Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?: A Population Based Case-Control Study

Abstract Background In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable. Material and methods Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries. Results Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p = 0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head. Conclusion All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.

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Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil

PLoS ONE ◽

10.1371/journal.pone.0153396 ◽

2016 ◽

Vol 11 (4) ◽

pp. e0153396 ◽

Cited By ~ 38

Author(s):

Ana Paula Esteves-Pereira ◽

Catherine Deneux-Tharaux ◽

Marcos Nakamura-Pereira ◽

Monica Saucedo ◽

Marie-Hélène Bouvier-Colle ◽

...

Keyword(s):

Maternal Mortality ◽

Caesarean Delivery ◽

Case Control Study ◽

Population Based ◽

Case Control ◽

Control Study

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Cesarean delivery complicated with peripartum infection increases the risk of uterine rupture during subsequent trial of labour: A retrospective case-control study

10.22541/au.163264948.81936761/v1 ◽

2021 ◽

Author(s):

Rina Tamir Yaniv ◽

Sivan Farladansky-Gershnabel ◽

Hadar Gluska ◽

Yair Daykan ◽

Gil Shechter Maor ◽

...

Keyword(s):

Cesarean Delivery ◽

Uterine Rupture ◽

Caesarean Delivery ◽

Case Control Study ◽

Case Control ◽

Control Group ◽

Vaginal Birth After Cesarean ◽

Retrospective Case ◽

Subsequent Trial ◽

Control Study

Objective: To evaluate the relation between peripartum infection at first caesarean delivery to uterine dehiscence or rupture at the subsequent delivery. Design: Retrospective case-control study from March 2014 to October 2020. Setting: University-affiliated medical centre. Sample: Women with a prior caesarean delivery and proven dehiscence or uterine rupture diagnosed during their subsequent delivery. The control group included women who had a successful vaginal birth after Cesarean section without evidence of dehiscence or uterine rupture. Methods: We compared the rate of peripartum infection during the first Cesarean delivery and other relevant variables, between the two groups. We also analysed the type of infection correlated with uterine rupture or dehiscence. Main Outcome Measures: Rate of peripartum infection. Results: A total of 168 women were included, 71 with uterine rupture or dehiscence and 97 with successful vaginal birth after Cesarean section as the control group. The rate of peripartum infection at the first caesarean delivery was significantly higher in the study group compared to the control group (22.2% vs. 8.2%, p=0.013). Multivariate logistic regression analysis found that peripartum infection remained an independent risk-factor for uterine rupture at the subsequent trial of labour after Cesarean delivery (95% CI, P=0.018). We also found that endometritis had the highest correlation to uterine rupture (9.8% vs. 0%, p=0.02) Conclusion: Peripartum infection in the first caesarean delivery, may be an independent risk-factor for uterine rupture in a subsequent delivery. Compared to other infections, endometritis may pose the greatest risk for uterine rupture or dehiscence.

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