Effect of Trial of Labor before Cesarean and Risk of Subsequent Placenta Accreta Spectrum Disorders

2019 ◽  
Vol 37 (06) ◽  
pp. 633-637
Author(s):  
Katharine N. O'Malley ◽  
Mary E. Norton ◽  
Sarah S. Osmundson
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Primary Outcome ◽  
Placenta Accreta ◽  
Secondary Analysis ◽  
Subsequent Pregnancy ◽  
Trial Of Labor ◽  
Increased Risk ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Abstract Objective This study aimed to examine whether labor before cesarean affects the risk of placenta accreta spectrum (PAS) disorders in a subsequent pregnancy. Study Design This is a secondary analysis of the Cesarean Registry, a prospective cohort study of women undergoing cesarean between 1999 and 2002. Women with one prior cesarean with known indications, which were categorized as likely associated with labor (labored cesarean) versus likely not associated with labor (unlabored cesarean), were included. Primary outcome was PAS disorder. Results Of 34,224 women, 60% had a “labored cesarean” and 40% had an “unlabored cesarean.” Women with prior unlabored cesarean were more likely to have subsequent PAS disorder compared with women with a prior labored cesarean after adjusting for confounders (0.28 vs. 0.13%; adjusted odds ratio: 2.03; 95% confidence interval: 1.22–3.38). Conclusion Prior unlabored cesarean is associated with an increased risk of PAS disorders in a subsequent pregnancy. This association may aid in risk stratification in women with suspected PAS disorders and help counsel about risks associated with cesarean on maternal request.

Epidurals and the Modern Labor Curve: How Epidural Timing Impacts Fetal Station during Active Labor

2017 ◽  
Vol 35 (05) ◽  
pp. 421-426
Author(s):  
Methodius Tuuli ◽  
Molly Stout ◽  
Candice Woolfolk ◽  
Kimberly Roehl ◽  
George Macones ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Single Institution ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Increased Risk ◽  
Active Labor ◽  
Secondary Outcomes ◽  
Singleton Pregnancies

Objective The objective of this study was to estimate epidural timing's impact on fetal station during active labor. Study Design This secondary analysis of a single-institution prospective cohort study included all term singleton pregnancies, stratified by parity. Those with early epidurals (placed at <6 cm) were compared with those with late epidurals (placed at ≥6 cm). The primary outcome was median fetal station from 6 to 10 cm. Secondary outcomes included rate of prolonged first or second stage of labor (>95%). Multivariable logistic regression adjusted for labor type. Results Among 7,647 women, 3,434 were nulliparous (2,983 with early epidurals and 451 with late epidurals) and 4,213 multiparous (3,141 with early epidurals and 1,072 with late epidurals). Interquartile ranges (IQRs) suggested fetal station at 6 cm was likely lower among those with early epidurals (nulliparous: median head station −1 [IQR: −1 to 0] for early epidural vs. −1 [IQR: −2 to 0] for late epidural, p < 0.01; multiparous: −1 (IQR: −2 to 0] for early epidural vs. −1 [IQR: −3 to −1] for late epidural, p < 0.01). Early epidurals were not associated with increased risk of prolonged first stage, but among nulliparous were associated with decreased risk of prolonged second stage (adjusted odds ratio: 0.66 [95% confidence interval: 0.44–0.99]). Conclusion Early epidurals were associated with lower fetal station in active labor but not prolonged first stage.

Intrauterine Pressure Catheter Use Is Associated with an Increased Risk of Postcesarean Surgical Site Infections

2019 ◽  
Vol 37 (06) ◽  
pp. 557-561 ◽  
Author(s):  
Stephen E. Gee ◽  
Marwan Ma'ayeh ◽  
Calvin Ward ◽  
Catalin Buhimschi ◽  
Mark Klebanoff ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Secondary Analysis ◽  
Surgical Site Infections ◽  
Vaginal Birth After Cesarean ◽  
Maternal Fetal Medicine ◽  
Intrauterine Pressure ◽  
Increased Risk ◽  
Potential Area ◽  
Pressure Catheter

Abstract Objective This study aimed to determine if intrapartum placement of an intrauterine pressure catheter (IUPC) is associated with an increased rate of surgical site infections in women undergoing a cesarean delivery. Study Design This was a secondary analysis of the prospective observational Maternal–Fetal Medicine Units Network Vaginal Birth after Cesarean Registry. We compared patients with and without IUPC use. A multivariable logistic regression was performed to evaluate for an association between IUPC use and postcesarean surgical site infections. Results The study included 16,887 women: 7,441 with IUPC use and 9,446 without IUPC use. After adjustment for potential cofounders, IUPC use was associated with an increased risk of postcesarean infections compared with those without IUPC use (adjusted odds ratio: 1.28; 95% confidence interval: 1.10–1.50; p = 0.002). Conclusion IUPC use is associated with an increased risk of postcesarean surgical site infections. This supports the judicious use of IUPC for limited clinical indications and provides a potential area of focus for reduction in postcesarean infections.

scholarly journals Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants

2019 ◽  
Vol 131 (4) ◽  
pp. 830-839 ◽  
Author(s):  
Jorge A. Gálvez ◽  
Samuel Acquah ◽  
Luis Ahumada ◽  
Lingyu Cai ◽  
Marcia Polanski ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Primary Outcome ◽  
Cross Sectional ◽  
Emergency Procedures ◽  
Academic Center ◽  
Healthy Infants ◽  
Increased Risk ◽  
History Of ◽  
American Society

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background The infant airway is particularly vulnerable to trauma from repeated laryngoscopy attempts. Complications associated with elective tracheal intubations in anesthetized infants may be underappreciated. We conducted this study of anesthetized infants to determine the incidence of multiple laryngoscopy attempts during routine tracheal intubation and assess the association of laryngoscopy attempts with hypoxemia and bradycardia. Methods We conducted a retrospective cross-sectional cohort study of anesthetized infants (age less than or equal to 12 months) who underwent direct laryngoscopy for oral endotracheal intubation between January 24, 2015, and August 1, 2016. We excluded patients with a history of difficult intubation and emergency procedures. Our primary outcome was the incidence of hypoxemia or bradycardia during induction of anesthesia. We evaluated the relationship between laryngoscopy attempts and our primary outcome, adjusting for age, weight, American Society of Anesthesiologists status, staffing model, and encounter location. Results A total of 1,341 patients met our inclusion criteria, and 16% (n = 208) had multiple laryngoscopy attempts. The incidence of hypoxemia was 35% (n = 469) and bradycardia was 8.9% (n = 119). Hypoxemia and bradycardia occurred in 3.7% (n = 50) of patients. Multiple laryngoscopy attempts were associated with an increased risk of hypoxemia (adjusted odds ratio: 1.78, 95% CI: 1.30 to 2.43, P &lt; 0.001). There was no association between multiple laryngoscopy attempts and bradycardia (adjusted odds ratio: 1.23, 95% CI: 0.74 to 2.03, P = 0.255). Conclusions In a quaternary academic center, healthy infants undergoing routine tracheal intubations had a high incidence of multiple laryngoscopy attempts and associated hypoxemia episodes.

scholarly journals Placenta accreta not previa: a rare case report of placenta accreta in an unscarred uterus

2019 ◽  
Vol 8 (12) ◽  
pp. 5050
Author(s):  
Renuka Malik ◽  
Swati Singh ◽  
Jaya Chawla ◽  
Meenakshi Bhardwaj
Keyword(s):  
Caesarean Delivery ◽  
Placenta Accreta ◽  
Surgical Scar ◽  
Dilatation And Curettage ◽  
Increased Risk ◽  
Uterine Anomalies ◽  
History Of ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
Placenta Accrete

Placenta accreta spectrum disorders are usually associated with direct surgical scar such as caesarean delivery, surgical termination of pregnancy, Dilatation and curettage, Myomectomy, Endometrial resection and Asherman’s syndrome. It can also be associated with non-surgical scar and uterine anomalies. Rarely it can be encountered in unscarred uterus. Mrs X, 35-year female, unbooked patient, G7P2L2A4 with nine months of amenorrhoea reported in emergency of RML Hospital on 30/07/2019 with history of labour pains since 2 days. Patient gave history of four dilatation and curettage for incomplete abortion. On examination patient was found to be severely anaemic (Hb -6 gm). 2 Packed RBC were transfused preoperatively. There was no progress in labour beyond 6 cm for 4 hours. Patient was thus taken for LSCS for NPOL, with blood on flow. Intraoperatively, after delivery of the baby placenta which was fundo-posterior did not separate. In view of parity and morbidly adherent placenta (clinical grade III), subtotal hysterectomy was done. Patient was transfused 4 PRBC, 4 FFP and 2 platelets. Uterus with placenta in situ was sent for histopathology. Patient was in ICU for 2 days and recovered well. Post-operative period was uneventful. Placenta accreta is defined as abnormal trophoblast invasion of whole or a part of placenta into myometrium of uterine wall. Caesarean delivery is associated with increased risk of placenta accrete and the risk increases with each caesarean section, from 0.3% in woman with one previous caesarean delivery to 6.47% for woman with five or more caesarean deliveries. Placenta accreta spectrum disorders occur in 3% of woman diagnosed with placenta previa and no prior caesarean. In the developing world, the obstetrician should be prepared to encounter un diagnosed placenta accrete even in absence of previous LSCS. Curretage following MTP is also a risk factor, so vigourous currettage should be avoided to prevent endometrial damage.

Change in Cervical Length across Pregnancies and Preterm Delivery

2019 ◽  
Vol 37 (06) ◽  
pp. 598-602
Author(s):  
Annie Dude ◽  
Emily S. Miller
Keyword(s):  
Cohort Study ◽  
Preterm Delivery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Length Change ◽  
Cervical Length ◽  
Subsequent Pregnancy ◽  
Short Cervix ◽  
Increased Risk ◽  
The Difference

Abstract Objective This study aimed to determine whether a decrease in midtrimester cervical length across pregnancies is associated with preterm delivery in a subsequent pregnancy. Study Design This is a cohort study of women who had two consecutive singleton births at the same institution. Midtrimester cervical length change across pregnancies was measured as the difference in centimeters (cm) between cervical lengths using the measurement taken closest to 200/7 weeks' gestation in each pregnancy. Cervical length shortening was defined as present if the cervical length decreased by at least one standard deviation in the subsequent pregnancy. Results Among 1,552 women, 114 (7.4%) experienced a preterm delivery in the subsequent pregnancy. Compared with women whose subsequent pregnancy cervical length remained stable or increased, women whose cervical length shortened were more likely to experience a preterm delivery (10.3 vs. 6.7%; p = 0.04). Cervical length shortening remained associated with preterm delivery even when accounting for a woman's prior preterm delivery, prior pregnancy short cervix, interdelivery interval, progesterone use, and cervical length in the subsequent pregnancy (adjusted odds ratio = 1.89; 95% confidence interval = 1.11–3.20). Conclusion Midtrimester cervical length shortening across pregnancies is independently associated with an increased risk of preterm delivery.

scholarly journals Placenta Accreta Spectrum Disorders and Cesarean Scar Pregnancy Screening: Are we Asking the Right Questions?

2021 ◽  
Vol 43 (05) ◽  
pp. 347-350
Author(s):  
Conrado Milani Coutinho ◽  
Laure Noel ◽  
Veronica Giorgione ◽  
Lígia Conceição Assef Marçal ◽  
Amar Bhide ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
The Right

scholarly journals Time to First Cigarette and Self-Reported Health Among US Adult Smokers

2019 ◽  
Vol 12 ◽  
pp. 1179173X1882526 ◽  
Author(s):  
Baksun Sung
Keyword(s):  
United States ◽  
Propensity Score ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Smoking Behavior ◽  
The United States ◽  
Elevated Risk ◽  
Poor Health ◽  
Increased Risk ◽  
Reported Health

Background: Numerous studies have reported that shorter time to first cigarette (TTFC) is linked to elevated risk for smoking-related morbidity. However, little is known about the influence of early TTFC on self-reported health among current smokers. Hence, the objective of this study was to examine the association between TTFC and self-reported health among US adult smokers. Methods: Data came from the 2012-2013 National Adult Tobacco Survey (NATS). Current smokers aged 18 years and older (N = 3323) were categorized into 2 groups based on TTFC: ≤ 5 minutes (n = 1066) and >5 minutes (n = 2257). Propensity score matching (PSM) was used to control selection bias. Results: After adjusting for sociodemographic and smoking behavior factors, current smokers with early TTFC had higher odds for poor health in comparison with current smokers with late TTFC in the prematching (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.31-2.08) and postmatching (AOR = 1.60; 95% CI = 1.22-2.09) samples. Conclusions: In conclusion, smokers with early TTFC were associated with increased risk of poor health in the United States. To reduce early TTFC, elaborate efforts are needed to educate people about harms of early TTFC and benefits of stopping early TTFC.

Abstract WP200: Post-operative Infection Does not Increase Risk of Post-operative Stroke: Analysis From a Nationwide Quality Initiative Program

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Benjamin R Kummer ◽  
Rebecca Hazan ◽  
Hooman Kamel ◽  
Alexander E Merkler ◽  
Joshua Z Willey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Odds Ratio ◽  
Postoperative Infection ◽  
Adjusted Odds Ratio ◽  
Risk Of Infection ◽  
Postoperative Stroke ◽  
Increased Risk ◽  
Increase Risk ◽  
Initiative Program ◽  
The Relationship

Introduction: Infection has been described as a trigger for acute ischemic stroke, but the relationship between postoperative infection and the risk of postoperative stroke is unclear. We investigated the association between postoperative infection and stroke using the American College of Surgeons National Surgical Quality Initiative Program (NSQIP) database. Hypothesis: Postoperative infection is associated with an increased risk of postoperative stroke. Methods: We used the NSQIP database to identify all patients who underwent surgery between the years of 2000 and 2010 and developed a postoperative stroke within 30 days of surgery. The group was further stratified according to the presence of infection preceding stroke. Using a logistic regression model adjusted for age, race, sex, medical comorbidities, surgical type, and dichotomized functional status, we compared the risk of stroke in patients with and without preceding infections, and investigated the risk of infection following stroke. Results: 729,886 surgical patients were identified, of whom 2,703 (0.3%) developed postoperative stroke. 848 (0.12%) patients developed both postoperative stroke and infection. Among patients who had postoperative stroke, 100 (3.7%) had developed an infection prior to developing a stroke. Patients with infection prior to stroke had a lower risk of stroke than patients who did not develop infection prior to stroke (adjusted odds ratio [OR] 0.25, 95%CI 0.20-0.32). 748 patients (0.1%) developed an infection after having a postoperative stroke. These patients had a higher risk of infection (incidence rate ratio 2.76, 95%CI 2.57-2.97) and a higher odds of infection (adjusted odds ratio [OR] 3.47, 95%CI 3.18-3.78) than patients who did not have a stroke. Conclusions: We found that the presence of a preceding infection was associated with a low risk of postoperative stroke in a large surgical inpatient sample. Although the total number of strokes may have been under-reported, these results conflict with other studies that report that infection is a trigger for ischemic stroke. Further analyses using more granular data are needed to investigate the relationship between postoperative infection and the risk of postoperative stroke.

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