Induction of Labor versus Cesarean Delivery in Twin Pregnancies

2019 ◽  
Vol 37 (13) ◽  
pp. 1324-1334
Author(s):  
Kelly B. Zafman ◽  
Andrei Rebarber ◽  
Stephanie Melka ◽  
Mariam Naqvi ◽  
Nathan S. Fox
Keyword(s):  
Length Of Stay ◽  
Cesarean Delivery ◽  
Induction Of Labor ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
High Rate ◽  
Ratio Analysis ◽  
Neonatal Ventilation ◽  
Maternal And Neonatal Outcomes ◽  
Twin Pregnancies

Abstract Objective This study was aimed to compare maternal and neonatal outcomes between women with twin pregnancies who underwent induction of labor with those women who had planned Cesarean delivery (CD). Study Design This is a retrospective cohort study of women with twin pregnancies ≥ 24 weeks with an indication for delivery but not in labor. Two groups were examined, women who underwent induction and women who underwent planned CD. Maternal and neonatal outcomes were compared between groups both for deliveries at gestational age ≥ 37 weeks and < 37 weeks. Results A total of 453 patients were included. Overall, 212 (46.8%) women underwent induction and 241 (53.2%) underwent planned CD. Women who underwent induction of labor had a high rate of VD, both in the term and preterm groups (69.8 and 73.6%, respectively). Women who underwent induction of labor had reduced maternal length of stay, neonatal length of stay, and blood loss, without any increase in adverse outcomes. Neonatal ventilation of either twin delivered < 37 weeks was higher in the CD compared with induction group (27.5 vs. 9.4%, p < 0.01), but this was not significant on adjusted odds ratio analysis (aOR = 0.71, 95% CI: 0.19–2.66). Conclusion Labor induction in twin gestations have improved maternal outcomes and similar neonatal outcomes compared with planned CD.

scholarly journals Maternal and Neonatal Outcomes after Attempted External Cephalic Version among Women with One Previous Cesarean Delivery

2018 ◽  
Vol 08 (04) ◽  
pp. e349-e354 ◽  
Author(s):  
Rodney McLaren ◽  
Fouad Atallah ◽  
Nelli Fisher ◽  
Howard Minkoff
Keyword(s):  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
External Cephalic Version ◽  
Multivariable Logistic Regression Analysis ◽  
Success Rates ◽  
Trial Of Labor ◽  
Maternal And Neonatal Outcomes ◽  
Previous Cesarean

Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD. Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes. Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% (p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17–5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19–21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10–2.82]). Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.

Nonmedically Indicated Induction of Labor Compared with Expectant Management in Nulliparous Women Aged 35 Years or Older

2018 ◽  
Vol 36 (01) ◽  
pp. 045-052 ◽  
Author(s):  
Katherine Bowers ◽  
Jane Khoury ◽  
Tetsuya Kawakita
Keyword(s):  
Intensive Care Unit ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Expectant Management ◽  
Induction Of Labor ◽  
Neonatal Outcomes ◽  
Nulliparous Women ◽  
Maternal And Neonatal Outcomes ◽  
Nicu Admission

Objective This article compares maternal and neonatal outcomes in women aged ≥ 35 years who experienced nonmedically indicated induction of labor (NMII) versus expectant management. Study Design This was a retrospective cohort study of nulliparas aged ≥ 35 years with a singleton and cephalic presentation who delivered at term. Outcomes were compared between women who underwent NMII at 37, 38, 39, and 40 weeks' gestation and those with expectant management that week. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for predefined covariates. Results Of 3,819 nulliparas aged ≥ 35 years, 1,409 (36.9%) women underwent NMII. Overall at 39 weeks' gestation or later, maternal and neonatal outcomes were similar or improved with NMII. At 37, 38, and 39 weeks' gestation, NMII compared with expectant management was associated with decreased odds of cesarean delivery at 37, 38, and 39 weeks' gestation. At 40 weeks' gestation, NMII compared with expectant management was associated with an increased odds of operative vaginal delivery and a decreased odds of neonatal intensive care unit (NICU) admission. Conclusion In nulliparous women aged ≥ 35 years, NMII was associated with decreased odds of cesarean delivery at 37 to 39 weeks' gestation and decreased odds of NICU admission at 40 weeks' gestation compared with expectant management.

scholarly journals Maternal and neonatal outcomes associated with induction of labor after one previous cesarean delivery: A French retrospective study

PLoS ONE ◽  
2020 ◽  
Vol 15 (8) ◽  
pp. e0237132
Author(s):  
Emma Vecchioli ◽  
Anne-Gaël Cordier ◽  
Anne Chantry ◽  
Alexandra Benachi ◽  
Isabelle Monier
Keyword(s):  
Retrospective Study ◽  
Cesarean Delivery ◽  
Induction Of Labor ◽  
Neonatal Outcomes ◽  
Maternal And Neonatal Outcomes ◽  
Previous Cesarean

scholarly journals Association between Adherence with Recommended Antenatal Care in Low-Risk, Uncomplicated Pregnancy, and Maternal and Neonatal Adverse Outcomes: Evidence from Italy

2020 ◽  
Vol 18 (1) ◽  
pp. 173
Author(s):  
Giovanni Corrao ◽  
Anna Cantarutti ◽  
Anna Locatelli ◽  
Gloria Porcu ◽  
Luca Merlino ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Prevalence Ratio ◽  
Population Based ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Lombardy Region ◽  
Uncomplicated Pregnancy ◽  
Maternal And Neonatal Outcomes ◽  
Estimate Prevalence

Antenatal care (ANC) aims of monitoring wellbeing of mother and foetus during pregnancy. We validate a set of indicators aimed of measuring the quality of ANC of women on low-risk, uncomplicated pregnancy through their relationship with maternal and neonatal outcomes. We conducted a population-based cohort study including 122,563 deliveries that occurred between 2015 and 2017 in the Lombardy Region, Italy. Promptness and appropriateness of number and timing of gynaecological visits, ultrasounds and laboratory tests were evaluated. We assessed several maternal and neonatal outcomes. Log-binomial regression models were used to estimate prevalence ratio (PR), and corresponding 95% confidence interval (95% CI), for the exposure→outcome association. Compared with women who adhered with recommendations, those who were no adherent had a significant higher prevalence of maternal intensive care units admission (PR: 3.1, 95%CI: 1.2–7.9; and 2.7, 1.1–7.0 respectively for promptness of gynaecological visits, and appropriateness of ultrasound examinations), low Apgar score (1.6, 1.1–1.2; 1.9, 1.3–2.7; and 2.1, 1.5–2.8 respectively for appropriateness and promptness of gynaecological visits, and appropriateness of ultrasound examinations), and low birth weight (1.8, 1.5–2.3 for appropriateness of laboratory test examinations). Benefits for mothers and newborn are expected from improving adherence to guidelines-driven recommendations regarding antenatal care even for low-risk, uncomplicated pregnancies.

Assessing Maternal and Fetal Risks Associated with Prolonged Induction of Labor

2018 ◽  
Vol 36 (05) ◽  
pp. 455-459 ◽  
Author(s):  
Jourdan Triebwasser ◽  
Jamie VanArtsdalen ◽  
Emily Kobernik ◽  
Kristian Seiler ◽  
Elizabeth Langen
Keyword(s):  
Propensity Score ◽  
Cesarean Delivery ◽  
Postpartum Hemorrhage ◽  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
Neonatal Morbidity ◽  
Induction Of Labor ◽  
Neonatal Outcomes ◽  
Cervical Dilation ◽  
Intensive Care Admission

Objective To assess whether prolonged induction of labor was associated with increased maternal or neonatal morbidity. Study Design We performed a retrospective cohort study of women undergoing induction of labor at a single institution. We included women with singletons ≥ 36 weeks with initial cervical dilation ≤4 cm. Prolonged induction of labor was defined as lasting > 36 hours from the time of initial method to delivery. A 2-to-1 propensity score-matched analysis was performed between women with and those without prolonged induction of labor. Maternal outcomes were cesarean delivery, chorioamnionitis, endometritis, postpartum hemorrhage, severe perineal laceration, and length of postpartum admission. Neonatal outcomes included Apgar scores, umbilical artery pH, and neonatal intensive care admission. Results Among 2,021 women, 407 (20.1%) had a prolonged induction. In unadjusted analyses, prolonged induction of labor was associated with increased cesarean delivery and chorioamnionitis. After 2-to-1 propensity score matching, there were 267 women with prolonged induction and 424 controls. Women with prolonged induction of labor had higher rates of cesarean delivery (35.6 vs. 16%, p < 0.001), chorioamnionitis (14.2 vs. 4.7%, p < 0.001), endometritis (6.4 vs. 1.9%, p = 0.002), and postpartum hemorrhage (18.8 vs. 11.9%, p = 0.008). There were no significant differences in neonatal outcomes. Conclusion Overall length of induction impacts maternal outcome.

Outcomes Associated With Trial of Labor After Cesarean Delivery

2021 ◽  
pp. 86-91
Author(s):  
Hadi Erfani ◽  
Alireza A. Shamshirsaz
Keyword(s):  
Cesarean Delivery ◽  
Study Design ◽  
Population Study ◽  
Patient Population ◽  
Neonatal Outcomes ◽  
Clinical Scenario ◽  
Trial Of Labor ◽  
Maternal And Neonatal Outcomes

This article provides a summary of a prominent study in obstetrics. What are the risks of adverse maternal and neonatal outcomes associated with trial of labor after cesarean delivery? With this question, the article presents the basics of the study, including funding, location, patient population, study design, endpoints, results, and criticism and limitations. It then briefly reviews other relevant studies in the field and information and the main recommendations of the most recent practice bulletin provided by the American College of Obstetricians and Gynecologists and concludes with a relevant clinical scenario.

Maternal and Neonatal Outcomes Following Induction of Labor

2013 ◽  
Vol 33 (1) ◽  
pp. 23
Author(s):  
R.M. Grivell ◽  
A.J. Reilly ◽  
H. Oakey ◽  
A. Chan ◽  
J.M. Dodd
Keyword(s):  
Induction Of Labor ◽  
Neonatal Outcomes ◽  
Maternal And Neonatal Outcomes
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