Association between morbidity among term newborns and low‐risk cesarean delivery rates

2021 ◽  
Author(s):  
Mark A Clapp ◽  
Jamie R Daw ◽  
Kaitlyn E James ◽  
Sarah E Little ◽  
Julian N Robinson ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Low Risk ◽  
Term Newborns

scholarly journals Impact of Labor Induction at 39 Weeks Gestation Compared with Expectant Management on Maternal and Perinatal Morbidity among a Cohort of Low-risk Women

2021 ◽  
Author(s):  
Sabrina C. Burn ◽  
Ruofan Yao ◽  
Maria Diaz ◽  
Jordan Rossi ◽  
Stephen Contag
Keyword(s):  
Cesarean Delivery ◽  
Lower Risk ◽  
Fetal Death ◽  
Expectant Management ◽  
Low Risk ◽  
P Value ◽  
Cesarean Hysterectomy ◽  
Increased Risk ◽  
Nicu Admission ◽  
Low Risk Women

Abstract Objective: To determine rates of maternal and perinatal outcomes after induction of labor (IOL) at 39 weeks compared with expectant management.Methods: Cohort study of low risk women delivered between 39-42 weeks from 2015 to 2018. We excluded births with fetal abnormalities, previous cesarean, multiple pregnancies or those with spontaneous onset of labor (SOL) or indicated delivery at 39 weeks. Data was abstracted from National Center for Health Statistics birth files. Relative risks (aRR) were estimated with multivariable log-binomial regression. Main Outcome Measures: Maternal outcomes: chorioamnionitis (Triple I), blood transfusion, neonatal intensive care unit (NICU) admission, uterine rupture, cesarean delivery and cesarean hysterectomy. Fetal and infant outcomes: fetal death, 5-minute Apgar ≤3, prolonged ventilation, seizures, ICU admission, and death within 28 days. Results: There were 15,900,956 births, with 8,540,063 after exclusions. The IOL group included 1,177,790 births excluding women with diabetes or hypertensive disease. There were 3,835,185 births after 39 weeks excluding women with diabetes or chronic hypertension. With IOL at 39 weeks the risk for blood transfusion (p-value < 0.01; aRR 0.78; 95% CI [0.75-0.82]), Triple I (p-value < 0.01; aRR 0.71; 95% CI [0.70-0.73]) and cesarean delivery (p-value <0.01; aRR 0.87; 95% CI [0.87-0.88]) were lower, albeit increased risk of cesarean hysterectomy (p-value <0.01; aRR 1.23; 95% CI [1.07-1.41]). Neonates had a lower risk for 5-minute Apgar ≤3 (p-value < 0.01; aRR 0.68; 95% CI [0.66-0.71]), prolonged ventilation (p-value < 0.01; aRR 0.84; 95% CI [0.81-0.87]), NICU admission (p-value < 0.01; aRR 0.86; 95% CI [0.85-0.87]), and neonatal seizures (p-value <0.01; aRR 0.85; 95% CI [0.76-0.96]). There was no difference in risk for neonatal death 0.99% (p-value 0.99; aRR 1.00; 95%CI [0.99-1.00]), or fetal death (p-value 0.78; aRR 1.0002; 95%CI [0.99-1.002]. This benefit was greater compared with each subsequent week.Conclusions: Induction of labor at 39 weeks of gestation in a low risk cohort is associated a lower risk of cesarean delivery, transfusions and infection, as well as lower neonatal morbidity, without difference in fetal or neonatal death. This appears to be associated with increased risk for cesarean hysterectomy.

Cesarean Delivery Rates and Neonatal Morbidity in a Low-Risk Population

2004 ◽  
Vol 104 (1) ◽  
pp. 11-19 ◽  
Author(s):  
Jeffrey B. Gould ◽  
Beate Danielsen ◽  
Lisa M. Korst ◽  
Roderic Phibbs ◽  
Kathy Chance ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Neonatal Morbidity ◽  
Low Risk ◽  
Risk Population

Respiratory Pauses in Very Low Risk Prematurely Born Infants Reaching Normal Term. A Comparison to Full-Term Newborns

1984 ◽  
Vol 15 (01) ◽  
pp. 13-17 ◽  
Author(s):  
L. Curzi-Dascalova ◽  
L. Christova-Guéorguiéva ◽  
F. Lebrun ◽  
G. Firtion
Keyword(s):  
Full Term ◽  
Low Risk ◽  
Normal Term ◽  
Term Newborns ◽  
Prematurely Born Infants

Comparing Variation in Hospital Rates of Cesarean Delivery Among Low-risk Women Using 3 Different Measures

2016 ◽  
Vol 36 (4) ◽  
pp. 214
Author(s):  
J.C. Armstrong ◽  
K.B. Kozhimannil ◽  
P. McDermott ◽  
G.R. Saade ◽  
S.K. Srinivas
Keyword(s):  
Cesarean Delivery ◽  
Low Risk ◽  
Low Risk Women

scholarly journals Development and validation of models to predict cesarean delivery among low-risk nulliparous women at term: a retrospective study in China

2020 ◽  
Author(s):  
Fangcan Sun ◽  
Bing Han ◽  
Fangfang Wu ◽  
Qianqian Shen ◽  
Minhong Shen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cesarean Delivery ◽  
Prediction Models ◽  
External Validation ◽  
Curve Analysis ◽  
Low Risk ◽  
Calibration Plot ◽  
Fetal Sex ◽  
Decision Curve Analysis ◽  
Nulliparous Women

Abstract Background A prediction algorithm to identify women with high risk of an emergency cesarean could help reduce morbidity and mortality associated with labor. The objective of the present study was to derive and validate a simple model to predict intrapartum cesarean delivery for low-risk nulliparous women in Chinese population.Methods We conducted a retrospective cohort study of low-risk nulliparous women with singleton, term, cephalic pregnancies. A predictive model for cesarean delivery was derived using univariate and multivariable logistic regression from the hospital of the First Affiliated Hospital of Soochow University. External validation of the prediction model was then performed using the data from Sihong county People’s Hospital. A new nomogram was established based on the development cohort to predict the cesarean. The ROC curve, calibration plot and decision curve analysis were used to assess the predictive performance.Results The intrapartum cesarean delivery rates in the development cohort and the external validation cohort were 8.79% (576/6,551) and 7.82% (599/7,657). Multivariable logistic regression analysis showed that maternal age, height, BMI, weight gained during pregnancy, gestational age, induction method, meconium-stained amniotic fluid and neonatal sex were independent factors affecting cesarean outcome. We had established two prediction models according to fetal sex was involved or not. The AUC was 0.782 and 0.774, respectively. The two prediction models were well-calibrated with Hosmer-Lemeshow test P=0.263 and P=0.817, respectively. Decision curve analysis demonstrated that two models had clinical application value, and they provided greatest net benefit between threshold probabilities of 4% to 60%. And internal validation using Bootstrap method demonstrated similar discriminatory ability. We external validated the model involving fetal sex, for which the AUC was 0.775, while the slope and intercept of the calibration plot were 0.979 and 0.004, respectively. On the external validation set, another model had an AUC of 0.775 and a calibration slope of 1.007. The online web server was constructed based on the nomogram for convenient clinical use.Conclusions Both two models established by these factors have good prediction efficiency and high accuracy, which can provide the reference for clinicians to guide pregnant women to choose an appropriate delivery mode.

scholarly journals The Health Effects of Cesarean Delivery for Low-Risk First Births

2018 ◽  
Author(s):  
David Card ◽  
Alessandra Fenizia ◽  
David Silver
Keyword(s):  
Cesarean Delivery ◽  
Health Effects ◽  
Low Risk

Heart-rate variability in low-risk prematurely born infants reaching normal term: A comparison with full-term newborns

1993 ◽  
Vol 32 (2-3) ◽  
pp. 183-195 ◽  
Author(s):  
M. Eiselt ◽  
L. Curzi-Dascalova ◽  
J. Clairambault ◽  
F. Kauffmann ◽  
C. Médigue ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Full Term ◽  
Low Risk ◽  
Normal Term ◽  
Term Newborns ◽  
Prematurely Born Infants

Variations in Low-Risk Cesarean Delivery Rates in the United States Using the Society for Maternal-Fetal Medicine Definition

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Lijing Ouyang ◽  
Shanna Cox ◽  
Cynthia Ferre ◽  
Likang Xu ◽  
William M. Sappenfield ◽  
...  
Keyword(s):  
United States ◽  
Cesarean Delivery ◽  
The United States ◽  
Low Risk ◽  
Maternal Fetal Medicine ◽  
Fetal Medicine

Development And Validation Of Models To Predict Cesarean Delivery Among Low-Risk Nulliparous Women At Term: A Retrospective Study In China

2020 ◽  
Author(s):  
Fangcan Sun ◽  
Bing Han ◽  
Fangfang Wu ◽  
Qianqian Shen ◽  
Minhong Shen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cesarean Delivery ◽  
Prediction Models ◽  
External Validation ◽  
Curve Analysis ◽  
Low Risk ◽  
Multivariable Logistic Regression Analysis ◽  
Decision Curve Analysis ◽  
Nulliparous Women

Abstract Background: Cesarean delivery after failure of trial of labor is associated with adverse maternal and perinatal outcomes. A prediction algorithm to identify women with high risk of an emergency cesarean could help reduce morbidity and mortality associated with labor. The objective of the present study was to derive and validate a simple model to predict cesarean delivery for low-risk nulliparous women in Chinese population.Methods: This retrospective study analyzed the low-risk nulliparous women with singleton cephalic full-term fetus delivered in two medical centers. After the clinical data of the women who delivered at the tertiary referral center (n=6 551) was collected and was used univariate and multivariable logistic regression analysis, the prediction model was fitted. We performed external validation using data from nulliparous who delivered from another hospital(secondary referral center, n=7 657). A new nomogram was established based on the development cohort to predict the cesarean. The ROC curve, calibration plot and decision curve analysis were used to assess the predictive performance. Results: The cesarean delivery rates in the development cohort and the external validation cohort were 8.79% (576/6 551) and 7.82% (599/7 657). Multivariable logistic regression analysis showed that maternal age, height, BMI, weight gained during pregnancy, gestational age, induction method, meconium-stained amniotic fluid and neonatal sex were independent factors affecting cesarean outcome. Because sex of the fetuses were unknown until they born(China's Fertility Policy), we established two prediction models according to fetal sex was involved or not. The AUC was 0.782 and 0.774, respectively. The Hosmer-Lemeshow goodness-of-fit test showed that these two models fitted well. Decision curve analysis demonstrated that the models were clinically useful. And internal validation using Bootstrap method showed that these prediction models perform well. On the external validation set, the AUC were 0.775 and 0.775, respectively. The calibration plots for the probability of cesarean showed a good correlation. The online web server was constructed based on the nomogram for convenient clinical use.Conclusions: Both two models established by these factors have good prediction efficiency and high accuracy, which can provide the reference for clinicians to guide pregnant women to choose an appropriate delivery mode.

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