235; placebo, n = 223) were included in the analysis. Women allocated to receive vaginal progesterone had a lower rate of preterm birth before 33 weeks than did those allocated to placebo (8.9% (n = 21) vs 16.1% (n = 36); relative risk (RR), 0.55; 95% CI, 0.33–0.92; P = 0.02). The effect remained signi cant after adjustment for covariables (adjusted RR, 0.52; 95% CI, 0.31–0.91; P = 0.02). Vaginal progesterone was also associated with a signi cant reduction in the rate of preterm birth before 28 weeks(5.1%vs10.3%; RR, 0.50;95%CI, 0.25–0.97; P = 0.04) and 35 weeks (14.5% vs 23.3%; RR, 0.62; 95% CI, 0.42–0.92; P = 0.02), respiratory distress syndrome (3.0% vs 7.6%; RR, 0.39; 95% CI, 0.17–0.92; P = 0.03), any neonatal morbidity or mortality event (7.7% vs 13.5%; RR, 0.57; 95% CI, 0.33–0.99; P = 0.04) and birth weight < 1500 g (6.4% (15/234) vs 13.6% (30/220); RR, 0.47; 95% CI, 0.26–0.85; P = 0.01). There were no differences

Regional Gradients in Institutional Cesarean Delivery Rates: Evidence from Five Countries in Asia.

PubMed

Sepehri, Ardeshir; Guliani, Harminder

2017-03-01

Although the influence of the type of institutional setting on the risk of cesarean birth is well documented, less is known about the regional variations in institution-specific cesarean rates within countries. Our purpose was to examine regional variations in cesarean rates across public and private facilities in five Asian countries with a sizeable private sector: Bangladesh, India, Indonesia, Pakistan, and the Philippines. Demographic Health Survey data and a hierarchical model were used to assess regional variations in the mode of delivery while controlling for a wide range of socioeconomic, demographic, and maternal risk factors. The risk of cesarean birth was greater in a private facility than in a government hospital by 36-48 percent in India and Indonesia and by 130 percent in Bangladesh. Regional gradients in cesarean birth were found to be steeper for deliveries in private facilities than in government hospitals in India, Indonesia, and the Philippines. The residents of India's high-use states were 55 percent more likely to undergo a cesarean delivery in a government hospital and 83 percent more likely in a private facility than their counterparts in the medium-use states. Similarly, compared to the residents of the Philippines's medium-use provinces, giving birth in a government facility increased the likelihood of a cesarean delivery by 84 percent and by 173 percent in a private facility. Large regional variations in cesarean rates suggest the need for more informed clinical decision making with respect to the selection of cases for cesarean delivery and the establishment of well-developed guidelines and standards at the provincial or state levels. © 2016 Wiley Periodicals, Inc.

Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

PubMed Central

2014-01-01

Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

Giving birth with rape in one's past: a qualitative study.

PubMed

Halvorsen, Lotta; Nerum, Hilde; Oian, Pål; Sørlie, Tore

2013-09-01

Rape is one of the most traumatizing violations a woman can be subjected to, and leads to extensive health problems, predominantly psychological ones. A large proportion of women develop a form of posttraumatic stress termed Rape Trauma Syndrome. A previous study by our research group has shown that women with a history of rape far more often had an operative delivery in their first birth and those who gave birth vaginally had second stages twice as long as women with no history of sexual assault. The aim of this study is to examine and illuminate how women previously subjected to rape experience giving birth for the first time and their advice on the kind of birth care they regard as good for women with a history of rape. A semi-structured interview with 10 women, who had been exposed to rape before their first childbirth. Data on the birth experience were analyzed by qualitative content analysis. The main theme was "being back in the rape" with two categories: "reactivation of the rape during labor," with subcategories "struggle," "surrender," and "escape" and "re-traumatization after birth," with the subcategories "objectified," "dirtied," and "alienated body." A rape trauma can be reactivated during the first childbirth regardless of mode of delivery. After birth, the women found themselves re-traumatized with the feeling of being dirtied, alienated, and reduced to just a body that another body is to come out of. Birth attendants should acknowledge that the common measures and procedures used during normal birth or cesarean section can contribute to a reactivation of the rape trauma. © 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.

Accidental fetal lacerations during cesarean delivery: experience in an Italian level III university hospital.

PubMed

Dessole, Salvatore; Cosmi, Erich; Balata, Antonio; Uras, Luisa; Caserta, Donatella; Capobianco, Giampiero; Ambrosini, Guido

2004-11-01

The purpose of this study was to investigate the incidence, type, location, and risk factors of accidental fetal lacerations during cesarean delivery. Total deliveries, cesarean deliveries, and neonatal records for documented accidental fetal lacerations were reviewed retrospectively in our level III university hospital. The gestational age, the presenting part of the fetus, the cesarean delivery indication, the type of incision, and the surgeon who performed the procedure were recorded. Cesarean deliveries were divided into scheduled, unscheduled, and emergency procedures. Fetal lacerations were divided into mild, moderate, and severe. Neonatal follow-up examinations regarding laceration sequelae were available for 6 months. Of 14926 deliveries, 3108 women were delivered by cesarean birth (20.82%). Neonatal records documented 97 accidental fetal lacerations. Of these accidental lacerations, 94 were mild; 2 were moderate, and 1 was severe. The overall rate of accidental fetal laceration per cesarean delivery was 3.12%; the accidental laceration rate in the cohort of fetuses was 2.46%. The crude odds ratios were 0.34 for scheduled procedures, 0.57 for unscheduled procedures, and 1.7 for emergency procedures. The risk for fetal accidental lacerations was higher in fetuses who underwent emergency cesarean birth and lower for unscheduled and scheduled cesarean births (P < .001). Fetal accidental laceration may occur during cesarean delivery; the incidence is significantly higher during emergency cesarean delivery compared with elective procedures. The patient should be counseled about the occurrence of fetal laceration during cesarean delivery to avoid litigation.

Qualitative website analysis of information on birth after caesarean section.

PubMed

Peddie, Valerie L; Whitelaw, Natalie; Cumming, Grant P; Bhattacharya, Siladitya; Black, Mairead

2015-08-19

The United Kingdom (UK) caesarean section (CS) rate is largely determined by reluctance to augment trial of labour and vaginal birth. Choice between repeat CS and attempting vaginal birth after CS (VBAC) in the next pregnancy is challenging, with neither offering clear safety advantages. Women may access online information during the decision-making process. Such information is known to vary in its support for either mode of birth when assessed quantitatively. Therefore, we sought to explore qualitatively, the content and presentation of web-based health care information on birth after caesarean section (CS) in order to identify the dominant messages being conveyed. The search engine Google™ was used to conduct an internet search using terms relating to birth after CS. The ten most frequently returned websites meeting relevant purposive sampling criteria were analysed. Sampling criteria were based upon funding source, authorship and intended audience. Images and written textual content together with presence of links to additional media or external web content were analysed using descriptive and thematic analyses respectively. Ten websites were analysed: five funded by Government bodies or professional membership; one via charitable donations, and four funded commercially. All sites compared the advantages and disadvantages of both repeat CS and VBAC. Commercially funded websites favoured a question and answer format alongside images, 'pop-ups', social media forum links and hyperlinks to third-party sites. The relationship between the parent sites and those being linked to may not be readily apparent to users, risking perception of endorsement of either VBAC or repeat CS whether intended or otherwise. Websites affiliated with Government or health services presented referenced clinical information in a factual manner with podcasts of real life experiences. Many imply greater support for VBAC than repeat CS although this was predominantly conveyed through subtle

No reduction in instrumental vaginal births and no increased risk for adverse perineal outcome in nulliparous women giving birth on a birth seat: results of a Swedish randomized controlled trial

PubMed Central

2011-01-01

Background The WHO advises against recumbent or supine position for longer periods during labour and birth and states that caregivers should encourage and support the woman to take the position in which she feels most comfortable. It has been suggested that upright positions may improve childbirth outcomes and reduce the risk for instrumental delivery; however RCTs of interventions to encourage upright positions are scarce. The aim of this study was to test, by means of a randomized controlled trial, the hypothesis that the use of a birthing seat during the second stage of labor, for healthy nulliparous women, decreases the number of instrumentally assisted births and may thus counterbalance any increase in perineal trauma and blood loss. Methods A randomized controlled trial in Sweden where 1002 women were randomized to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The primary outcome measurement was the number of instrumental deliveries. Secondary outcome measurements included perineal lacerations, perineal edema, maternal blood loss and hemoglobin. Analysis was by intention to treat. Results The main findings of this study were that birth on the birth seat did not reduce the number of instrumental vaginal births, there was an increase in blood loss between 500 ml and 1000 ml in women who gave birth on the seat but no increase in bleeding over 1000 ml and no increase in perineal lacerations or perineal edema. Conclusions The birth seat did not reduce the number of instrumental vaginal births. The study confirmed an increased blood loss 500 ml - 1000 ml but not over 1000 ml for women giving birth on the seat. Giving birth on a birth seat caused no adverse consequences for perineal outcomes and may even be protective against episiotomies. Trial registration number ClinicalTrials.gov.ID: NCT01182038 PMID:21435238

Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae.

PubMed

Matinnia, Nasrin; Haghighi, Mohammad; Jahangard, Leila; Ibrahim, Faisal B; Rahman, Hejar A; Ghaleiha, Ali; Holsboer-Trachsler, Edith; Brand, Serge

2018-01-01

Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched. A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs. Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support. The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.

Indications for Cesarean Delivery in Mexico: Evaluation of Appropriate Use and Justification.

PubMed

Aranda-Neri, Juan Carlos; Suárez-López, Leticia; DeMaria, Lisa M; Walker, Dilys

2017-03-01

Cesarean delivery is one of the most widely used surgical interventions in Latin America and in many cases it is performed with no clear medical indication. Our objective was to analyze the relationship between reported indications for a cesarean and support for that indication in the clinical record in four Mexican hospitals, during the 2006-2007 period. The data are from 604 (37.1%) women from a total of 1,625 who were admitted to the hospital in labor, and who gave birth through cesarean. Multivariate logistical regression analysis was used to explore the association between indications for clinically justified or unjustified surgery and other clinical and sociodemographic variables. Supporting clinical information for indications of cesarean delivery were found in only 45 percent of the cases considered. The adjusted statistical analysis showed that the variables associated with an unjustified indication for cesarean were: not having had a prior birth (OR 1.84 [95% CI 1.16-2.89]), having a maximum cervical dilation of 4 centimeters or less at time of cesarean (OR 2.44 [95% CI 1.53-3.87]), and having received care in a private hospital (OR 6.11 [95% CI 1.90-19.57]). The indications for cesarean related to labor dynamics were those least supported. Not having had a prior birth poses the greatest risk of having a poorly supported indication for a cesarean delivery. It would be prudent to institute audits, and greater requirements for and surveillance of documentation for cesarean delivery indications. © 2016 Wiley Periodicals, Inc.

Disciplinary discourses: rates of cesarean section explained by medicine, midwifery, and feminism.

PubMed

Lee, Amy Su May; Kirkman, Maggie

2008-05-01

In the context of international concern about increasing rates of cesarean sections, we used discourse analysis to examine explanations arising from feminism and the disciplines of medicine and midwifery, and found that each was positioned differently in relation to the rising rates. Medical discourses asserted that doctors are authorities on birth and that, although cesareans are sometimes medically necessary, women recklessly choose unnecessary cesareans against medical advice. Midwifery discourses portrayed medicine as paternalistic toward both women and midwifery, and feminist discourses situated birth and women's bodies in the context of a patriarchally structured society. The findings illustrate the complex ways in which this intervention in birth is discursively constructed, and demonstrate its significance as a site of disciplinary conflict.

The significance of peripartum fever in women undergoing vaginal deliveries.

PubMed

Bensal, Adi; Weintraub, Adi Y; Levy, Amalia; Holcberg, Gershon; Sheiner, Eyal

2008-10-01

We investigated whether patients undergoing vaginal delivery who developed peripartum fever (PPF) had increased rates of other gestational complications. A retrospective study was undertaken comparing pregnancy complications of patients who developed PPF with those who did not. A multivariable logistic regression model was constructed to control for confounders. To avoid ascertainment bias, the year of birth was included in the model. Women who underwent cesarean delivery and those with multiple pregnancies were excluded from the study. During the study period, there were 169,738 singleton vaginal deliveries, and 0.4% of the women suffered from PPF. Hypertensive disorders, induction of labor, dystocia of labor in the second stage, suspected fetal distress, meconium-stained amniotic fluid, postpartum hemorrhage, manual lysis of a retained placenta, and revision of the uterine cavity and cervix were found to be independently associated with PPF by multivariable analysis. Year of birth was found to be a risk factor for fever. Apgar scores lower than 7 at 1 but not 5 minutes were significantly higher in the PPF group. Perinatal mortality rates were significantly higher among women with PPF (6.7% versus 1.3%, odds ratio [OR] = 5.4; 95% confidence interval [CI] 3.9 to 7.3; P < 0.001). Using another multivariable analysis, with perinatal mortality as the outcome variable, PPF was found as an independent risk factor for perinatal mortality (OR = 2.9; 95% CI 1.9 to 4.6; P < 0.001). PPF in women undergoing vaginal deliveries is associated with adverse perinatal outcomes and specifically is an independent risk factor for perinatal mortality.

Successful vaginal delivery at term after vaginal reconstruction with labium minus flaps in a patient with vaginal atresia: A rare case report.

PubMed

Liu, Yu; Wang, Yi-Feng

2017-07-01

We report a case of successful vaginal delivery after vaginal reconstruction with labium minus flaps in a 23-year-old patient with congenital vaginal atresia. The patient primarily presented with amenorrhea and cyclic abdominal pain; transabdominal ultrasonography revealed an enlarged uterus due to hematometra and absence of the lower segment of the vagina. Eight years ago, she had undergone an unsuccessful attempt at canalization at a local hospital. Upon referral to our hospital, she underwent vaginal reconstruction with labium minus flaps. Four months after this procedure, she became pregnant and, subsequently, successfully and safely vaginally delivered a healthy female baby weighing 3250 g at 38 +1 weeks' gestation. The delivery did not involve perineal laceration by lateral episiotomy. To the best of our knowledge, this is the first reported case of successful vaginal delivery at term after vaginal reconstruction with labium minus flaps in a patient with vaginal atresia. © 2017 Japan Society of Obstetrics and Gynecology.

Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis.

PubMed

Keag, Oonagh E; Norman, Jane E; Stock, Sarah J

2018-01-01

Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of this systematic review is to describe the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies. The primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death. Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were systematically searched for published studies in human subjects (last search 25 May 2017), supplemented by manual searches. Included studies were randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies with greater than or equal to one-year follow-up comparing outcomes of women delivering by cesarean delivery and by vaginal delivery. Two assessors screened 30,327 abstracts. Studies were graded for risk of bias by two assessors using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies. Results were pooled in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I2 ≥ 40%). One RCT and 79 cohort studies (all from high income countries) were included, involving 29,928,274 participants. Compared to vaginal delivery, cesarean delivery was associated with decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies). Children delivered by cesarean delivery had increased risk of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies) and obesity up to the age of 5 years (OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies). Pregnancy after cesarean delivery was associated with

Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis

PubMed Central

Keag, Oonagh E.; Stock, Sarah J.

2018-01-01

Background Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of this systematic review is to describe the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies. The primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death. Methods and findings Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were systematically searched for published studies in human subjects (last search 25 May 2017), supplemented by manual searches. Included studies were randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies with greater than or equal to one-year follow-up comparing outcomes of women delivering by cesarean delivery and by vaginal delivery. Two assessors screened 30,327 abstracts. Studies were graded for risk of bias by two assessors using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies. Results were pooled in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I2 ≥ 40%). One RCT and 79 cohort studies (all from high income countries) were included, involving 29,928,274 participants. Compared to vaginal delivery, cesarean delivery was associated with decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies). Children delivered by cesarean delivery had increased risk of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies) and obesity up to the age of 5 years (OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies). Pregnancy after cesarean

An economic analysis of trial of labor after cesarean delivery.

PubMed

Friedman, Alexander M; Ananth, Cande V; Chen, Ling; D'Alton, Mary E; Wright, Jason D

2016-01-01

Given that cesarean delivery is one of the most commonly performed surgical procedures in the United States and an important contributor to obstetric care costs, this analysis sought to examine maternal hospital costs associated with trial of labor after cesarean delivery (TOLAC) versus repeat cesarean delivery (RCD). A national sample was used to identify women with singleton pregnancy who underwent either TOLAC or RCD from 2006 to 2012. Women with diagnoses that could confound cost via extended hospital length of stay prior to delivery were excluded. Other medical and obstetric covariates that could influence cost were included in an adjusted model. A total of 485,247 women were identified, including 365,596 (75.3%) cesarean deliveries without labor, 41,988 (8.6%) successful and 77,663 (16.0%) unsuccessful TOLAC deliveries. The inflation-adjusted median costs in this cohort were $5512 for cesarean without labor, $4175 for successful TOLAC, $5166 for all TOLAC attempts, and $5759 for failed TOLAC. In a multivariable model, hospital region was a major predictor of median cost as were demographic variables and medical comorbidities. TOLAC is associated with modest reductions of cost for maternal hospitalizations. However, other medical, demographic and hospital factors appear to be more important factors.

A randomized trial of levonorgestrel intrauterine system insertion 6 to 48 h compared to 6 weeks after vaginal delivery; lessons learned.

PubMed

Stuart, Gretchen S; Lesko, Catherine R; Stuebe, Alison M; Bryant, Amy G; Levi, Erika E; Danvers, Antoinette I

2015-04-01

The objective of this randomized trial was to compare breastfeeding among women who received a levonorgestrel-releasing intrauterine system within 6-48 h (early) or 4-6 weeks (standard) after an uncomplicated vaginal birth. Analysis groups of 86 women in each arm were needed to demonstrate a 20% difference in any breastfeeding. Thirty-five women were randomized to the early (N=17) and standard (N=18) arms. The combination of unsuccessful placement (2/17; 12%), expulsions (7/17; 41%) and removals (3/17; 18%) reached 71% (12/17) in the early arm, so the study was stopped. In our small study cohort, levonorgestrel-releasing intrauterine system insertion between 6 and 48 h after vaginal birth was associated with a high rate of expulsion or removal soon after insertion. Copyright © 2015 Elsevier Inc. All rights reserved.

Vaginal colonization by Escherichia coli as a risk factor for very low birth weight delivery and other perinatal complications.

PubMed

Krohn, M A; Thwin, S S; Rabe, L K; Brown, Z; Hillier, S L

1997-03-01

This study evaluated the relationship of vaginal Escherichia coli colonization to birth weight <1500 g and other perinatal complications in a cross-sectional study of 2646 women at the University of Washington Medical Center, Seattle, between October 1992 and January 1995. Vaginal E. coli colonization was more strongly associated with delivery at <34 weeks (relative risk [RR], 1.7; 95% confidence interval [CI], 1.3-2.3) and very low birth weight (RR, 1.9; 95% CI, 1.3-2.7) than with prematurity between 34 and 36 weeks or low birth weight. Heavy growth of E. coli had a higher risk of very low birth weight than light growth (RR, 2.4; 95% CI, 1.0-6.2). It may be important to screen and treat pregnant women for genital tract colonization with E. coli during prenatal care.

[Surgical technique for cesarean section of Eduardo Porro (1842-1902) and its significance for obstetric development. In the 150th anniversary year of the method's creator].

PubMed

Waszyński, E

1994-04-01

It has passed 150th birth anniversary of a great, Italian Obstetrician Eduardo Porro, author of a cesarean section technique consisted of uterine corpus amputation and suturing of the cervix stump into the abdominal wall incision. Eduardo Porro was born in 1842 in Padwa. In 1876, he became the Head of Obstetrics Department in Pawia, and since 1882, the Head of Midwifery School in Milano. He died on May 25th, 1901. That original cesarean section method was introduced by him in 1876. Its main idea was exsection of the uterus, infected at the time of labor. The operation was also performed because of other reasons, such as: wide uterine ruptures, osteomalation, spacions vaginal cicatrization, and uterine atony. In the second part of the 18th century, maternal mortality following so called, classical cesarean section was nearly 100 percent. Introducing the Porro's operative technique decreased maternal mortality to 58%. This method aroused an interest of cesarean section technique improvement at all. The twilight, of the Porro's operation took place in the 1920s as the new method appeared, elaborated by Adolf Kehrer--uterine lower segment transverse incision.

Do Italian women prefer cesarean section? Results from a survey on mode of delivery preferences

PubMed Central

2013-01-01

Background About 20 million cesareans occur each year in the world and rates have steadily increased in almost all middle- and high-income countries over the last decades. Maternal request is often argued as one of the key forces driving this increase. Italy has the highest cesarean rate of Europe, yet there are no national surveys on the views of Italian women about their preferences on route of delivery. This study aimed to assess Italian women´s preference for mode of delivery, as well as reasons and factors associated with this preference, in a nationally representative sample of women. Methods This cross sectional survey was conducted between December 2010-March 2011. An anonymous structured questionnaire asked participants what was their preferred mode of delivery and explored the reasons for this preference by assessing their agreement to a series of statements. Participants were also asked to what extent their preference was influenced by a series of possible sources. The 1st phase of the study was carried out among readers of a popular Italian women´s magazine (Io Donna). In a 2nd phase, the study was complemented by a structured telephone interview. Results A total of 1000 Italian women participated in the survey and 80% declared they would prefer to deliver vaginally if they could opt. The preference for vaginal delivery was significantly higher among older (84.7%), more educated (87.6%), multiparous women (82.3%) and especially among those without any previous cesareans (94.2%). The main reasons for preferring a vaginal delivery were not wanting to be separated from the baby during the first hours of life, a shorter hospital stay and a faster postpartum recovery. The main reasons for preferring a cesarean were fear of pain, convenience to schedule the delivery and because it was perceived as being less traumatic for the baby. The source which most influenced the preference of these Italian women was their obstetrician, followed by friends or relatives

Cesarean section delivery and development of food allergy and atopic dermatitis in early childhood.

PubMed

Papathoma, Evangelia; Triga, Maria; Fouzas, Sotirios; Dimitriou, Gabriel

2016-06-01

Delivery by Cesarean section (CS) may predispose to allergic disorders, presumably due to alterations in the establishment of normal gut microbiota in early infancy. In this study, we sought to investigate the association between CS and physician-diagnosed food allergy and atopic dermatitis during the first 3 years of life, using data from a homogeneous, population-based, birth cohort. A total of 459 children born and cared for in the same tertiary maternity unit were examined at birth and followed up at 1, 6, 12, 18, 24, 30 and 36 months of age. Participants with symptoms suggestive of food allergy or atopic dermatitis were evaluated by a pediatric allergy specialist to confirm the diagnosis based on well-defined criteria. The rate of CS was 50.8% (n = 233). Food allergy was diagnosed in 24 participants (5.2%) while atopic dermatitis was diagnosed in 62 children (13.5%). Cesarean section (OR 3.15; 95% CI 1.14-8.70), atopic dermatitis of the child (OR 3.01; 95% CI 1.18-7.80), parental atopy (OR 4.33; 95% CI 1.73-12.1), and gestational age (OR 1.57; 95% CI 1.07-2.37) were significant and independent predictors of food allergy. Children with at least one allergic parent delivered by CS had higher probability of developing food allergy compared with vaginally delivered children of non-allergic parents (OR 10.0; 95% CI 3.06-32.7). Conversely, the effect of CS on atopic dermatitis was not significant (OR 1.35; 95% CI 0.74-2.47). Delivery by CS predisposes to the development of food allergy but not atopic dermatitis in early childhood. Cesarean section delivery seems to upregulate the immune response to food allergens, especially in children with allergic predisposition. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The impact of payment source and hospital type on rising cesarean section rates in Brazil, 1998 to 2008.

PubMed

Hopkins, Kristine; de Lima Amaral, Ernesto Friedrich; Mourão, Aline Nogueira Menezes

2014-06-01

High cesarean section rates in Brazilian public hospitals and higher rates in private hospitals are well established. Less is known about the relationship between payment source and cesarean section rates within public and private hospitals. We analyzed the 1998, 2003, and 2008 rounds of a nationally representative household survey (PNAD), which includes type of delivery, where it took place, and who paid for it. We construct cesarean section rates for various categories, and perform logistic regression to determine the relative importance of independent variables on cesarean section rates for all births and first births only. Brazilian cesarean section rates were 42 percent in 1998 and 53 percent in 2008. Women who delivered publicly funded births in either public or private hospitals had lower cesarean section rates than those who delivered privately financed deliveries in public or private hospitals. Multivariate models suggest that older age, higher education, and living outside the Northeast region all positively affect the odds of delivering by cesarean section; effects are attenuated by the payment source-hospital type variable for all women and even more so among first births. Cesarean section rates have risen substantially in Brazil. It is important to distinguish payment source for the delivery to have a better understanding of those rates. © 2014 Wiley Periodicals, Inc.

The Impact of Payment Source and Hospital Type on Rising Cesarean Section Rates in Brazil, 1998 to 2008

PubMed Central

Hopkins, Kristine; de Lima Amaral, Ernesto Friedrich; Mourão, Aline Nogueira Menezes

2015-01-01

Background High cesarean section rates in Brazilian public hospitals and higher rates in private hospitals are well established. Less is known about the relationship between payment source and cesarean section rates within public and private hospitals. Methods We analyzed the 1998, 2003, and 2008 rounds of a nationally representative household survey (PNAD), which includes type of delivery, where it took place, and who paid for it. We construct cesarean section rates for various categories, and perform logistic regression to determine the relative importance of independent variables on cesarean section rates for all births and first births only. Results Brazilian cesarean section rates were 42 percent in 1998 and 53 percent in 2008. Women who delivered publicly funded births in either public or private hospitals had lower cesarean section rates than those who delivered privately financed deliveries in public or private hospitals. Multivariate models suggest that older age, higher education, and living outside the Northeast region all positively affect the odds of delivering by cesarean section; effects are attenuated by the payment source–hospital type variable for all women and even more so among first births. Conclusions Cesarean section rates have risen substantially in Brazil. It is important to distinguish payment source for the delivery to have a better understanding of those rates. PMID:24684250

Improvements in Cesarean Section Techniques: Arad's Obstetrics Department Experience on Adapting the Vejnovic Cesarean Section Technique

PubMed Central

FURAU, Cristian; FURAU, Gheorghe; DASCAU, Voicu; CIOBANU, Gheorghe; ONEL, Cristina; STANESCU, Casiana

2013-01-01

ABSTRACT Objectives: Cesarean section has become recently the first choice for delivery in many clinics in Romania and worldwide. The purpose of our study is to assess the benefits of introducing the adapted Vejnovic uterine suture technique into daily practice. Material and Methods: A total of 1703 out of the 1776 cesarean section performed in the period January, 2012 - March, 2013 in the Obstetric Department of the Emergency Clinical County Hospital of Arad were retrospectively analyzed based on the cesarean section registries, birth registries and patient's personal medical records. We compared results between the group of patients undergoing adapted Vejnovic cesarean section technique and the group of patients operated in a classic manner. Outcomes: The cesarean section rate in the studied period was 56.48%. Adapted Vejnovic cesarean section technique was performed in 548 cases (30.86% of the cases), furthermore in the last 3 months studied it reached 57.27%. Mean APGAR score was better in the adapted Vejnovic cesarean section group (8.43) compared with the reference group (8.34). No significant differences were seen between the two groups regarding maternal age, gestation, weeks of gestation, newborn weight, anesthesia and indications for cesarean section. Exteriorizing the uterus helped the incidental diagnosis of 35 uterine myoma, 22 adnexal masses and 13 uterine malformations. Conclusion: In a society with a constant growth of cesarean rate, the adapted Vejnovic cesarean section technique is becoming popular amongst clinicians for its advantages, but further studies need to be developed for its standardization. PMID:24371494

The influence of women’s preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study

PubMed Central

2014-01-01

Background This study aimed to examine whether a mismatch between a woman’s preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth. Methods The study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women’s preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups. Results Examining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p < 0.001). However, Bonferroni post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety. Conclusions The results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms

Coding update of the SMFM definition of low risk for cesarean delivery from ICD-9-CM to ICD-10-CM.

PubMed

Armstrong, Joanne; McDermott, Patricia; Saade, George R; Srinivas, Sindhu K

2017-07-01

In 2015, the Society for Maternal-Fetal Medicine developed a low risk for cesarean delivery definition based on administrative claims-based diagnosis codes described by the International Classification of Diseases, Ninth Revision, Clinical Modification. The Society for Maternal-Fetal Medicine definition is a clinical enrichment of 2 available measures from the Joint Commission and the Agency for Healthcare Research and Quality measures. The Society for Maternal-Fetal Medicine measure excludes diagnosis codes that represent clinically relevant risk factors that are absolute or relative contraindications to vaginal birth while retaining diagnosis codes such as labor disorders that are discretionary risk factors for cesarean delivery. The introduction of the International Statistical Classification of Diseases, 10th Revision, Clinical Modification in October 2015 expanded the number of available diagnosis codes and enabled a greater depth and breadth of clinical description. These coding improvements further enhance the clinical validity of the Society for Maternal-Fetal Medicine definition and its potential utility in tracking progress toward the goal of safely lowering the US cesarean delivery rate. This report updates the Society for Maternal-Fetal Medicine definition of low risk for cesarean delivery using International Statistical Classification of Diseases, 10th Revision, Clinical Modification coding. Copyright © 2017. Published by Elsevier Inc.

Cohort study of the depression, anxiety, and anhedonia components of the Edinburgh Postnatal Depression Scale after delivery.

PubMed

Zanardo, Vincenzo; Giliberti, Lara; Volpe, Francesca; Parotto, Matteo; de Luca, Federico; Straface, Gianluca

2017-06-01

To investigate the applicability of the Edinburgh Postnatal Depression Scale (EPDS) for identifying depressive symptoms following vaginal or cesarean delivery. The present observational study included consecutive Italian-speaking women who underwent vaginal or cesarean deliveries of uncomplicated singleton pregnancies at term at Policlinico Abano Terme, Abano Terme, Italy, between February 1, 2014, and May 31, 2015, who completed the EPDS 2 days after delivery. EPDS scores and the depression, anxiety, and anhedonia subscale items were compared between delivery methods to identify factors predictive of high EPDS scores. There were 950 patients included in the analysis; 694 (73.1%) and 256 (26.9%) patients underwent vaginal and cesarean deliveries, respectively. Total EPDS scores were higher among patients who had cesarean deliveries compared with vaginal deliveries (6.95±4.80 vs 6.05±4.20; P=0.007); the depression (0.53±0.72 vs 0.37±0.65; P=0.007), anxiety (1.07±0.88 vs 1.16±0.93; P=0.021), and anhedonia (0.32±0.59 vs 0.19±0.48; P=0.009) subscale scores were all higher among patients who underwent cesarean deliveries. Women who underwent cesarean deliveries demonstrated higher EPDS scores and could be at increased risk of developing early postpartum depressive symptomatology, particularly anhedonia, anxiety, and depression. © 2017 International Federation of Gynecology and Obstetrics.

Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications.

PubMed

Tower, Amanda M; Frishman, Gary N

2013-01-01

The gynecologic sequelae due to deficient uterine scar healing after cesarean section are only recently being identified and described. These include conditions such as abnormal bleeding, pelvic pain, infertility, and cesarean scar ectopic pregnancy, as well as a potentially higher risk of complications and difficulties during gynecologic procedures such as uterine evacuation, hysterectomy, endometrial ablation, and insertion of an intrauterine device. The proposed mechanism of abnormal uterine bleeding is a pouch or "isthmocele" in the lower uterine segment that causes delayed menstrual bleeding. The prevalence of symptomatic or clinically relevant cesarean scar defects (CSDs) ranges from 19.4% to 88%. Possible risk factors for CSD include number of cesarean sections, uterine position, labor before cesarean section, and surgical technique used to close the uterine incision. There are no accepted guidelines for the diagnostic criteria of CSD. We propose that a CSD be defined on transvaginal ultrasound or saline infusion sonohysterography as a triangular hypoechoic defect in the myometrium at the site of the previous hysterotomy. We also propose a classification system to aid in standardized classification for future research. Surgical techniques for repair of CSD include laparoscopic excision, resectoscopic treatment, vaginal revision, and endometrial ablation. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Cesarean Delivery in the United States 2005 - 2014: A Population-Based Analysis Using the Robson Ten Group Classification System.

PubMed