Neonatal outcomes according to actual delivery mode after planned vaginal delivery in women with a twin pregnancy

2021 ◽  
Vol 256 ◽  
pp. 17-24
Author(s):  
Simone MTA Goossens ◽  
Sabine Ensing ◽  
Frans JME Roumen ◽  
Jan G. Nijhuis ◽  
Ben W Mol
Keyword(s):  
Vaginal Delivery ◽  
Twin Pregnancy ◽  
Neonatal Outcomes ◽  
Delivery Mode

scholarly journals Delivery of Twin Gestation (≥ 32.0 Weeks): The Vaginal Route as a Practicable and Safe Alternative to Cesarean Section

2020 ◽  
Vol 80 (10) ◽  
pp. 1033-1040
Author(s):  
Anne Dathan-Stumpf ◽  
Katharina Winkel ◽  
Holger Stepan
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Neonatal Outcome ◽  
Neonatal Outcomes ◽  
University Hospital ◽  
Delivery Mode ◽  
Safe Alternative ◽  
Vaginal Deliveries ◽  
Twin Pregnancies ◽  
Second Twin

Abstract Objective The appropriate delivery mode for twins is discussed controversially in the literature. The aim of this study was to investigate delivery modes and short-term neonatal outcomes of twin pregnancies delivered in University Hospital Leipzig. Material and Methods A total of 274 twin pregnancies (32.0 to 39.4 weeks of gestation) delivered between 2015 and 2017 were analyzed retrospectively with regard to the planned and final delivery mode as well as neonatal outcomes. The inclusion and exclusion criteria for vaginal delivery were comparable to those of the Twin Birth Study. Results The spontaneous birth rate for births planned as vaginal deliveries was 78.5%; the rate of secondary cesarean section was 19.4%. The final total cesarean rate was 58.8%, and the rate of vaginal deliveries was 41.2%. Vertex or non-vertex position of the second twin had no significant effect on neonatal outcome or mean delivery interval between the birth of the first and second twin. Chorionicity, neonatal weight and gender had no significant impact on delivery mode. However, successful vaginal delivery was associated with higher gestational age and both fetuses in vertex position. The combined neonatal outcome for both twins was significantly worse if they were delivered by cesarean section compared to spontaneous birth. In addition, the leading twin in monochorionic/diamniotic (MC/DA) pregnancies was intubated more frequently after cesarean delivery and had significantly lower Apgar scores. Conclusion Vaginal delivery in twin pregnancies is a practicable and safe option in specific defined conditions and when the appropriate infrastructure and clinical experience is available.

scholarly journals Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy

2014 ◽  
Vol 69 (2) ◽  
pp. 61-62 ◽  
Author(s):  
Jon F.R. Barrett ◽  
Mary E. Hannah ◽  
Eileen K. Hutton ◽  
Andrew R. Willan ◽  
Alexander C. Allen ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Vaginal Delivery ◽  
Twin Pregnancy

scholarly journals Birth delivery mode alters perinatal cell death in the mouse brain

2018 ◽  
Vol 115 (46) ◽  
pp. 11826-11831 ◽  
Author(s):  
Alexandra Castillo-Ruiz ◽  
Morgan Mosley ◽  
Andrew J. Jacobs ◽  
Yarely C. Hoffiz ◽  
Nancy G. Forger
Keyword(s):  
Cell Death ◽  
Brain Development ◽  
Vaginal Delivery ◽  
Maternal Separation ◽  
Developmental Process ◽  
Neuronal Cell Death ◽  
Neuronal Cell ◽  
Brain Regions ◽  
Delivery Mode ◽  
Gestation Length

Labor and a vaginal delivery trigger changes in peripheral organs that prepare the mammalian fetus to survive ex utero. Surprisingly little attention has been given to whether birth also influences the brain, and to how alterations in birth mode affect neonatal brain development. These are important questions, given the high rates of cesarean section (C-section) delivery worldwide, many of which are elective. We examined the effect of birth mode on neuronal cell death, a widespread developmental process that occurs primarily during the first postnatal week in mice. Timed-pregnant dams were randomly assigned to C-section deliveries that were yoked to vaginal births to carefully match gestation length and circadian time of parturition. Compared with rates of cell death just before birth, vaginally-born offspring had an abrupt, transient decrease in cell death in many brain regions, suggesting that a vaginal delivery is neuroprotective. In contrast, cell death was either unchanged or increased in C-section–born mice. Effects of delivery mode on cell death were greatest for the paraventricular nucleus of the hypothalamus (PVN), which is central to the stress response and brain–immune interactions. The greater cell death in the PVN of C-section–delivered newborns was associated with a reduction in the number of PVN neurons expressing vasopressin at weaning. C-section–delivered mice also showed altered vocalizations in a maternal separation test and greater body mass at weaning. Our results suggest that vaginal birth acutely impacts brain development, and that alterations in birth mode may have lasting consequences.

Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates < 32 Weeks

2021 ◽  
Author(s):  
Nadia S. Eugster ◽  
Florence Corminboeuf ◽  
Gilbert Koch ◽  
Julia E. Vogt ◽  
Thomas Sutter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Preterm Neonates ◽  
Multiple Birth ◽  
Plasma Sodium ◽  
Delivery Mode ◽  
Antenatal Corticosteroids ◽  
Clinical Complications

Abstract Background Preterm neonates frequently experience hypernatremia (plasma sodium concentrations >145 mmol/l), which is associated with clinical complications, such as intraventricular hemorrhage. Study design In this single center retrospective observational study, the following 7 risk factors for hypernatremia were analyzed in very low gestational age (VLGA, below 32 weeks) neonates: gestational age (GA), delivery mode (DM; vaginal or caesarian section), sex, birth weight, small for GA, multiple birth, and antenatal corticosteroids. Machine learning (ML) approaches were applied to obtain probabilities for hypernatremia. Results 824 VLGA neonates were included (median GA 29.4 weeks, median birth weight 1170 g, caesarean section 83%). 38% of neonates experienced hypernatremia. Maximal sodium concentration of 144 mmol/l (interquartile range 142–147) was observed 52 hours (41–65) after birth. ML identified vaginal delivery and GA as key risk factors for hypernatremia. The risk of hypernatremia increased with lower GA from 22% for GA ≥ 31–32 weeks to 46% for GA < 31 weeks and 60% for GA < 27 weeks. A linear relationship between maximal sodium concentrations and GA was found, showing decreases of 0.29 mmol/l per increasing week GA in neonates with vaginal delivery and 0.49 mmol/l/week after cesarean section. Sex, multiple birth and antenatal corticosteroids were not associated hypernatremia. Conclusion VLGA neonates with vaginal delivery and low GA have the highest risk for hypernatremia. Early identification of neonates at risk and early intervention may prevent extreme sodium excursions and associated clinical complications.

scholarly journals Strength of preference for vaginal birth as a predictor of delivery mode among women who attempt a vaginal delivery

2014 ◽  
Vol 210 (5) ◽  
pp. 440.e1-440.e6 ◽  
Author(s):  
Erica Wu ◽  
Anjali J. Kaimal ◽  
Kathryn Houston ◽  
Lynn M. Yee ◽  
Sanae Nakagawa ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Vaginal Birth ◽  
Delivery Mode ◽  
Strength Of Preference

scholarly journals Caesarean Section to Prevent Transmission of Hepatitis B: A Meta-Analysis

2014 ◽  
Vol 28 (8) ◽  
pp. 439-444 ◽  
Author(s):  
Matthew S Chang ◽  
Sravanya Gavini ◽  
Priscila C Andrade ◽  
Julia McNabb-Baltar
Keyword(s):  
Caesarean Section ◽  
Hepatitis B ◽  
Vaginal Delivery ◽  
Vertical Transmission ◽  
Meta Analysis ◽  
Delivery Mode ◽  
Significant Heterogeneity ◽  
Case Control Studies ◽  
Manual Search ◽  
Hbv Transmission

BACKGROUND: Vertical transmission of hepatitis B virus (HBV) occurs in up to 10% to 20% of births.OBJECTIVE: To assess whether Caesarean section, compared with vaginal delivery, prevents HBV transmission.METHODS: A systematic review and meta-analysis was conducted. Two investigators independently searched PubMed, EMBASE and other databases for relevant studies published between 1988 and 2013. A manual search of relevant topics and major conferences for abstracts was also conducted. Randomized trials, cohort and case-control studies assessing the effect of delivery mode on vertical transmission of HBV were included. Studies assessing antiviral therapy and patients with coinfection were excluded. The primary outcome was HBV transmission rates according to delivery method.RESULTS: Of the 430 studies identified, 10 were included. Caesarean section decreased the odds of HBV transmission by 38% compared with vaginal delivery (OR 0.62 [95% CI 0.40 to 0.98]; P=0.04) based on a random-effects model. Significant heterogeneity among studies was found (I2=63%; P=0.003), which was largely explained by variation in hepatitis B immune globulin (HBIG) administration. Meta-regression showed a significant linear association between the percentage of infants receiving HBIG per study and the log OR (P=0.005), with the least benefit observed in studies with 100% HBIG administration. Subgroup analysis of hepatitis B e-antigen-positive women who underwent Caesarean section did not show a significant reduction in vertical transmission.DISCUSSION: Caesarean section may protect against HBV transmission; however, convincing benefit could not be demonstrated due to significant study heterogeneity from variable HBIG administration, highlighting the importance of HBIG in HBV prevention.CONCLUSION: More high-quality studies are needed before any recommendations can be made.

scholarly journals Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhifen Hua ◽  
Fadwa El Oualja
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Placenta Previa ◽  
Mode Of Delivery ◽  
Fetal Membrane ◽  
Delivery Mode ◽  
Maternal Preference

Abstract Background The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). Methods Pregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded. Results Out of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery. Conclusions We concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.

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