Timing of Repeat Cesarean Delivery for Women with a Prior Classical Incision

2020 ◽  
Author(s):  
Marwan Ma'ayeh ◽  
Paulina Haight ◽  
Emily A. Oliver ◽  
Mark B. Landon ◽  
Kara M. Rood
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cesarean Delivery ◽  
Secondary Analysis ◽  
Neonatal Morbidity ◽  
Neonatal Outcomes ◽  
Maternal Outcomes ◽  
Adverse Neonatal Outcomes ◽  
Nicu Admission ◽  
Repeat Cesarean Delivery

Objective This study aimed to compare neonatal outcomes for delivery at 36 weeks compared with 37 weeks in women with prior classical cesarean delivery (CCD). Study Design This was a secondary analysis of the prospective observational cohort of the Eunice Kennedy National Institute for Child and Human Development's Maternal-Fetal Medicine Unit Network Cesarean Registry. Data on cases of repeat cesarean delivery (RCD) in the setting of a prior CCD were abstracted and used for analysis. This study compared outcomes of women who delivered at 360/7 to 366/7 versus 370/7 to 376/7 weeks. The primary outcome was a composite of adverse neonatal outcomes that included neonatal intensive care unit (NICU) admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), hypoglycemia, mechanical ventilation, sepsis, length of stay ≥5 days, and neonatal death. A composite of maternal outcomes that included uterine rupture, blood transfusion, general anesthesia, cesarean hysterectomy, venous thromboembolism, maternal sepsis, intensive care unit admission, and surgical complications was also evaluated. Results There were 436 patients included in the analysis. Women who delivered at 36 weeks (n = 176) were compared those who delivered at 37 weeks (n = 260). There were no differences in baseline characteristics. Delivery at 37 weeks was associated with a reduction in composite neonatal morbidity (24 vs. 34%, adjusted odds ratio [aOR] = 0.61 [0.31–0.94]), including a decrease in NICU admission rates (20 vs. 29%, aOR = 0.63 [0.40–0.99]), hospitalization ≥5 days (13 vs. 24%, aOR = 0.48 [0.29–0.8]), and RDS or TTN (9 vs. 19%, aOR = 0.43 [0.24–0.77]). There was no difference in adverse maternal outcomes (7 vs. 7%, aOR = 0.98 [0.46–2.09]). Conclusion Delivery at 37 weeks for women with a history of prior CCD is associated with a decrease in adverse neonatal outcomes, compared with delivery at 36 weeks. Key Points

Neonatal Outcomes Associated with Noncephalic Presentation at Delivery in Preterm Birth

2018 ◽  
Vol 35 (12) ◽  
pp. 1131-1137
Author(s):  
Annalisa Post ◽  
Geeta Swamy ◽  
Chad Grotegut ◽  
Amber Wood
Keyword(s):  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Secondary Analysis ◽  
Neonatal Outcomes ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stratified Analysis

Objective The objective of this study is to evaluate the effect of noncephalic presentation on neonatal outcomes in preterm delivery. Study Design In this study a secondary analysis of the BEAM trial was performed. It included women with singleton, liveborn, and nonanomalous fetuses. Neonatal outcomes were compared in noncephalic versus cephalic presentation. Adjusted odds ratios and 95% confidence intervals were calculated for each outcome with logistic regression while controlling for possible confounders. A stratified analysis by mode of delivery was also performed in this study. Results A total of 458 noncephalic deliveries were compared with 1,485 cephalic deliveries. In multivariate analysis, noncephalic presentation was associated with increased risk of death in the neonatal intensive care unit (NICU) or death at <15 months corrected gestational age (cGA), and a decreased risk of IVH. The risk of death persisted in stratified analysis, with increased risk of death at <15 months cGA in noncephalic neonates born via cesarean delivery. In the vaginal delivery group, there was an increased risk of death at <15 months cGA and NICU death. Conclusion After controlling for possible confounders, neonates who are noncephalic at delivery have higher risk for death <15 months cGA and death in the NICU while their risk of IVH is reduced. The risk of death persisted in stratified analyses by mode of delivery.

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.

Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes

2021 ◽  
pp. 92-96
Author(s):  
Katherine Johnson ◽  
Brett C. Young
Keyword(s):  
Cesarean Delivery ◽  
Obstetric Care ◽  
Neonatal Outcomes ◽  
National Guidelines ◽  
Population Number ◽  
Adverse Neonatal Outcomes ◽  
Study Population ◽  
Location Study ◽  
Elective Repeat Cesarean ◽  
Repeat Cesarean Delivery

This article provides a summary of a landmark study in obstetrics. The article provides insight on a pivotal question; Is delivery before 39 weeks among patients undergoing elective repeat cesarean delivery associated with increased risk of adverse neonatal outcomes? The authors describe the basics of the study, including study location, study population, number of patients, study design, endpoints, results, and limitations. The article briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The article places these finding in contemporary context and highlights its impact on obstetric care. In addition, the author reference updated national guidelines developed as a result of this study.

scholarly journals Associations of ultrasound estimated early mid pregnancy visceral and subcutaneous fat depths and early pregnancy BMI with adverse neonatal outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emelie Lindberger ◽  
Anna-Karin Wikström ◽  
Eva Bergman ◽  
Karin Eurenius ◽  
Ajlana Mulic-Lutvica ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Pregnancy ◽  
Neonatal Intensive Care ◽  
Subcutaneous Fat ◽  
Neonatal Outcomes ◽  
Composite Outcome ◽  
Neonatal Hypoglycemia ◽  
Adverse Neonatal Outcomes

AbstractThis study investigated whether maternal central adiposity and body mass index (BMI) were associated with neonatal hypoglycemia and adverse neonatal outcomes. A cohort study was performed at Uppsala University Hospital, Sweden, between 2015 and 2018. Visceral and subcutaneous fat depths were measured by ultrasound at the early second-trimester anomaly scan in 2771 women giving birth to singleton infants. Body mass index was assessed in early pregnancy. Logistic regression models were performed. Adjustments were made for age, BMI (not in model with BMI as exposure), smoking, maternal country of birth, and parity. Outcomes were neonatal hypoglycemia (blood glucose concentration < 2.6 mmol/l), a composite of adverse neonatal outcomes (Apgar < 7 at 5 min of age, or umbilical artery pH ≤ 7.0, or admission to neonatal intensive care unit), and the components of the composite outcome. Visceral and subcutaneous fat depths measured by ultrasound in early mid pregnancy were not associated with any of the outcomes in adjusted analyses. For every unit increase in BMI, the likelihood of neonatal hypoglycemia increased by 5% (aOR 1.05, 95% CI 1.01–1.10), the composite outcome by 5% (aOR 1.05, 95% CI 1.01–1.08), and admission to neonatal intensive care unit by 6% (aOR 1.06, 95% CI 1.02–1.10).

The Risk of Adverse Neonatal Outcomes With Maternal Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Kristel K Leung ◽  
Parul Tandon ◽  
Vivek Govardhanam ◽  
Cynthia Maxwell ◽  
Vivian Huang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Adverse Neonatal Outcomes ◽  
Inflammatory Bowel ◽  
Active Disease

Abstract Background Patients with inflammatory bowel disease (IBD) may be at increased risk of adverse neonatal outcomes. The aim of this study was to determine pooled incidences and risk factors for these outcomes. Methods Medline, Embase, and Cochrane Library were searched through May 2019 for studies reporting adverse neonatal outcomes in IBD. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results The pooled incidence of preterm birth, low birth weight, congenital anomalies, and infants transferred to the neonatal intensive care unit was 8.6% (95% CI, 7.0%–10.1%), 8.9% (95% CI, 7.3%–10.5%), 2.1% (95% CI, 1.6%–2.6%), and 4.9% (95% CI, 2.9%–6.9), respectively. Compared with healthy controls, patients with IBD were more likely to deliver infants with low birth weight (&lt;2500 grams; OR, 2.78; 95% CI, 1.16–6.66) and infants admitted to the intensive care unit (OR, 3.33; 95% CI, 1.83–6.05). Patients with Crohn’s disease had an increased incidence of congenital anomalies (OR, 3.03; 95% CI, 1.43–6.42). Among IBD patients, active disease was associated with increased incidence of preterm birth (OR, 2.06; 95% CI, 1.21–3.51), low birth weight (OR, 2.96; 95% CI, 1.54–5.70), and small for gestational age (OR, 2.62; 95% CI, 1.18–5.83). Antitumor necrosis factor (anti-TNF) use during pregnancy was associated with an increased incidence of neonatal intensive care unit admission (OR, 2.42; 95% CI, 1.31–4.45) and low birth weight (OR, 1.54; 95% CI, 1.01–2.35). Conclusions Patients with IBD, particularly with active disease or requiring anti-TNF therapy, may be at increased risk of developing adverse neonatal outcomes.

673: Effect of Asian race on adverse neonatal outcomes after elective repeat cesarean delivery

2014 ◽  
Vol 210 (1) ◽  
pp. S329
Author(s):  
Gustavo Vilchez ◽  
Elaine Brantley ◽  
Jocelyn Leon-Peters ◽  
Anushka Chelliah ◽  
Michael Kruger ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Neonatal Outcomes ◽  
Asian Race ◽  
Adverse Neonatal Outcomes ◽  
Elective Repeat Cesarean ◽  
Repeat Cesarean Delivery

scholarly journals Neonatal Outcomes in Relation to Timing of Repeat Cesarean Delivery at Term

2009 ◽  
Vol 5 (3) ◽  
pp. 239-242
Author(s):  
Methodius G Tuuli ◽  
Anthony O Odibo
Keyword(s):  
Cesarean Delivery ◽  
Neonatal Intensive Care ◽  
Neonatal Morbidity ◽  
Fetal Lung ◽  
Current Data ◽  
Neonatal Outcomes ◽  
Multicenter Cohort Study ◽  
The Usa ◽  
Elective Cesarean ◽  
Repeat Cesarean Delivery

Evaluation of: Tita AT, Landon MB, Spong CY et al.: Timing of elective repeat cesarean delivery at term and neonatal outcomes. N. Engl. J. Med. 360(2), 111–120 (2009). The increasing rates of repeat cesarean delivery necessitate, more than ever, the need to time deliveries to optimize neonatal outcomes. A recent large multicenter cohort study demonstrated that, contrary to current recommendations, a high proportion of elective cesarean deliveries in the USA are performed before 39 weeks' gestation. These early deliveries are associated with a significant increase in several adverse neonatal events, including respiratory complications, treated hypoglycemia, newborn sepsis and admission to the neonatal intensive care unit. This, together with results of previous studies, supports the recommendation to delay elective delivery to 39 weeks' gestation. From the current data, it is uncertain whether delivery before 39 weeks' gestation with documented fetal lung maturity will prevent the increased neonatal morbidity.

scholarly journals Determination of antepartum and intrapartum risk factors associated with neonatal intensive care unit admission

2016 ◽  
Vol 44 (5) ◽  
Author(s):  
Angela P.H. Burgess ◽  
Justin Katz ◽  
Joanna Pessolano ◽  
Jane Ponterio ◽  
Michael Moretti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Risk Model ◽  
Neonatal Morbidity ◽  
Second Stage Of Labor ◽  
Nicu Admission ◽  
Intrapartum Factors

AbstractTo determine antepartum and intrapartum factors that are associated with admission to neonatal intensive care unit (NICU) among infants delivered between 36.0 and 42.0 weeks at our institution.The retrospective cohort study included 73 consecutive NICU admissions and 375 consecutive non-NICU admissions. Data on demographic, antepartum, intrapartum and neonatal factors were collected. The primary endpoint defined was admission to NICU. Univariate analyses using the Student’sThose with a significantly higher risk of NICU admission underwent induction of labor with prostaglandin analogs (12.5% vs. 24.7%, P=0.007). Length of first stage ≥720 min (33.5% vs. 51.9%, P=0.011), length of second stage of labor ≥240 min (10.6% vs. 31.6%, P<0.001) and prolonged rupture of membranes ≥120 min (54.0% vs. 80.0%, P=0.001) were all associated with an increased chance of NICU admission. Intrapartum factors predictive of NICU admission included administration of meperidine (11.7% vs. 27.4%, P<0.001), presence of preeclampsia (5.5% vs. 0.8%, P=0.015), use of intrapartum IV antihypertensives (1.1% vs. 13.7%, P<0.001), maternal fever (5.3% vs. 31.5%, P<0.001), fetal tachycardia (1.9% vs. 12.3%, P<0.001), and presence of meconium (30% vs. 8%, P<0.001).Identification of modifiable risk factors may reduce neonatal morbidity and mortality. Results from this study can be used to develop and validate a risk model based on combined antepartum and intrapartum risk factors.

Changes in Delivery Timing for High-Risk Pregnancies in the United States

2020 ◽  
Author(s):  
Sarah E. Little ◽  
Julian N. Robinson ◽  
Chloe A. Zera
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Neonatal Morbidity ◽  
The United States ◽  
Assisted Ventilation ◽  
High Risk Population ◽  
Risk Population ◽  
Nicu Admission

Objective This study was aimed to assess whether the “39-week” rule is being extended to high-risk pregnancies and if so whether this has led to changes in neonatal morbidity or stillbirth. Study Design Birth certificate data between 2010 and 2014 from 23 states (55% of births in the United States) were used. Pregnancies were classified as high risk if they had any one of the following: maternal age greater than or equal to 40 years, prepregnancy body mass index (BMI) greater than or equal to 40 kg/m2, chronic (prepregnancy) hypertension, or diabetes (pregestational or gestational). Delivery timing changes for all pregnancies at term (37 weeks or greater) were compared with changes in the high-risk population. Neonatal morbidities (neonatal intensive care unit [NICU] admission, need for assisted ventilation, 5-minute Apgar score, and macrosomia), maternal morbidities (intensive care unit [ICU] admission, cesarean delivery, operative vaginal delivery, chorioamnionitis, and severe perineal laceration), and stillbirth rates were compared across time periods. Multivariate logistic regression was used to analyze whether gestational age–specific morbidity changes were due to shifts in delivery timing. Results For the overall population, there was a shift in delivery timing between 2010 and 2014, a 2.5% decrease in 38-week deliveries, and a 2.3% increase in 39-week deliveries (p < 0.01). This gestational age shift was identical in the high-risk population (2.7% decrease in 38-week deliveries and 2.9% increase in 39-week deliveries). For the high-risk population, NICU admission increased from 5.4 to 6.3% in 2014 (p < 0.01) and assisted ventilation rates declined from 3.8 to 2.9% (p < 0.01). These changes, however, were independent of changes in delivery timing. There was no increase in the rate of stillbirth (0.23% in 2010 and 0.23% in 2014; p = 0.50). Conclusion There was a significant shift in delivery timing for high-risk pregnancies in the United States between 2010 and 2014. This shift, however, did not result in statistically significant changes in either neonatal morbidity or stillbirth. Key Points

Peripartum Morbidity after Cesarean Delivery for Arrest of Dilation at 4 to 5 cm Compared with 6 to 10 cm

2018 ◽  
Vol 35 (12) ◽  
pp. 1173-1177 ◽  
Author(s):  
Jeffrey Sperling ◽  
Phinnara Has ◽  
Todd Lovgren ◽  
Brendan Connealy ◽  
Dwight Rouse ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Secondary Analysis ◽  
Neonatal Morbidity ◽  
Active Phase ◽  
Wound Complication ◽  
Neonatal Outcomes ◽  
Historical Cohort ◽  
Nulliparous Women ◽  
Maternal And Neonatal Outcomes ◽  
Using Data

Objective Given that recent consensus guidelines established to decrease cesarean delivery (CD) rates use 6 cm to define the onset of the active phase of labor, our objective was to evaluate maternal and neonatal outcomes after CD for the indication of arrest of dilation at 4 to 5 cm compared with ≥ 6 cm. Study Design We performed a secondary analysis using data from the Maternal Fetal-Medicine Units Network Cesarean Registry. We included nulliparous women with term, singleton, vertex gestations who underwent primary CD for arrest of dilation. We compared those who reached a maximum cervical dilation of 4 to 5 cm with those of ≥6 cm. Our primary outcome was composite maternal morbidity that included chorioamnionitis, endometritis, transfusion, wound complication, operative injury, intensive care unit admission, or death. Results Of the 73,257 women in the dataset, 5,681 met the inclusion criteria. After adjusting for confounders, there was no difference in composite maternal (adjusted odds ratio [aOR]: 1.19; 95% confidence interval [CI]: 0.94–1.52) or neonatal morbidity (aOR: 0.94; 95% CI: 0.79–1.10) between the groups. Conclusion In this historical cohort, maternal and neonatal outcomes after CD for arrest of dilation ≥ 6 cm were comparable to those performed at 4 to 5 cm and support recent labor management guidelines.

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