Impact of timing of delivery on maternal and neonatal outcomes for women after three previous caesarean deliveries; a secondary analysis of the caesarean section registry

Abstract Background The aim of this study was to compare rates of induction and subsequent caesarean delivery among nulliparous women with private versus publicly funded health care at a single institution. This is a retrospective cohort study using the electronic booking and delivery records of nulliparous women with singleton pregnancies who delivered between 2010 and 2015 in an Irish Tertiary Maternity Hospital (approx. 9000 deliveries per annum). Methods Data were extracted from the National Maternity Hospital (NMH), Dublin, Patient Administration System (PAS) on all nulliparous women who delivered a liveborn infant at ≥37 weeks gestation during the 6-year period. At NMH, all women in spontaneous labour are managed according to a standardised intrapartum protocol. Twenty-two thousand two hundred thirty-two women met the inclusion criteria. Of these, 2520 (12.8%) were private patients; the remainder (19,712; 87.2%) were public. Mode of and gestational age at delivery, rates of and indications for induction of labour, rates of pre-labour caesarean section, and maternal and neonatal outcomes were examined. Rates of labour intervention and subsequent maternal and neonatal outcomes were compared between those with and without private health cover. Results Women attending privately were more than twice as likely to have a pre-labour caesarean section (12.7% vs. 6.5%, RR = 2.0, [CI 1.8–2.2])); this finding persisted following adjustment for differences in maternal age and body mass index (BMI) (adjusted relative risk 1.74, [CI 1.5–2.0]). Women with private cover were also more likely to have induction of labour and significantly less likely to labour spontaneously. Women who attended privately were significantly more likely to have an operative vaginal delivery, whether labour commenced spontaneously or was induced. Conclusions These findings demonstrate significant differences in rates of obstetric intervention between those with private and public health cover. This division is unlikely to be explained by differences in clinical risk factors as no significant difference in outcomes following spontaneous onset of labour were noted. Further research is required to determine the roots of the disparity between private and public decision-making. This should focus on the relative contributions of both mothers and maternity care professionals in clinical decision making, and the potential implications of these choices.

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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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Adverse Maternal and Neonatal Outcomes in Indicated Compared with Spontaneous Preterm Birth in Healthy Nulliparas: A Secondary Analysis of a Randomized Trial

American Journal of Perinatology ◽

10.1055/s-0037-1608787 ◽

2017 ◽

Vol 35 (07) ◽

pp. 624-631 ◽

Cited By ~ 1

Author(s):

Lindsay Doherty ◽

Jim Roberts ◽

Leslie Myatt ◽

Kenneth Leveno ◽

Michael Varner ◽

...

Keyword(s):

Blood Transfusion ◽

Neonatal Intensive Care ◽

Secondary Analysis ◽

Preterm Births ◽

Neonatal Outcomes ◽

Composite Outcome ◽

Spontaneous Preterm Birth ◽

Membrane Rupture ◽

Nulliparous Women ◽

Maternal And Neonatal Outcomes

Objective To compare the risks of adverse maternal and neonatal outcomes associated with spontaneous (SPTB) versus indicated preterm births (IPTB). Methods A secondary analysis of a multicenter trial of vitamin C and E supplementation in healthy low-risk nulliparous women. Outcomes were compared between women with SPTB (due to spontaneous membrane rupture or labor) and those with IPTB (due to medical or obstetric complications). A primary maternal composite outcome included: death, pulmonary edema, blood transfusion, adult respiratory distress syndrome (RDS), cerebrovascular accident, acute tubular necrosis, disseminated intravascular coagulopathy, or liver rupture. A neonatal composite outcome included: neonatal death, RDS, grades III or IV intraventricular hemorrhage (IVH), sepsis, necrotizing enterocolitis (NEC), or retinopathy of prematurity. Results Of 9,867 women, 10.4% (N = 1,038) were PTBs; 32.7% (n = 340) IPTBs and 67.3% (n = 698) SPTBs. Compared with SPTB, the composite maternal outcome was more frequent in IPTB—4.4% versus 0.9% (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4–11.8), as were blood transfusion and prolonged hospital stay (3.2 and 3.7 times, respectively). The frequency of composite neonatal outcome was higher in IPTBs (aOR, 1.8; 95% CI, 1.1–3.0), as were RDS (1.7 times), small for gestational age (SGA) < 5th percentile (7.9 times), and neonatal intensive care unit (NICU) admission (1.8 times). Conclusion Adverse maternal and neonatal outcomes were significantly more likely with IPTB than with SPTB.

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On the question of increasing the frequency of caesarean section and effects on maternal and neonatal outcomes (Part 1)

PERINATOLOGIYA I PEDIATRIYA ◽

10.15574/pp.2016.66.9 ◽

2016 ◽

pp. 9-13

Author(s):

Iu. Davydova ◽

◽

E. Shevchuk ◽

A. Limanskaya ◽

E. Garmish ◽

...

Keyword(s):

Caesarean Section ◽

Neonatal Outcomes ◽

Maternal And Neonatal Outcomes

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Maternal and neonatal outcomes in teenage pregnancy: an observational study from Odisha

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210470 ◽

2021 ◽

Vol 10 (3) ◽

pp. 889

Author(s):

Arabinda Nepak ◽

Surendra Nath Soren ◽

Ashish Kumar Karjee

Keyword(s):

Caesarean Section ◽

Observational Study ◽

Teenage Pregnancy ◽

Caesarean Section Rate ◽

Mode Of Delivery ◽

Fetal Distress ◽

Neonatal Outcomes ◽

Public Health Issue ◽

Maternal Complications ◽

Maternal And Neonatal Outcomes

Background: With changing socio-demographic landscape of India, teenage pregnancy has become an important public health issue. The present study was conducted to assess the incidence of teenage pregnancy in Berhampur, Odisha and various maternal and neonatal outcomes of these pregnancies.Methods: This observational study was conducted on 564 antenatal mothers aged 16 to 19 years, who from October 2018 to September 2020. Demographic information of the mothers was noted. Maternal complications during antenatal, intrapartum and postpartum period were noted. Neonatal outcomes, mode of delivery, complications and need for intensive care unit admission was noted. The data collected was described in tabulated form.Results: The incidence of teenage pregnancy at our centre was 4%. Of the 564 teenage pregnancies, 214 were anaemic, pregnancy induced hypertension in 74 and 129 had preterm labour. The caesarean section rate was performed in 51.9%, and the most common indications for caesarean section were fetal distress and cephalopelvic disproportion. Of the 553 live births, 1.04% of them weighed <1.5 kg, 29.16% weighed 1.5 till 2.5 kg, 65.5% weighed between 2.5 to 3.5 kg and 5.2% weighed >3.5 kg. NICU admission was required for 26.9% of the neonates and the most common complication was neonatal jaundice, which was observed in 14.3%.Conclusions: Teenage pregnancies represent a high-risk. The present study demonstrated the various maternal as well as neonatal complications in teenage pregnancies. Those who experience teenage pregnancy should be given extra attention and care.

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