MODE OF DELIVERY AND ITS IMPACT ON NEONATAL OUTCOMES IN PRETERM INFANTS

Abstract BACKGROUND The optimal mode of delivery for preterm infants remains controversial, and routine Caesarean sections (C/S) are not recommended, except for maternal indications. Nonetheless, many preterm infants are delivered by C/S, particularly those in breech presentation, and recent retrospective data have suggested that these infants may have improved outcomes. OBJECTIVES To examine whether C/S as the mode of preterm delivery is associated with decreased mortality and improved short term outcomes. DESIGN/METHODS This retrospective, population-based cohort study examined infants with a gestational age between 23 0/7 weeks and 32 6/7 weeks, born between January 1, 2007 and December 31, 2016, and admitted to the Neonatal Intensive Care Unit at a single Canadian Tertiary Care hospital. Infants with major congenital anomalies were excluded. Data were abstracted from the local Neonatal-Perinatal database for all infants. Two groups, those delivered vaginally and those delivered by C/S, were compared for major neonatal outcomes including the primary outcomes of death and severe intraventricular hemorrhage (IVH), defined as grade 3 or higher. RESULTS A total of 1442 infants met inclusion criteria (784 born by C/S and 658 vaginally). There was no significant difference in neonatal mortality (7.0% vs 7.1%, p=0.925) or severe IVH (6.1% vs 7.4%, p=0.317). There was, however, a significant difference in the incidence of IVH, any grade (19.9% vs 27.5%, p=0.001), which remained after controlling for other significant predictors. There were no other significant differences in the secondary outcomes examined including need for extensive resuscitation, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia, or retinopathy of prematurity. CONCLUSION Caesarean section was not associated with decreased mortality in preterm infants, relative to vaginal births. Caesarean section was associated with a reduced rate of IVH (any grade) and there was a trend towards decreased severe IVH which may warrant further study.

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Short-term outcome in preterm infants depending on whether they were born from singleton, twin or triplet pregnancy: Data from a tertiary care hospital in Serbia

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh181228061v ◽

2020 ◽

Vol 148 (1-2) ◽

pp. 58-63

Author(s):

Gordana Velisavljev-Filipovic ◽

Aleksandra Matic ◽

Marina Dragicevic ◽

Divna Damjanovski

Keyword(s):

Preterm Infants ◽

Tertiary Care ◽

Mode Of Delivery ◽

Fertility Treatment ◽

Care Hospital ◽

Multiple Pregnancies ◽

Short Term ◽

Gestation Age ◽

Increased Risk ◽

Significant Difference

Introduction/Objective. After the introduction of the national program of fertility treatment, increased frequency of multiple pregnancies was noted. The literature has shown controversies regarding the higher risk of morbidity and mortality of the preterm newborns from multiple pregnancies. Methods. Preterm singletons, twins and triplets born within a two-year study period were included in the analysis. Data about preterm twins were extracted first. For each pair of twins, two singletons of the same gestation age were chosen. The set of the examinees was completed by including the triplets born during the same period. The short-term outcomes were compared between these three groups. Results. A total of 210 preterm infants were included in the study, out of which 84 singletons, 84 twins and 42 triplets. Statistical analysis showed significant difference between the three groups regarding type of conception (p < 0.0001), mode of delivery (p < 0.001) and birth weight (p = 0.005). Short-term mortality and morbidity (neonatal death, the need for intubation at birth, respiratory support, surfactant therapy, and intracranial hemorrhage) were significantly increased in triplets comparing to singletons and twins. Conclusion. Preterm triplets have an increased risk for adverse short-term outcomes comparing to singletons and twins of the similar gestation age in our study sample.

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Study of fetomaternal outcome in various modes of breech delivery in a tertiary care hospital- MGM GH, Trichy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205761 ◽

2020 ◽

Vol 10 (1) ◽

pp. 154

Author(s):

Uma Mohanraj ◽

A. Adhirai

Keyword(s):

Caesarean Section ◽

Tertiary Care ◽

Mode Of Delivery ◽

Breech Presentation ◽

Care Hospital ◽

Breech Delivery ◽

Medical College ◽

Maternity Hospitals ◽

Insignificant Difference ◽

Case Basis

Background: Aim of the study was to optimize the fetomaternal outcome using different modes of delivery in breech presentation and objective of the study was to optimize the maternal and perinatal outcome in various modes of breech delivery.Methods: Among 150 mothers with different parity and gestational age having singleton breech were studied during May 2019- October 2019 for the period of 6 months at KAPV government medical college. Fetomaternal outcome was compared in various modes of breech delivery during this study period in our institute. This study was a prospective analytical study.Results: Incidence of breech presentation was 3.3% of total deliveries in this institute. Around 4 (26.6%) cases by emergency LSCS, 48 (32%) cases delivered vaginally, 62 (41.3%) cases by elective LSCS. Comparatively, large number of cases were delivered by planned caesarean section in our institute. The maternal and perinatal morbidity and mortality was found to be less in planned caesarean section compared with other modes of delivery in this study.Conclusions: In view of insignificant difference in the fetomaternal outcome balanced decision about mode of delivery on a case by case basis will go a long way in improving both fetal and maternal outcome. Regular drills and conduct of assisted vaginal breech delivery should be pursued in all maternity hospitals.

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The Management of Myelomeningocele Study: Short-Term Neonatal Outcomes

Fetal Diagnosis and Therapy ◽

10.1159/000509245 ◽

2020 ◽

Vol 47 (12) ◽

pp. 865-872 ◽

Cited By ~ 1

Author(s):

Natalie E. Rintoul ◽

Roberta L. Keller ◽

William F. Walsh ◽

Pamela K. Burrows ◽

Elizabeth A. Thom ◽

...

Keyword(s):

New England ◽

Gestational Age ◽

Periventricular Leukomalacia ◽

Ductus Arteriosus ◽

Outcome Data ◽

Neonatal Outcomes ◽

Increased Risk ◽

Significant Difference ◽

The Impact ◽

Prenatal Surgery

Introduction: The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal repair of myelomeningocele (MMC). Neonatal outcome data for 158 of the 183 randomized women were published in The New England Journal of Medicine in 2011. Objective: Neonatal outcomes for the complete trial cohort (N = 183) are presented outlining the similarities with the original report and describing the impact of gestational age as a mediator. Methods: Gestational age, neonatal characteristics at delivery, and outcomes including common complications of prematurity were assessed. Results: Analysis of the complete cohort confirmed the initial findings that prenatal surgery was associated with an increased risk for earlier gestational age at birth. Delivery occurred before 30 weeks of gestation in 11% of neonates that had fetal MMC repair. Adverse pulmonary sequelae were rare in the prenatal surgery group despite an increased rate of oligohydramnios. There was no significant difference in other complications of prematurity including patent ductus arteriosus, sepsis, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. Conclusion: The benefits of prenatal surgery outweigh the complications of prematurity.

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MATERNOFETAL OUTCOME IN MECONIUM STAINED LIQUOR AT TERTIARY CARE HOSPITAL

10.36106/ijsr/3731386 ◽

2021 ◽

pp. 48-50

Author(s):

Neha Agarwal ◽

Samta Bali Rathore ◽

Shivani Baberwal-

Keyword(s):

Caesarean Section ◽

Perinatal Asphyxia ◽

Tertiary Care ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Meconium Aspiration Syndrome ◽

Care Hospital ◽

Pregnancy Induced Hypertension ◽

Meconium Aspiration ◽

Induced Hypertension

BACKGROUND: Occurance of meconium-stained amniotic uid (MSAF) during labour may be considered as a measure for prediction of poor fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia ,resulting in perinatal as well as neonatal morbidity and mortality. It constitutes about 5% of deliveries with meconium stained amniotic uid and death results in about 12% of infants with MAS. METHODS: 40 cases of meconium stained liquor detected after spontaneous or artical rupture of membranes taken during labour from june 2020 to december 2020 and their outcome in terms of mode of delivery(whether vaginal delivery or lower segment caesarean section) and fetal outcome and associated maternal high risk were studied RESULT: Anemia was co existant in around 15%, pregnancy induced hypertension(PIH) in 25%and premature rupture of membrane in 10%.Pregnancies complicated with Pregnancy induced hypertension had signicant higher rate of meconium stained liquor among all cases. Caesarean Section was commonly performed in meconium stained amniotic uid cases and accounted for about 65%of all cases. CONCLUSIONS: Meconium Stained amniotic uid increases the chances of caesarean rates,leading to birth asphyxia ,Meconium Aspiration Syndrome and hence increases the chances of neonatal intensive unit admission.

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Clinico-radiological Observations in Meconium Aspiration Syndrome

Journal of Nepal Medical Association ◽

10.31729/jnma.3340 ◽

2018 ◽

Vol 56 (209) ◽

pp. 510-515 ◽

Cited By ~ 2

Author(s):

Susana Lama ◽

Shyam Kumar Mahato ◽

Nagendra Chaudhary ◽

Nikhil Agrawal ◽

Santosh Pathak ◽

...

Keyword(s):

Apgar Score ◽

Tertiary Care ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Meconium Aspiration Syndrome ◽

Care Hospital ◽

Radiological Findings ◽

Female Ratio ◽

Meconium Aspiration ◽

Significant Difference

Introduction: To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal. Methods: An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied. Results: Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02) Conclusions: Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.

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Maternal and foetal outcome in elective versus emergency caesarean sections

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170927 ◽

2017 ◽

Vol 6 (4) ◽

pp. 1222

Author(s):

Amit A. Gurunule ◽

Himangi S. Warke

Keyword(s):

Caesarean Section ◽

Elective Caesarean Section ◽

Tertiary Care ◽

Breech Presentation ◽

Emergency Caesarean Section ◽

Tertiary Care Centre ◽

Emergency Caesarean ◽

Significant Difference ◽

Foetal Outcome ◽

Tract Infections

Background: Caesarean delivery is defined as the birth of the foetus through an incision in the abdominal wall (i.e. laparotomy) and the uterine wall (hysterotomy). The purpose was to analyze the maternal and foetal outcome in elective versus emergency caesarean sections retrospectively in a tertiary care centre and to analyze the indications of elective versus emergency caesarean sections.Methods: A retrospective observational study of the cases undergoing caesarean sections in KEM hospital, Mumbai, India was carried out during the period of September 2013 to September 2015. Maternal and foetal outcome was studied. The data was collected and analyzed from the maternal medical records. The neonatology records were also examined.Results: Out of the 600 selected patients, 300 patients in each group of elective and emergency caesarean section were studied. The usual indications of emergency caesarean sections were foetal distress, followed by meconium stained amniotic fluid (MSAF) and cephalopelvic disproportion (CPD). The most frequent indicator for elective lower segment caesarean section (LSCS) was patient with previous LSCS not willing for vaginal birth, followed by breech presentation and previous multiple LSCS. There was a significant difference seen in the occurrence of fever, urinary tract infections and wound infections in the two groups. These were more common in the emergency caesarean section group. Significant difference was also seen in the incidence of postpartum haemorrhage in the two groups, which was more in the elective caesarean section group.Conclusions: The maternal morbidity, intra operative and postoperative complications were more in the emergency LSCS group as compared to patients who underwent elective LSCS.

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Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH)

Medicine Today ◽

10.3329/medtoday.v31i1.40317 ◽

2019 ◽

Vol 31 (1) ◽

pp. 23-26

Author(s):

Mahe Jabeen ◽

Sabiha Shimul ◽

Ummay Salma ◽

Jebunnesa

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Maternal Morbidity ◽

Neonatal Outcome ◽

Elective Caesarean Section ◽

Tertiary Care ◽

Mode Of Delivery ◽

Breech Presentation ◽

Cost Of Care ◽

Increased Risk

Introduction: Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation. Materials and Methods: This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22. Results: APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births. Conclusion: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill & confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. Medicine Today 2019 Vol.31(1): 23-26

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Maternal and neonatal outcomes for the gentle caesarean section in breech presentation

British Journal of Midwifery ◽

10.12968/bjom.2020.28.9.660 ◽

2020 ◽

Vol 28 (9) ◽

pp. 660-664

Author(s):

Christa H Brethouwer ◽

Sicco A Scherjon ◽

Ayten Elvan-Taşpinar

Keyword(s):

Retrospective Study ◽

Caesarean Section ◽

Neonatal Outcome ◽

Breech Presentation ◽

Neonatal Outcomes ◽

Chi Square ◽

Significant Difference ◽

Mother And Child ◽

Maternal And Neonatal Outcomes ◽

Clinically Significant

Background The gentle caesarean section (GCS) is an alternative to the conventional caesarean section. It aims to optimise the wellbeing of mother and child by mimicking certain aspects of a vaginal delivery when a caesarean section is indicated. Aim To compare the maternal and neonatal outcomes of a GCS in cephalic and breech presentation. Methods In this retrospective study, the outcomes of 180 women who underwent a GCS were analysed, where 120 fetuses were in cephalic and 60 were in breech position. Comparisons were made using Chi-square, Mann-Whitney U and t-tests. Maternal and neonatal outcomes were analysed. Results Apgar 1 was significantly lower for breech position (P=0.019). The Apgar 5 and 10 showed no difference. Neonatal temperature was slightly lower in breech position (36.8°C ± 0.36 versus 36.9°C ± 0.39, P=0.046). Birthweight was significantly lower for breech position (P=0.009). Blood loss was significantly higher in cephalic position (441 ± 230 versus 353 ± 151, P=0.002). Conclusions When performing a GCS, there is no clinically significant difference in maternal or neonatal outcome between a cephalic and a breech presentation. It seems safe to perform a GCS for breech presentation.

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Analysis of caesarean section rate in tertiary care hospital according to Robson`s 10 groups classification

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181023 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1380

Author(s):

Varija T. ◽

Veerendra Kumar C. M. ◽

Chandrasekhar Tarihalli

Keyword(s):

Caesarean Section ◽

Classification System ◽

Caesarean Section Rate ◽

Tertiary Care ◽

Case Series ◽

Breech Presentation ◽

Group Classification ◽

Care Hospital ◽

Case Series Study ◽

Group 5

Background: The caesarean section (CS) delivery rate is steadily increasing worldwide, including India. Identifying the proportion of women in various categories as per Robson's ten group classification system and CS rate among them is important to bring down the increasing CS rate.Methods: This case series study was conducted at Vijayanagar Institute of Medical Sciences (VIMS), a tertiary care teaching hospital in Ballari, Karnataka, India. All pregnant women who have been admitted for delivery were enrolled and the data was collected for the women delivered by CS during January 2016 to December 2016 and proportions in various groups as per Robson’s ten-group classification system were calculated.Results: Among a total of 6980 women delivered during study period, 2992 (42.8%) delivered by CS. The CS rates among various groups varied from 100% among women with abnormal lies and group 6-95% (all nulliparous breeches) group 5-94% (Previous CS, single cephalic, >37 weeks) to 10 to 15% among multiparous women with spontaneous labour having single cephalic pregnancy (group 3). Among women with previous section, CS rate was very high (89.6%). Women with previous CS (group 5) contributed maximum (40.24%) to the total number of CS.Conclusions: In the present study, all women with breech presentation and abnormal lies delivered by CS and repeat CS was the highest contributor to all CS deliveries.

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Comparative study of vaginal delivery and caesarean section in antepartum eclampsia at tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170007 ◽

2017 ◽

Vol 6 (2) ◽

pp. 457 ◽

Cited By ~ 1

Author(s):

Priti Kumari ◽

Sipra Singh ◽

Salma Khatun ◽

. Shashikar

Keyword(s):

Caesarean Section ◽

Perinatal Mortality ◽

Vaginal Delivery ◽

Tertiary Care ◽

Mode Of Delivery ◽

Multiple Pregnancy ◽

Fetal Outcome ◽

Sudden Onset ◽

Care Hospital ◽

Maternal Complications

Background: Eclampsia is characterized by the sudden onset of generalized tonic clonic seizures. Eclampsia is usually preceded by a history of the pre-eclampsia but rarely arises in a woman with minimally increased blood pressure and no proteinuria. Eclampsia most commonly occurs in the third trimester, though rarely eclampsia may occur before 20 wks in molar or multiple pregnancy. The aim of the study was to compare maternal and fetal outcome in antepartum eclampsia when terminated by vaginal delivery and caesarean section.Methods: 50 women with eclampsia attending emergency department OBG department of Katihar Medical College, Katihar were collected from Feb 2015 to Sep 2016. Depending upon the mode of delivery, they were divided into two groups, CD group where caesarean section was performed and VD group where vaginal delivery was performed.Results: Of the 50 cases, caesarean section was done in 40% of the cases, while vaginal delivery was carried was carried in 60%.Maternal complications in CD group was 35% and 80% in VD group (p<0.001).The incidence of live births, still birth and neonatal death was 85%, 15%, 0% in CD group and 60%, 40%, 10% in VD group. The corrected perinatal mortality was 50%.Conclusions: Timely caesarean section reduces maternal and perinatal mortality and improves their outcome in antepartum eclampsia.

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