scholarly journals Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047040
Author(s):  
Hannah G Dahlen ◽  
Charlene Thornton ◽  
Soo Downe ◽  
Ank de Jonge ◽  
Anna Seijmonsbergen-Schermers ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Gestational Age ◽  
Linked Data ◽  
Child Outcomes ◽  
Population Based ◽  
Induction Of Labour ◽  
Vaginal Repair ◽  
Fourth Degree ◽  
Multiparous Women ◽  
Primiparous Women

ObjectivesWe compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live births.DesignWe used population linked data from New South Wales, Australia (2001–2016) for healthy women giving birth at 37+0 to 41+6 weeks. Descriptive statistics and logistic regression were performed for intrapartum interventions, postnatal maternal and neonatal outcomes, and long-term child outcomes adjusted for maternal age, country of birth, socioeconomic status, parity and gestational age.ResultsOf 474 652 included births, 69 397 (15%) had an IOL for non-medical reasons. Primiparous women with IOL versus spontaneous onset differed significantly for: spontaneous vaginal birth (42.7% vs 62.3%), instrumental birth (28.0% vs 23.9%%), intrapartum caesarean section (29.3% vs 13.8%), epidural (71.0% vs 41.3%), episiotomy (41.2% vs 30.5%) and postpartum haemorrhage (2.4% vs 1.5%). There was a similar trend in outcomes for multiparous women, except for caesarean section which was lower (5.3% vs 6.2%). For both groups, third and fourth degree perineal tears were lower overall in the IOL group: primiparous women (4.2% vs 4.9%), multiparous women (0.7% vs 1.2%), though overall vaginal repair was higher (89.3% vs 84.3%). Following induction, incidences of neonatal birth trauma, resuscitation and respiratory disorders were higher, as were admissions to hospital for infections (ear, nose, throat, respiratory and sepsis) up to 16 years. There was no difference in hospitalisation for asthma or eczema, or for neonatal death (0.06% vs 0.08%), or in total deaths up to 16 years.ConclusionIOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed. The size of effect varied by parity and gestational age, making these important considerations when informing women about the risks and benefits of IOL.

scholarly journals Frequency of Caesarean Section in Pregnancies with Borderline Amniotic Fluid Index at Term

2017 ◽  
Vol 23 (2) ◽  
Author(s):  
Natasha Bushra ◽  
Khaula Zeeshan ◽  
Sara Ejaz ◽  
Javeria Mushtaq ◽  
Khadija Waheed ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Amniotic Fluid ◽  
Gestational Age ◽  
Cross Sectional Study ◽  
Induction Of Labour ◽  
Amniotic Fluid Index ◽  
Cross Sectional ◽  
Increased Risk ◽  
Failed Induction ◽  
One Year

AbstractThe increased risk of caesarean section after induced labour is well documented. Rate of induction of labour has doubled in the past decade from 10 to 20%. Low Amniotic Fluid Index (AFI) as an isolated finding leads to increased obstetrical interventions but without any improvement in outcome.Objectives:  To determine the frequency of caesarean section due to failed induction in pregnancies at term with borderline AFI.Patients and Methods:  This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Unit-III, SIMS/Services Hospital, Lahore. The duration of study was one year from January, 2015 to December, 2015. A total of 150 patients were included in this study. AFI was measured by recent obstetric ultrasound. All patients with borderline AFI (5 – 8 cm) were included in the study. They were induced by glandin E2 gel. If induction of patients failed with two doses of glandin E2 gel, given vaginally 6 hours apart, patients were considered for cesarean section. The outcome measure was rate of caesarean section due to failed induction. All data were analyzed by SPSS version 20.Results:  Mean age of the patients was 30.34 ± 6.68 years. Mean gestational age was noted 38.34 ± 1.05 weeks. Out of 150 patients, 103 (68.7%) were para 1 – 3 and 47 patients (31.3%) were para 4 – 6. Caesarean section due to failed induction with borderline AFI was performed in 27 patients (18.0%). Stratification with regard to age, gestational age and parity was carried out and was found significant only for gestational age being > 39 weeks.Conclusion:  It is concluded that failed induction of labour at term in women with borderline AFI is not associated with increased risk of caesarean delivery.

scholarly journals Discrimination by parity is a prerequisite for assessing induction of labour outcome – cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Branko Denona ◽  
Michael Foley ◽  
Rhona Mahony ◽  
Michael Robson
Keyword(s):  
Caesarean Section ◽  
Cross Sectional Study ◽  
Induction Of Labour ◽  
Previous Caesarean Section ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nulliparous Women ◽  
Significant Difference ◽  
Multiparous Women ◽  
Group 3

Abstract Background To demonstrate that studies on induction of labour should be analyzed by parity as there is a significant difference in the labour outcome among induced nulliparous and multiparous women. Methods Obstetric outcome, specifically caesarean section rates, among induced term nulliparous and multiparous women without a previous caesarean section were analyzed in this cross-sectional study using the Robson 10 group classification for the year 2016. Results In the total number of 8851 women delivered in 2016, the caesarean section rates among nulliparous women in spontaneous and induced labour, Robson groups 1 and 2A, were 7.84% (151/1925) and 32.63% (437/1339) respectively and among multiparous (excluding those women with a previous caesarean section), Robson group 3 and 4A were 1%(24/2389) and 4.37% (44/1005), respectively. Pre labour caesarean rates for nulliparous and multiparous women, Robson groups 2B and 4B (Robson M, Fetal Matern Med Rev, 12; 23–39, 2001) were 3.91% (133/3397) and 2.86% (100/3494), of the respective single cephalic cohort at term. Conclusion The data suggests that studies on induction of labour should be analyzed by parity as there is a significant difference between nulliparous and multiparous women.

scholarly journals Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019509 ◽  
Author(s):  
Mohammed Zimmo ◽  
Katariina Laine ◽  
Sahar Hassan ◽  
Erik Fosse ◽  
Marit Lieng ◽  
...  
Keyword(s):  
Cohort Study ◽  
Caesarean Section ◽  
Birth Cohort ◽  
Population Based ◽  
Emergency Caesarean Section ◽  
Birth Cohort Study ◽  
Emergency Caesarean ◽  
Reference Hospital ◽  
Primiparous Women ◽  
Singleton Pregnancies

ObjectiveTo assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals.DesignA prospective population-based birth cohort study.SettingObstetric departments in six governmental Palestinian hospitals.Participants32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016.MethodsTo assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ2test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed.Main outcome measuresThe primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1).ResultsThe prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women.ConclusionSubstantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics.

scholarly journals Are socioeconomic inequalities in the incidence of small-for-gestational-age birth narrowing? Findings from a population-based cohort in the South of England

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026998 ◽  
Author(s):  
Sam Wilding ◽  
Nida Ziauddeen ◽  
Paul Roderick ◽  
Dianna Smith ◽  
Debbie Chase ◽  
...  
Keyword(s):  
Educational Attainment ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Maternal Smoking ◽  
Employment Status ◽  
Population Based ◽  
Socioeconomic Inequalities ◽  
Lone Mothers ◽  
Primiparous Women ◽  
Over Time

ObjectivesTo investigate socioeconomic inequalities, using maternal educational attainment, maternal and partner employment status, and lone motherhood indicators, in the risk of small-for-gestational-age (SGA) births, their time trend, potential mediation by maternal smoking and body mass index, and effect modification by parity.DesignPopulation-based birth cohort using routine antenatal healthcare data.SettingBabies born at University Hospital Southampton, UK, between 2004 and 2016.Participants65 909 singleton live births born to mothers aged ≥18 years between 24-week and 42-week gestation.Main outcome measuresSGA (birth weight <10th percentile for others born at the same number of completed weeks compared with 2013/2014 within England and Wales).ResultsBabies born to mothers educated up to secondary school level (adjusted OR (aOR) 1.32, 99% CI 1.19 to 1.47), who were unemployed (aOR 1.27, 99% CI 1.16 to 1.38) or with unemployed partners (aOR 1.27, 99% CI 1.13 to 1.43), were at greater risk of being SGA. There was no statistically significant change in the magnitude of this risk difference by these indicators over time between 2004 and 2016, as estimated by linear interactions with year of birth. Babies born to lone mothers were not at higher risk compared with partnered mothers after adjusting for maternal smoking (aOR 1.05, 99% CI 0.93 to 1.20). The inverse association between maternal educational attainment and SGA risk appeared greater in multiparous (aOR 1.40, 99% CI 1.10 to 1.77) compared with primiparous women (aOR 1.28, 99% CI 1.12 to 1.47), and the reverse was true for maternal and partner’s unemployment where the association was stronger in primiparous women.ConclusionsSocioeconomic inequalities in SGA risk by educational attainment and employment status are not narrowing over time, with differences in association strength by parity. The greater SGA risk in lone mothers was potentially explained by maternal smoking. Preventive interventions should target socially disadvantaged women, including preconception and postpartum smoking cessation to reduce SGA risk.

scholarly journals Pregnancy-associated cancers and birth outcomes in children: a Danish and Swedish population-based register study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022946 ◽  
Author(s):  
Natalie C Momen ◽  
Linn Håkonsen Arendt ◽  
Andreas Ernst ◽  
Jørn Olsen ◽  
Jiong Li ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Birth Weight ◽  
Caesarean Section ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Apgar Score ◽  
Population Based ◽  
Register Study ◽  
Adverse Birth Outcomes

ObjectivesThis study aims to estimate the association between pregnancy-associated maternal cancers, diagnosed both prenatally and postnatally, and birth outcomes.DesignPopulation-based register study.SettingNational registers of Denmark and Sweden.ParticipantsA total of 5 523 365 children born in Denmark (1977–2008) and Sweden (1973–2006).Primary and secondary outcome measures: gestational age, birth weight, size for gestational age, Apgar score, caesarean section and sex were the outcomes of interest. ORs and relative risk ratios (RRR) with 95% CIs were estimated using logistic regression and multinomial logistic regression, respectively.ResultsIn this study, 2% of children were born to mothers with a diagnosis of cancer. Children whose mothers received a prenatal cancer diagnosis had higher risk of being born preterm (RRR: 1.77, 95% CI 1.64 to 1.90); low birth weight (RRR 1.84, 95% CI 1.69 to 2.01); low Apgar score (OR 1.36, 95% CI 1.20 to 1.56); and by caesarean section (OR: 1.69, 95% CI 1.59 to 1.80). Associations moved towards the null for analyses using postnatal diagnoses, but preterm birth (RRR: 1.13, 95% CI 1.09 to 1.17) and low birth weight (RRR: 1.14, 95% CI 1.09 to 1.18) remained statistically significant, while risk of caesarean section became so (OR: 0.95, 95% CI 0.91 to 0.98). Additionally, statistical significance was reached for large for gestational age (RRR: 1.06, 95% CI 1.01 to 1.11), high birth weight (RRR: 1.04, 95% CI 1.01 to 1.06) and caesarean section (OR: 0.95, 95% CI 0.91 to 0.98).ConclusionsResults suggest an association between pregnancy-associated cancers and adverse birth outcomes in the offspring. While this is strongest for prenatally diagnosed cancers, some smaller associations exist for postnatally diagnosed cancers, indicating that cancer itself could affect fetal development, or that cancer and adverse birth outcomes share risk factors. Future studies on maternal cancer during pregnancy should consider including some postnatal years in their exposure window.

scholarly journals A comparative study of perinatal outcome in primary caesarean in multiparous women to that in nulliparous women

2020 ◽  
Vol 9 (8) ◽  
pp. 3265
Author(s):  
Surabhi Kokate ◽  
Abhishek Kokate
Keyword(s):  
Caesarean Section ◽  
Perinatal Outcome ◽  
Tertiary Care ◽  
Fetal Distress ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Nulliparous Women ◽  
Significant Difference ◽  
Multiparous Women ◽  
Primiparous Women

Background: To compare indication, incidence, complication, fetal and maternal morbidity and mortality in primary caesarean section in multiparous women and nulliparous women. Objective of this study was to compare perinatal outcome of caesarean section in multiparous women to that in nulliparous women.Methods: It is a prospective observational study conducted in a tertiary care centre during April 2017 to April 2018. All patients who delivered vaginally and abdominally were noted during study period. All patients undergoing primary caesarean section were noted. Their indication, incidence and complication throughout stay were noted. Statistics were calculated separately for multiparous women and primiparous women. Statistical analysis was done using chi square test.Results: Total 150 primary caesarean section in primiparous women and 100 primary caesarean section in multiparous women were done.  Fetal distress and meconium stained amniotic fluid forms the most common indication in study. Birth weight of babies was more in multiparous women. Need of blood and blood products was more in multiparous women compared to nulliparous women. Complications like postpartum fever and wound gape was more in multiparous women.Conclusions: In the study population significant difference was seen between the indication and complication between multiparous and nulliparous women.

scholarly journals Discrimination by parity is a prerequisite for assessing induction of labour outcome – cross-sectional study

2020 ◽  
Author(s):  
Branko Denona ◽  
Michael Foley ◽  
Rhona Mahony ◽  
Michael Robson
Keyword(s):  
Caesarean Section ◽  
Cross Sectional Study ◽  
Induction Of Labour ◽  
Previous Caesarean Section ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nulliparous Women ◽  
Significant Difference ◽  
Multiparous Women ◽  
Group 3

Abstract Background: To demonstrate that studies on induction of labour should be analyzed by parity as there is a significant difference in the labour outcome among induced nulliparous and multiparous women Methods: Obstetric outcome, specifically caesarean section rates, among induced term nulliparous and multiparous women without a previous caesarean section were analyzed in this cross-sectional study [BD1] using the Robson 10 group classification2 for the year 2016.Results: In the total number of 8851 women delivered in 2016[BD2] , the caesarean section rates among nulliparous women in spontaneous and induced labour, Robson groups 1 and 2A, were 7.8% (151/1925) and 32.6% (437/1339) respectively and among multiparous (excluding those women with a previous caesarean section), Robson group 3 and 4A were 1%(24/2389) and 4.4% (44/1005), respectively. Pre labour caesarean rates for nulliparous and multiparous women, Robson groups 2B and 4B2 were 3.9% (133/3397) and 2.8% (100/3494), of the respective single cephalic cohort at term.Conclusion: The data suggests that studies on induction of labour should be analyzed by parity as there is a significant difference between nulliparous and multiparous women.

scholarly journals Induction of Labour in Growth Restricted and Small for Gestational Age Foetuses – A Historical Cohort Study

2019 ◽  
Vol 79 (04) ◽  
pp. 402-408
Author(s):  
Sven Kehl ◽  
Christel Weiss ◽  
Ulf Dammer ◽  
Sebastian Berlit ◽  
Thomas Große-Steffen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Caesarean Section ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Caesarean Section Rate ◽  
Growth Restriction ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Historical Cohort ◽  
Foetal Growth

Abstract Purpose Induction of labour for small-for-gestational-age (SGA) foetus or intrauterine growth restriction (IUGR) is common, but data are limited. The aim of this study was therefore to compare labour induction for SGA/IUGR with cases of normal foetal growth above the 10th percentile. Material and Methods This historical multicentre cohort study included singleton pregnancies at term. Labour induction for SGA/IUGR (IUGR group) was compared with cases of foetal growth above the 10th percentile (control group). Primary outcome measure was caesarean section rate. Results The caesarean section rate was not different between the 2 groups (27.0 vs. 26.2%, p = 0.9154). In the IUGR group, abnormal CTG was more common (30.8 vs. 21.9%, p = 0.0214), and foetal blood analysis was done more often (2.5 vs. 0.5%, p = 0.0261). There were more postpartum transfers to the NICU in the IUGR group (40.0 vs. 12.8%, p < 0.0001), too. Conclusion Induction of labour for foetal growth restriction was not associated with an increased rate of caesarean section.

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