Risk factors for Caesarean delivery after induction of labour among nulliparous women at term

The aim of the study was to identify which groups of women contribute to interinstitutional variation of caesarean delivery (CD) rates and which are the reasons for this variation. In this regard, 15,726 deliveries from 11 regional centers were evaluated using the 10-group classification system. Standardized indications for CD in each group were used. Spearman’s correlation coefficient was used to calculate (1) relationship between institutional CD rates and relative sizes/CD rates in each of the ten groups/centers; (2) correlation between institutional CD rates and indications for CD in each of the ten groups/centers. Overall CD rates correlated with both CD rates in spontaneous and induced labouring nulliparous women with a single cephalic pregnancy at term (P=0.005). Variation of CD rates was also dependent on relative size and CD rates in multiparous women with previous CD, single cephalic pregnancy at term (P<0.001). As for the indications, “cardiotocographic anomalies” and “failure to progress” in the group of nulliparous women in spontaneous labour and “one previous CD” in multiparous women previous CD correlated significantly with institutional CD rates (P=0.021,P=0.005, andP<0.001, resp.). These results supported the conclusion that only selected indications in specific obstetric groups accounted for interinstitutional variation of CD rates.

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Term Induction of Labour in Nulliparous Women: When to draw the line?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.1058 ◽

2022 ◽

Vol 226 (1) ◽

pp. S641-S642

Author(s):

Jill M. Mitchell ◽

Patrick Dicker ◽

Sarah M. Nicholson ◽

Suzanne Smyth ◽

Grace Madigan ◽

...

Keyword(s):

Induction Of Labour ◽

Nulliparous Women

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Patterns of Cardiovascular Risk Factors in the Years Before Pregnancy in Nulliparous Women With and Without Preterm Birth and Small‐for‐Gestational‐Age Delivery

Journal of the American Heart Association ◽

10.1161/jaha.121.021321 ◽

2021 ◽

Author(s):

Ravi Retnakaran ◽

Baiju R. Shah

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Preterm Delivery ◽

Alanine Aminotransferase ◽

Fasting Glucose ◽

Glycosylated Hemoglobin ◽

Density Lipoprotein ◽

Nulliparous Women ◽

Over Time

Background Women with either preterm or small‐for‐gestational‐age (SGA) delivery have an elevated lifetime risk of cardiovascular disease that has been attributed to the accrual of vascular risk factors over time. We sought to determine whether an adverse cardiovascular risk factor profile develops in the years before pregnancies complicated by preterm delivery or SGA. Methods and Results Using administrative databases, we identified all 156 278 nulliparous women in Ontario, Canada, who had singleton pregnancies between January 2011 and December 2018 and ≥2 measurements of the following analytes between January 2008 and the start of pregnancy: glycosylated hemoglobin, glucose, lipids, and alanine aminotransferase. There were 11 078 women with preterm delivery and 19 367 with SGA. The 2 most recent pregravid tests were performed at median 0.6 (interquartile range, 0.3–1.4) and 1.9 (interquartile range, 1.1–3.3) years before pregnancy, respectively. Women with preterm delivery had higher pregravid glycosylated hemoglobin, glucose, low‐density lipoprotein cholesterol, triglycerides, and alanine aminotransferase, and lower high‐density lipoprotein cholesterol, than those without preterm delivery. In contrast, women with SGA had lower pregravid fasting glucose, random glucose, and triglycerides than those without SGA. In the years before pregnancy, women with preterm delivery had higher annual increases than their peers in glycosylated hemoglobin (0.7‐times higher), triglycerides (7.9‐times higher), and alanine aminotransferase (2.2‐times higher). During this time, fasting glucose increased in women who developed preterm delivery but decreased in their peers. Conclusions An adverse cardiovascular risk factor profile evolves over time in the years before pregnancy complicated by preterm delivery, but does not necessarily precede SGA.

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Abstract 14090: Multiparity is Associated With Aortic Pathology in Women From the Dallas Heart Study

Circulation ◽

10.1161/circ.142.suppl_3.14090 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Kavisha Singh ◽

Rina Mauricio ◽

Wanpen Vongpatanasin ◽

Katy Lonergan ◽

Monika Sanghavi ◽

...

Keyword(s):

Risk Factors ◽

Continuous Variable ◽

Aortic Compliance ◽

Cross Sectional ◽

Live Births ◽

Nulliparous Women ◽

Heart Study ◽

Aortic Pathology ◽

Dallas Heart Study ◽

Aortic Size

Introduction: The proximal aorta has been shown to enlarge with aging in humans, but the long-term impact of hormonal and hemodynamic changes associated with pregnancy on aortic size and function are unknown. We examined if number of live births was independently associated with aortic dimensions and stiffness in a healthy multi-ethnic population-based cohort, the Dallas Heart Study (DHS). We hypothesized that multiparity (>/=4 live births) is independently associated with aortic dilation and aortic stiffness after adjustment for CV risk factors. Methods: Women with available thoracic aortic MRI measurements (n=1468, mean 44.5 years old) from DHS were stratified based on self-reported number of live births (0,1,2,3,>/=4). Sequential multivariable logistic regression models were used to assess independent associations of the number of live births with ascending aortic cross-sectional area/height, aortic pulse wave velocity (PWV) and aortic compliance. Models were adjusted for major CV risk factors. Results: Women with >/=4 live births were older, more likely to be Black, and had higher blood pressure, triglycerides and body mass index. Compared with nulliparous women, women with >/=4 had larger ascending aortic areas indexed to height [5.19 vs 4.74 cm2/m; p<0.0001; Table 1]. After adjustment for risk factors, multiparity remained a significant predictor of aortic size. Compared to nulliparous women, women with >/=4 live births also had higher aortic PWV (5.54 vs 4.54 m/s; p<0.0001) and lower aortic compliance (21.9 vs 27.2 mL/mmHg; p 0.0002), but these relationships were no longer significant after multivariable adjustment (Table 1). Analyzing live births as a continuous variable did not change these results. Conclusions: Multiparity was associated with thoracic aortic enlargement, independent of age and relevant risk factors. Parity is an emerging sex-specific risk factor in cardiovascular disease that may have an impact on aortic remodeling in women.

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Do you pay to go private?: a single centre comparison of induction of labour and caesarean section rates in private versus public patients

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03443-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Simon Craven ◽

Fionnuala Byrne ◽

Rhona Mahony ◽

Jennifer M. Walsh

Keyword(s):

Decision Making ◽

Caesarean Section ◽

Maternity Hospital ◽

Neonatal Outcomes ◽

Induction Of Labour ◽

Adjusted Relative Risk ◽

Nulliparous Women ◽

Significant Difference ◽

Private And Public ◽

Maternal And Neonatal Outcomes

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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03334-8 ◽

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.

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