170 What are the independent risk factors for repeated cesarean section in trial of VBAC?

Abstract Background Currently, FM is a sole subjective index which depends on self-assessment of pregnant women, and it can objectively reflect the well being of intrauterine fetus. It has been the focus of obstetricians' research and attention how to quantify fetal movement (FM) and change it into a relatively objective evaluation index. We sought to predict and evaluate the well being of intrauterine fetal with umbilical cord around the neck (UCAN) by performance of daily fetal movement counting chart (DFMC). Methods To retrospectively select 100-case pregnant women who met the enrolled requirements, and whether the fetal was intrauterine safety or not was predicted by analysis of the DFMC before delivery. According to the different perinatal outcomes after delivery, 100-cases pregnant women were divided into intrauterine safety (IUS) group (44 cases) and intrauterine unsafe (IUNS) group (56 cases). And the independent risk factors of fetal intrauterine safety, including maternal age, gestational week, umbilical artery systolic blood flow to diastolic blood flow ratio (S/D), amniotic fluid index (AFI), modified Fischer score of non stress test (NST), DFMC and mode of delivery were analyzed by multi-factors Binary Logistic Regression. Results Only FM and mode of delivery were independent risk factors affecting fetal safety intrauterine (all p value < 0.05). There was no remarkable difference between DFMC prediction and clinical retrospective evaluation of fetal safety in natural delivery and forceps delivery (all P value > 0.05), except in cesarean section (p < 0.05). The sensitivity, specificity and Yuden index of DFMC for predicting the intrauterine safety in natural vaginal delivery were 86.5%, 90.0% and 0.77 respectively, and in cesarean section were 66.7%, 94.6% and 0.61, respectively. Abnormal DFMC may account for the highest proportion of emergency cesarean section (87.5%, 35/40). Conclusions DFMC can effectively predict and evaluate the well being of intrauterine fetus with UCAN. At the same time, it can also provide limited clinical proofs for pregnant women with UCAN to choose model of delivery.

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Independent risk factors for cesarean section among women with thrombophilia

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2006.10.267 ◽

2006 ◽

Vol 195 (6) ◽

pp. S84

Author(s):

Anat Arodi ◽

Asher Bashiri ◽

Michael Friger ◽

Ana Smolin ◽

Moshe Mazor

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Independent Risk Factors

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Placenta previa: risk factors, feto-maternal outcome and complications

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20195331 ◽

2019 ◽

Vol 8 (12) ◽

pp. 4842

Author(s):

Pushpa A. Yadava ◽

Riya R. Patel ◽

Anushka S. Mehta

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Placenta Previa ◽

Caesarean Section Rate ◽

Case Fatality ◽

Normal Vaginal Delivery ◽

Perinatal Complications ◽

Maternal And Neonatal Outcomes ◽

Independent Risk Factors ◽

Timely Delivery

Background: Placenta previa is defined as placenta that is implanted somewhere in the lower uterine segment either over or very near the internal cervical os. Placenta previa and coexistent accrete syndromes contribute substantively to maternal and perinatal morbidity and mortality.Methods: All This is a retrospective study of 88 cases of placenta previa, which were admitted under department of obstetrics and gynecology in our institute during July 2017 to June 2019. All patients of placenta previa with gestational age > 28 weeks up to full term were included in the study. All cases were confirmed by ultrasound examination. Outcome measures prevalence of placenta previa, maternal and neonatal outcomes, and case fatality rate.Results: The total number of deliveries performed during the study period was 16330, of them, 88 cases were placenta previa. Thus, the prevalence of PP was 0.53%. Multiparity was one of the etiological factors in 84.09%, whereas previous LSCS was 47.73%, previous H/O D and E was 14.73%, previous H/O placenta previa was 7.95%. Obstetric hysterectomy was done in 7 (7.95%) patients out of 88 patients. 92.04% of patients delivered with cesarean section and 7.95% patients delivered with normal vaginal delivery. 22 (26.50%) babies out of 83 live born were admitted in NICU.Conclusions: Advancing maternal age, multiparity, prior cesarean section, and prior abortions are independent risk factors for placenta previa. Placenta previa remains a risk factor for adverse maternal and perinatal outcome. The detection of placenta previa should encourage a careful evaluation with timely delivery to reduce the associated maternal and perinatal complications. Measures to reduce the primary caesarean section rate should be adopted.

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Age and Body Mass Index as Independent Risk Factors in Different Indications for Scheduled Primary Cesarean Section [22G]

Obstetrics and Gynecology ◽

10.1097/01.aog.0000558721.44650.76 ◽

2019 ◽

Vol 133 (1) ◽

pp. 79S-79S

Author(s):

Emad A. Elsamadicy ◽

Laura Ha ◽

Mack Goldberg ◽

Chi Le

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Cesarean Section ◽

Body Mass ◽

Independent Risk Factors

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Risk Factors and Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo

10.26420/austinjpregnancychildbirth.2021.1002 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Ndomba MM ◽

◽

Mukuku O ◽

Tamubango HK ◽

Biayi JM ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Perinatal Outcomes ◽

Placenta Praevia ◽

Republic Of Congo ◽

Increased Risk ◽

Potential Risk Factors ◽

Independent Risk Factors

Introduction: Placenta Praevia (PP) is frequently associated with severe maternal bleeding leading to an increased risk for adverse outcome of mother and infant. This study aims to determine the prevalence, and to evaluate potential risk factors and respective outcomes of pregnancies with PP in Lubumbashi, Democratic Republic of Congo. Methods: Data were retrospectively collected from patients diagnosed with PP at 4 hospitals in Lubumbashi between January 2013 and December 2016. All women who gave birth to singleton infants were studied. Differences between women with PP and without PP were evaluated. Adjusted Odds Ratios (aOR) with 95% confidence intervals for risk factors, and adverse maternal and perinatal outcomes associated with PP were estimated in multivariable logistic regression. Results: The overall prevalence of PP was 1.49% (227/15,292). The following risk factors were independently associated with PP: multiparity ≥6 (aOR=2.36; 95% CI: 1.13-4.91), previous cesarean section (aOR=6.74; 95% CI: 2.99-15.18), and no antenatal care visit during pregnancy (aOR=7.15; 95% CI: 4.86-10.53). PP was significantly associated with adverse maternal outcomes such as delivery by cesarean section (aOR=3.09; 95% CI: 1.89- 5.06), maternal anemia (aOR=11.43; 95% CI: 6.20-21.06); and hospital stay of >4 days (aOR=2.02; 95% CI: 1.24-3.29). PP was also significantly associated with adverse perinatal outcomes such as Apgar scores of <7 at the 5th minute after birth (aOR=4.39; 95% CI: 2.62-7.36), low birth weight (aOR=4.10; 95% CI: 2.26-7.44), stillbirth (aOR=4.16; 95% CI: 1.39–12.46), and early neonatal death (aOR=5.72; 95% CI: 1.60–20.42). Conclusion: PP is associated with adverse maternal and perinatal outcomes, and multiple independent risk factors were identified. Therefore, detection and careful surveillance of these risk factors are important to ultimately improve maternal and perinatal outcomes.

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Risk Factors and Pregnancy Outcome in Women With a History of Cesarean Section Complicated by Placenta Accreta

10.21203/rs.3.rs-122477/v1 ◽

2020 ◽

Author(s):

Yingyu Liang ◽

lizi Zhang ◽

Shilei Bi ◽

Jingsi Chen ◽

Shanshan Zeng ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Cesarean Sections ◽

Han Ethnicity ◽

Parity Number ◽

History Of ◽

Independent Risk Factors ◽

Previous Cesarean

Abstract Objective: To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta.Methods: This retrospective study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in 7 provinces of China between January 2017 and December 2017. According to the intraoperative findings or the pathologic diagnosis after delivery, the study population was divided into placenta accreta (PA) and non-PA groups. We compared the pregnancy outcomes between the 2 groups, used multivariate logistic regression to analyze the risk factors for placental accreta, and used receiver operating characteristic curves to evaluate the value of the risk factors.Results: For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage, severe postpartum hemorrhage, diffuse intravascular coagulation, puerperal infection, intraoperative bladder injury, hysterectomy, and blood transfusion was significantly increased in the placenta accreta group (P<0.05)). At the same time, the rate of neonatal low-birth weight, the probability of neonatal comorbidities, and the rate of neonatal intensive care unit admission also increased significantly (P<0.05). Weight, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membrane, previous cesarean-section transverse incisions, history of placenta previa, and the combination of prenatal hemorrhage and placenta previa were all independent risk factors for placenta accreta; while non-Han ethnicity was an independent protective factor for placenta accreta (P<0.05). The area under the ROC curve (AUC) was 0.93 (95% CI=0.92-0.94); and the specificity, sensitivity, and accuracy rate were 0.87, 0.93, and 0.93, respectively.Conclusions: There was an increased risk of adverse outcomes in pregnancies complicated by placenta accreta in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, Han ethnicity, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with placenta accreta in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placental accreta in pregnancies of women with a history of cesarean section.

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Prediction of caesarean section for arrest of descent during the second stage of labour

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170565 ◽

2017 ◽

Vol 6 (3) ◽

pp. 963 ◽

Cited By ~ 1

Author(s):

Sunil Kumar Samal ◽

Setu Rathod

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Public Awareness ◽

Multivariable Analysis ◽

Second Stage Of Labor ◽

Second Stage ◽

Second Stage Of Labour ◽

Multiparous Women ◽

Fetal Complications ◽

Independent Risk Factors

Background: Friedman described the normal progress of labor in different curves for nulliparous and multiparous women in 1954. Any deviation from these curves during the second stage of labor is considered as failure to progress in the second stage of labor. The aim of the study is to define obstetrical risk factors for arrest of descent during the second stage of labour.Methods: All singleton, vertex, term deliveries with an unscarred uterus, between December 2013 to November 2016 (3 years) were included. Univariable and multivariable analysis were performed to investigate independent risk factors associated with arrest of descent during the second stage of labor.Results: The study included 7260 deliveries, of these 163 (3.3%) were complicated with arrest of descent during the second stage of labor. Using a multivariable analysis, the following obstetric risk factors were found to be significantly associated with arrest of descent: primigravida (RR=7.8, 95% CI=6.9-8.7, p<0.001), obesity (RR=1.8, 95% CI=1.6-2.0, p<0.001), short stature (RR=2.3, 95% CI=1.9-2.8, p<0.001), hypertensive disorders(RR=1.5, 95% CI=1.3-1.8,p<0.001), gestational diabetes(RR=1.5, 95% CI=1.2-1.8, p<0.001), free floating head before labour(RR=3.4, 95%CI=2.5-4.1, p<0.001), Occipito-posterior position(RR=3.3, 95% CI=2.1-4.5, p<0.002), Prelabour rupture of membrane (PROM) (RR=1.3, 95% CI=1.0-1.6, p<0.02), induction of labour (RR=2.2, 95% CI=1.0-3.4, p<0.03) and birth weight>3.5 kg (RR=2.2, 95% CI=2.0-2.4, p<0.001). Deliveries complicated by arrest of descent resulted in cesarean section in 67% and 34% vaginal delivery.Conclusions: In this era of increased public awareness and medicolegal events it is very crucial to assess and evaluate every woman in labor and to identify in advance the possibility of arrest in advanced labor so that a timely obstetric intervention possibly Cesarean section can prevent unnecessary maternal- fetal complications.

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Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section

Infection Control and Hospital Epidemiology ◽

10.1086/587810 ◽

2008 ◽

Vol 29 (6) ◽

pp. 477-484 ◽

Cited By ~ 103

Author(s):

Margaret A. Olsen ◽

Anne M. Butler ◽

Denise M. Willers ◽

Preetishma Devkota ◽

Gilad A. Gross ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Tertiary Care ◽

University Teaching ◽

Skin Closure ◽

Care Hospital ◽

Site Infection ◽

Increased Risk ◽

Independent Risk Factors

Background.Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.Objective.To determine independent risk factors for SSI after low transverse cesarean section.Design.Retrospective case-control study.Setting.Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital.Patients.A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001.Methods.Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression.Results.SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval {CI}, 4.1–33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4–5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0–1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1–0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI.Conclusions.These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.

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