The impact of mode of delivery on neonatal outcome in preterm births

Aims: To examine the occurrence of chorioamnionitis and abruption among women who had a spontaneous preterm birth (SPTB), the correlation between clinical and placental findings, and the impact of these complications on neonatal outcome after delivery. Methods: This was a retrospective case-control study conducted between 2008 and 2012 at a single teaching hospital. The study group included all women who had an SPTB (23-36 weeks). Placentas were cultured and underwent histological examination. Results: A total of 478 women were included. The mean gestational age at delivery was 32.6 ± 3.1 weeks. Overall, 260 (54.4%) women had either clinical and/or histological abruption or chorioamnionitis. Clinical chorioamnionitis was diagnosed before birth in 14 (2.9%) women, while histological chorioamnionitis (HCA) in 84 (17.4%). Overall, 38 neonates had infection. Placental cultures were negative in 65.8% (25/38) of these neonates, and in 77.1% (27/38), HCA was ruled out. Logistic regression analysis revealed that neonatal morbidity and mortality were correlated with gestational age at delivery (p = 0.02), not with placental pathology (p = 0.08). Conclusions: Half of the women with PTB had clinical or histological abruption, chorioamnionitis or both. A partial correlation was found between clinical and placental findings. The main determinant of neonatal outcome was gestational age at delivery and not placental findings.

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Review of the Recent Literature on the Mode of Delivery for Singleton Vertex Preterm Babies

Journal of Pregnancy ◽

10.1155/2011/186560 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Smriti Ray Chaudhuri Bhatta ◽

Remon Keriakos

Keyword(s):

Recent Literature ◽

Neonatal Outcome ◽

Mode Of Delivery ◽

Preterm Births ◽

Individual Case ◽

Preterm Babies ◽

Controversial Topic ◽

Clinical Questions ◽

The Individual ◽

Route Of Delivery

Choosing the safest method of delivery and preventing preterm labour are obstetric challenges in reducing the number of preterm births and improving outcomes for mother and baby. Optimal route of delivery for preterm vertex neonates has been a controversial topic in the obstetric and neonatal community for decades and continues to be debated. We reviewed 22 studies, most of which have been published over the last five years with an aim to find answers to the clinical questions relevant to deciding the mode of delivery. Findings suggested that the neonatal outcome does not depend on the mode of delivery. Though Caesarean section rates are increasing for preterm births, it does not prevent neurodisability and cannot be recommended unless there are other obstetric indications to justify it. Therefore, clinical judgement of the obstetrician depending on the individual case still remains important in deciding the mode of delivery.

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Maternal SARS-CoV-2 Infection, Its Vertical Transmission and Impact on Overall Perinatal Outcomes: A Narrative Review

Current Pediatric Reviews ◽

10.2174/1573396317666211124095020 ◽

2021 ◽

Vol 17 ◽

Author(s):

Naina Kumar ◽

Vikas Bhatia

Keyword(s):

Pregnant Women ◽

Vertical Transmission ◽

English Language ◽

Neonatal Outcome ◽

Perinatal Outcomes ◽

Preterm Births ◽

Neonatal Infection ◽

World Health ◽

The World ◽

The Impact

Background: : COVID-19 pandemic caused by single-stranded RNA containing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in early December 2019 from the Wuhan city of China and till date has affected millions of people including pregnant women worldwide. Research from all over the world has shown that the SARS-CoV-2 infection can be transmitted vertically from mother to fetus, but is very rare. Neonatal infection with COVID-19 accounts for only a small proportion of the total population infected. Furthermore, very few studies have observed the impact of maternal SARS-CoV-2 infection on neonatal outcomes. Thus, the literature about neonatal transmission and outcome in COVID-19 infected antenatal women is very scattered and limited. The present review briefs on the transmission of SARS-CoV-2 infection from mother to fetus and its impact on perinatal outcomes. Methodology: : English language articles from various databases including PubMed, Scopus, EMBASE, Scholar, MedRxiv, and Web of Science and from the World Health Organization site were searched from the beginning of the COVID-19 pandemic up to June 2021. The search terms used were “SARS-CoV-2 and pregnancy outcome, “COVID-19 and neonatal outcome”, “Placental changes in COVID-19 infected pregnant women”, “Vertical transmission of COVID-19”. Conclusion: : Maternal SARS-CoV-2 infection can be transmitted to the fetus, though uncommon, and can lead to adverse perinatal outcomes including preterm births, intrauterine growth restriction, NICU admission, stillbirths. The data on transmission and the adverse neonatal outcome is sparse and many more studies are needed to fully understand the mechanism by which maternal COVID-19 infection can affect fetuses and neonates.

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A Standardized Approach for Category II Fetal Heart Rate with Significant Decelerations: Maternal and Neonatal Outcomes

American Journal of Perinatology ◽

10.1055/s-0038-1660459 ◽

2018 ◽

Vol 35 (14) ◽

pp. 1405-1410 ◽

Cited By ~ 3

Author(s):

Laurence Shields ◽

Suzanne Wiesner ◽

Catherine Klein ◽

Barbara Pelletreau ◽

Herman Hedriana

Keyword(s):

Neonatal Outcome ◽

Fetal Heart ◽

Mode Of Delivery ◽

Neonatal Outcomes ◽

Apgar Scores ◽

Intervention Process ◽

Maternal And Neonatal Outcomes ◽

Newborn Complications ◽

The Impact ◽

Minute Apgar Score

Objective To determine if a standardized intervention process for Category II fetal heart rates (FHRs) with significant decels (SigDecels) would improve neonatal outcome and to determine the impact on mode of delivery rates. Study Design Patients with Category II FHRs from six hospitals were prospectively managed using a standardized approach based on the presence of recurrent SigDecels. Maternal and neonatal outcomes were compared between pre- (6 months) and post-(11 months) implementation. Neonatal outcomes were: 5-minute APGAR scores of <7, <5, <3, and severe unexpected newborn complications (UNC). Maternal outcomes included primary cesarean and operative vaginal birth rates of eligible deliveries. Results Post implementation there were 8,515 eligible deliveries, 3,799 (44.6%) were screened, and 361 (9.5%) met criteria for recurrent SigDecels. Compliance with the algorithm was 97.8%. The algorithm recommended delivery in 68.0% of cases. Relative to pre-implementation, 5-minute APGAR score of <7 were reduced by 24.6% (p < 0.05) and severe UNC by −26.6%, p = < .05. The rate of primary cesarean decreased (19.8 vs 18.3%, p < 0.05), while there were nonsignificant increases in vaginal (74.6 vs 75.8%, p = 0.13) and operative vaginal births (5.7 vs 5.9%, p = 0.6). Conclusion Standardized management of recurrent SigDecels reduced the rate of 5-minute APGAR scores of < 7 and severe UNC.

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Preterm birth among pregnancies conceived by assisted reproduction techniques in Mumbai, Maharashtra, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181353 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1548

Author(s):

Anushree D. Patil ◽

Sanjay L. Chauhan ◽

Achhelal R. Pasi ◽

Rahul K. Gajbhiye ◽

Shalini Singh ◽

...

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Gestational Diabetes ◽

Assisted Reproduction ◽

Neonatal Outcome ◽

Mode Of Delivery ◽

Preterm Births ◽

Assisted Reproduction Techniques ◽

High Incidence ◽

Very High

Background: Preterm births are an enormous global problem on families, medical system and economy. The rates of preterm birth are increasing and one of the contributors is growing use of Assisted Reproduction Techniques (ART) leading to multifetal gestations. Some risk factors for preterm birth are specific to women who conceive by ART. Since there is limited data from India, this pilot study was undertaken to assess the magnitude of preterm birth among pregnancies conceived by ART and to study the contributing factors.Methods: Clinic based descriptive cohort study through eight ART clinics in Mumbai for one year. Data was collected using an in-depth questionnaire on socio-demographic characteristics, medical history, ART details, course and complications during pregnancy, mode of delivery, pregnancy outcome, risk factors related to preterm birth and neonatal outcome. Complete details of 113 participants who completed the study were analyzed.Results: Study showed high incidence of preterm birth (76.23%) among women conceived with ART. Multiple gestations were observed in 45.1%. Pregnancy related complications like heterotrophic pregnancy (3%), pre eclampsia (15%) and gestational diabetes (11%) were high. Incidence of caesarean section was very high (98%). Neonatal outcome was good with 98% live births and only 2 still births.Conclusions: Present study highlights that preterm birth, multiple pregnancies, pregnancy related complications like preeclampsia, gestational diabetes and caesarean sections are very high among women conceived by ART. With growing use of ART there is an urgent need to develop a National ART Surveillance system in India like the one in Centre for Disease Control Atlanta to get complete data on the pregnancy course and outcomes of ART conceptions. Efforts to limit the number of embryos transferred should be strengthened to prevent multiple births.

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Impact of Intended Mode of Delivery on Outcomes in Preterm Growth-Restricted Fetuses

American Journal of Perinatology ◽

10.1055/s-0037-1608812 ◽

2017 ◽

Vol 35 (07) ◽

pp. 605-610

Author(s):

Spencer Kuper ◽

Michelle Wang ◽

Robin Steele ◽

Joseph Biggio ◽

Lorie Harper ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Umbilical Artery ◽

Perinatal Death ◽

Mode Of Delivery ◽

Neonatal Resuscitation ◽

Preterm Births ◽

Growth Restriction ◽

Neonatal Outcomes ◽

The Impact

Background Scheduled cesarean is frequently performed for fetal growth restriction due to concerns for fetal intolerance of labor. Objective We compared neonatal outcomes in preterm growth-restricted fetuses by intended mode of delivery. Study Design We performed a retrospective cohort study of indicated preterm births with prenatally diagnosed growth restriction from 2011 to 2014 at a single institution. Patients were classified by intended mode of delivery. The primary outcome was a composite of adverse neonatal outcomes, including perinatal death, cord blood acidemia, chest compressions during neonatal resuscitation, seizures, culture-proven sepsis, necrotizing enterocolitis, and grade III–IV intraventricular hemorrhage. Secondary analysis was performed examining the impact of umbilical artery Dopplers. Results Of 101 fetuses with growth restriction, 75 underwent planned cesarean deliveries. Of those induced, 46.2% delivered vaginally. Delivery by scheduled cesarean was not associated with a decreased risk of the composite outcome (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 0.45–5.78), even when only those with abnormal umbilical artery Dopplers were considered (aOR, 2.8; 95% CI, 0.40–20.2). Conclusion In this cohort, planned cesarean was not associated with a reduction in neonatal morbidity, even when considering only those with abnormal umbilical artery Dopplers. In otherwise appropriate candidates for vaginal delivery, fetal growth restriction should not be considered a contraindication to trial of labor.

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Twin pregnancy: Neonatal outcome of second twins depending on presentation and mode of delivery

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-2006-952734 ◽

2006 ◽

Vol 66 (S 01) ◽

Author(s):

D Schlembach ◽

V Bjelic-Radisic ◽

G Pristauz-Telsnigg ◽

J Haas ◽

A Guliani ◽

...

Keyword(s):

Twin Pregnancy ◽

Neonatal Outcome ◽

Mode Of Delivery

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301: The impact of mode of delivery on subsequent pregnancy outcomes after periviable birth

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.11.322 ◽

2019 ◽

Vol 220 (1) ◽

pp. S212-S213

Author(s):

Andrea Desai ◽

Nicole Krenitsky ◽

Audrey A. Merriam ◽

Katherine Kohari ◽

Christian Pettker ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Mode Of Delivery ◽

Subsequent Pregnancy ◽

The Impact

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Neonatal Immune System Ontogeny: The Role of Maternal Microbiota and Associated Factors. How Might the Non-Human Primate Model Enlighten the Path?

Vaccines ◽

10.3390/vaccines9060584 ◽

2021 ◽

Vol 9 (6) ◽

pp. 584

Author(s):

Natalia Nunez ◽

Louis Réot ◽

Elisabeth Menu

Keyword(s):

Immune System ◽

Mode Of Delivery ◽

Microbial Colonization ◽

Therapeutic Interventions ◽

Primate Model ◽

Neonatal Immune System ◽

Gastrointestinal Colonization ◽

The Impact ◽

Human Primate

Interactions between the immune system and the microbiome play a crucial role on the human health. These interactions start in the prenatal period and are critical for the maturation of the immune system in newborns and infants. Several factors influence the composition of the infant’s microbiota and subsequently the development of the immune system. They include maternal infection, antibiotic treatment, environmental exposure, mode of delivery, breastfeeding, and food introduction. In this review, we focus on the ontogeny of the immune system and its association to microbial colonization from conception to food diversification. In this context, we give an overview of the mother–fetus interactions during pregnancy, the impact of the time of birth and the mode of delivery, the neonate gastrointestinal colonization and the role of breastfeeding, weaning, and food diversification. We further review the impact of the vaccination on the infant’s microbiota and the reciprocal case. Finally, we discuss several potential therapeutic interventions that might help to improve the newborn and infant’s health and their responses to vaccination. Throughout the review, we underline the main scientific questions that are left to be answered and how the non-human primate model could help enlighten the path.

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A synbiotic intervention modulates meta-omics signatures of gut redox potential and acidity in elective caesarean born infants

BMC Microbiology ◽

10.1186/s12866-021-02230-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christophe Lay ◽

Collins Wenhan Chu ◽

Rikky Wenang Purbojati ◽

Enzo Acerbi ◽

Daniela I. Drautz-Moses ◽

...

Keyword(s):

Risk Factor ◽

Gut Microbiome ◽

Reference Group ◽

Mode Of Delivery ◽

Controlled Study ◽

Double Blind ◽

Lipopolysaccharide Biosynthesis ◽

Infant Gut Microbiome ◽

Stool Samples ◽

The Impact

Abstract Background The compromised gut microbiome that results from C-section birth has been hypothesized as a risk factor for the development of non-communicable diseases (NCD). In a double-blind randomized controlled study, 153 infants born by elective C-section received an infant formula supplemented with either synbiotic, prebiotics, or unsupplemented from birth until 4 months old. Vaginally born infants were included as a reference group. Stool samples were collected from day 3 till week 22. Multi-omics were deployed to investigate the impact of mode of delivery and nutrition on the development of the infant gut microbiome, and uncover putative biological mechanisms underlying the role of a compromised microbiome as a risk factor for NCD. Results As early as day 3, infants born vaginally presented a hypoxic and acidic gut environment characterized by an enrichment of strict anaerobes (Bifidobacteriaceae). Infants born by C-section presented the hallmark of a compromised microbiome driven by an enrichment of Enterobacteriaceae. This was associated with meta-omics signatures characteristic of a microbiome adapted to a more oxygen-rich gut environment, enriched with genes associated with reactive oxygen species metabolism and lipopolysaccharide biosynthesis, and depleted in genes involved in the metabolism of milk carbohydrates. The synbiotic formula modulated expression of microbial genes involved in (oligo)saccharide metabolism, which emulates the eco-physiological gut environment observed in vaginally born infants. The resulting hypoxic and acidic milieu prevented the establishment of a compromised microbiome. Conclusions This study deciphers the putative functional hallmarks of a compromised microbiome acquired during C-section birth, and the impact of nutrition that may counteract disturbed microbiome development. Trial registration The study was registered in the Dutch Trial Register (Number: 2838) on 4th April 2011.

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