Delivery Modality Affect Neonatal Levels of Inflammation, Stress, and Growth Factors

Introduction: As part of the study CODIBINE, Correlations and Diagnoses for Biomarkers in New-borns, the main objective of the study was to explore neonatal inflammation, stress, neurodevelopment, and growth factors after in-labor and pre-labor cesarean section compared to vaginal delivery. Increasing evidence has shown that birth delivery mode has an impact on imminent and long-term child health. However, the effect of the timing of cesarean section is insufficiently elucidated. The main objective of the study was to explore the effect of different delivery modes, vaginal delivery compared to cesarean section with or without initiation of labor, on the infants.Methods: We designed a retrospective cohort study, including dried blood spot samples from mature (gestational age ≥ 37) newborns delivered in the years 2009-2011. The newborns were divided into three groups after delivery mode: (1) pre-labor cesarean section (n = 714), i.e., cesarean delivery without initiation of labor, (2) in-labor cesarean section (n = 655), i.e., cesarean section after initiation of labor, and (3) vaginal delivery (n = 5,897). We measured infant levels of inflammatory (IL-18, MCP-1, CRP, sTNF RI), stress (HSP-70), growth (EGF, VEGF-A), and neurotrophic factors (BDNF, NT-3, S100B) 2–4 days after birth.Results: The neonatal levels of inflammatory and stress markers were significantly lower, while the levels of growth factors were higher after pre-labor cesarean section compared to vaginal delivery. The biomarker levels were similar after in-labor cesarean section and vaginal delivery. Removing cases with pre-labor rupture of membranes and artificial rupture of membranes in the calculations did not change the results. The levels of neurotrophic factors were unaffected by delivery form. Males had generally higher levels of inflammation and lower levels of growth and neurotrophic factors. Overall, the levels of inflammatory markers increased, and the growth factors decreased with increasing gestational age.Conclusion: The present study of the biomarker levels after birth suggests that the labor process has an important effect on the fetal immune system and level of stress, regardless if the delivery ends with cesarean section or vaginal birth.

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Prenatal and Peripartum Exposure to Antibiotics and Cesarean Section Delivery Are Associated with Differences in Diversity and Composition of the Infant Meconium Microbiome

Microorganisms ◽

10.3390/microorganisms8020179 ◽

2020 ◽

Vol 8 (2) ◽

pp. 179

Author(s):

Wendy S.W. Wong ◽

Priya Sabu ◽

Varsha Deopujari ◽

Shira Levy ◽

Ankit A. Shah ◽

...

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Alpha Diversity ◽

Antibiotic Use ◽

Birth Cohort Study ◽

Delivery Mode ◽

Differential Abundance ◽

Bacterial Dna ◽

Cesarean Section Delivery

The meconium microbiome may provide insight into intrauterine and peripartum exposures and the very earliest intestinal pioneering microbes. Prenatal antibiotics have been associated with later obesity in children, which is thought to be driven by microbiome dependent mechanisms. However, there is little data regarding associations of prenatal or peripartum antibiotic exposure, with or without cesarean section (CS), with the features of the meconium microbiome. In this study, 16S ribosomal RNA gene sequencing was performed on bacterial DNA of meconium samples from 105 infants in a birth cohort study. After multivariable adjustment, delivery mode (p = 0.044), prenatal antibiotic use (p = 0.005) and peripartum antibiotic use (p < 0.001) were associated with beta diversity of the infant meconium microbiome. CS (vs. vaginal delivery) and peripartum antibiotics were also associated with greater alpha diversity of the meconium microbiome (Shannon and Simpson, p < 0.05). Meconium from infants born by CS (vs. vaginal delivery) had lower relative abundance of the genus Escherichia (p < 0.001). Prenatal antibiotic use and peripartum antibiotic use (both in the overall analytic sample and when restricting to vaginally delivered infants) were associated with differential abundance of several bacterial taxa in the meconium. Bacterial taxa in the meconium microbiome were also differentially associated with infant excess weight at 12 months of age, however, sample size was limited for this comparison. In conclusion, prenatal and peripartum antibiotic use along with CS delivery were associated with differences in the diversity and composition of the meconium microbiome. Whether or not these differences in the meconium microbiome portend risk for long-term health outcomes warrants further exploration.

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Relation between delivery mode and maternal mental status one month after delivery at a perinatal center in Japan: A cross-sectional study

F1000Research ◽

10.12688/f1000research.20677.3 ◽

2020 ◽

Vol 8 ◽

pp. 1755

Author(s):

Shunji Suzuki

Keyword(s):

Cesarean Section ◽

Mental Status ◽

Depression Scale ◽

Cross Sectional Study ◽

Elective Cesarean Section ◽

Delivery Mode ◽

Cross Sectional ◽

Delivery Modes ◽

Emergency Cesarean ◽

Elective Cesarean

Background: Maternal mental status has been thought to be affected by the delivery modes. We examined the relation between delivery modes and the mental status of women who delivered at our institute in Japan. Methods: Data were collected from the medical charts of 643 primiparous women without a history of mental disorders who delivered singleton babies and underwent a 1-month postpartum check-up at our institute from September 2018 to June 2019. The maternal mental status was examined based on the scores of the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-Infant Bonding Scale (MIBS). Results: The rate of high scores of the EPDS and the MIBS in women choosing elective cesarean section were higher than in women with vaginal delivery and emergency cesarean section. Conclusion: Mental health care may be necessary for women choosing elective cesarean section.

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Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates < 32 Weeks

Klinische Pädiatrie ◽

10.1055/a-1443-6208 ◽

2021 ◽

Author(s):

Nadia S. Eugster ◽

Florence Corminboeuf ◽

Gilbert Koch ◽

Julia E. Vogt ◽

Thomas Sutter ◽

...

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Vaginal Delivery ◽

Gestational Age ◽

Preterm Neonates ◽

Multiple Birth ◽

Plasma Sodium ◽

Delivery Mode ◽

Antenatal Corticosteroids ◽

Clinical Complications

Abstract Background Preterm neonates frequently experience hypernatremia (plasma sodium concentrations >145 mmol/l), which is associated with clinical complications, such as intraventricular hemorrhage. Study design In this single center retrospective observational study, the following 7 risk factors for hypernatremia were analyzed in very low gestational age (VLGA, below 32 weeks) neonates: gestational age (GA), delivery mode (DM; vaginal or caesarian section), sex, birth weight, small for GA, multiple birth, and antenatal corticosteroids. Machine learning (ML) approaches were applied to obtain probabilities for hypernatremia. Results 824 VLGA neonates were included (median GA 29.4 weeks, median birth weight 1170 g, caesarean section 83%). 38% of neonates experienced hypernatremia. Maximal sodium concentration of 144 mmol/l (interquartile range 142–147) was observed 52 hours (41–65) after birth. ML identified vaginal delivery and GA as key risk factors for hypernatremia. The risk of hypernatremia increased with lower GA from 22% for GA ≥ 31–32 weeks to 46% for GA < 31 weeks and 60% for GA < 27 weeks. A linear relationship between maximal sodium concentrations and GA was found, showing decreases of 0.29 mmol/l per increasing week GA in neonates with vaginal delivery and 0.49 mmol/l/week after cesarean section. Sex, multiple birth and antenatal corticosteroids were not associated hypernatremia. Conclusion VLGA neonates with vaginal delivery and low GA have the highest risk for hypernatremia. Early identification of neonates at risk and early intervention may prevent extreme sodium excursions and associated clinical complications.

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Delivery of Twin Gestation (≥ 32.0 Weeks): The Vaginal Route as a Practicable and Safe Alternative to Cesarean Section

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1181-8737 ◽

2020 ◽

Vol 80 (10) ◽

pp. 1033-1040

Author(s):

Anne Dathan-Stumpf ◽

Katharina Winkel ◽

Holger Stepan

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Neonatal Outcome ◽

Neonatal Outcomes ◽

University Hospital ◽

Delivery Mode ◽

Safe Alternative ◽

Vaginal Deliveries ◽

Twin Pregnancies ◽

Second Twin

Abstract Objective The appropriate delivery mode for twins is discussed controversially in the literature. The aim of this study was to investigate delivery modes and short-term neonatal outcomes of twin pregnancies delivered in University Hospital Leipzig. Material and Methods A total of 274 twin pregnancies (32.0 to 39.4 weeks of gestation) delivered between 2015 and 2017 were analyzed retrospectively with regard to the planned and final delivery mode as well as neonatal outcomes. The inclusion and exclusion criteria for vaginal delivery were comparable to those of the Twin Birth Study. Results The spontaneous birth rate for births planned as vaginal deliveries was 78.5%; the rate of secondary cesarean section was 19.4%. The final total cesarean rate was 58.8%, and the rate of vaginal deliveries was 41.2%. Vertex or non-vertex position of the second twin had no significant effect on neonatal outcome or mean delivery interval between the birth of the first and second twin. Chorionicity, neonatal weight and gender had no significant impact on delivery mode. However, successful vaginal delivery was associated with higher gestational age and both fetuses in vertex position. The combined neonatal outcome for both twins was significantly worse if they were delivered by cesarean section compared to spontaneous birth. In addition, the leading twin in monochorionic/diamniotic (MC/DA) pregnancies was intubated more frequently after cesarean delivery and had significantly lower Apgar scores. Conclusion Vaginal delivery in twin pregnancies is a practicable and safe option in specific defined conditions and when the appropriate infrastructure and clinical experience is available.

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Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2604-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Zhifen Hua ◽

Fadwa El Oualja

Keyword(s):

Retrospective Study ◽

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Gestational Age ◽

Placenta Previa ◽

Mode Of Delivery ◽

Fetal Membrane ◽

Delivery Mode ◽

Maternal Preference

Abstract Background The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). Methods Pregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded. Results Out of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery. Conclusions We concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.

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Feto-maternal Outcomes in Cesarean Section Compared to Vaginal Delivery in Eclamptic Patients in a Tertiary Level Hospital

Journal of Enam Medical College ◽

10.3329/jemc.v3i2.16128 ◽

2013 ◽

Vol 3 (2) ◽

pp. 77-83

Author(s):

Sheuly Begum ◽

Ferdousi Islam ◽

Arifa Akter Jahan

Keyword(s):

Cesarean Section ◽

Maternal Mortality ◽

Vaginal Delivery ◽

Gestational Age ◽

Birth Asphyxia ◽

Maternal Outcome ◽

Maternal Complications ◽

Medical College ◽

Group I ◽

Significant Difference

Background: Over half-a-million women die each year from pregnancy-related causes, and 99 percent of these occur in developing countries. In Bangladesh though maternal mortality rate (MMR) declined significantly around 40% in the past decade, still eclampsia accounts for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure is delivery regardless of gestational age. A rational therapy for general management of hypertension and convulsion has been established in Bangladesh by the Eclampsia Working Group. But controversy still exists regarding obstetric management. Objective: To evaluate the feto-maternal outcome in cesarean section compared to vaginal delivery in eclamptic patients. Materials and Methods: This prospective cohort study was conducted in the department of Obstretics & Gynecology, Dhaka Medical College & Hospital (DMCH), from January to December 2011. A total 100 eclamptic women with term pregnancy and live foetus were purposively included in the study (Group I, 50 patients with vaginal delivery and Group II, 50 with cesarean section). Results: Out of these 100 patients 56% were aged <20 years, 71% were primigravida and 77% were from low socioeconomic status. Sixteen percent patients from vaginal delivery group and 18% from cesarean section group had no antenatal care. The mean gestational age was about 38 weeks in two groups. No significant difference was found between the two groups regarding blood pressure, proteinuria, consciousness level and convulsion. Recurrence of convulsion occurred in 30% patients of vaginal delivery group compared to 6% in cesarean section group. Maternal complications such as postpartum hemorrhage, cerebrovascular accident, renal failure, obstetric shock and abruptio placenta were higher among vaginal delivery group patients (46%) than cesarean section patients (16%). Maternal mortality was 6% in the vaginal delivery group and none in the cesarean section group. Regarding fetal outcome, stillbirth was 20% after vaginal delivery and 6% after cesarean section, the result was statistically significant. Birth asphyxia was less in the cesarean section group (23.4%) than in vaginal delivery group (60%) and this was statistically significant. Conclusions: The result of the present study shows a better feto- maternal outcome in the cesarean section group than in the vaginal delivery group. Journal of Enam Medical College; Vol 3 No 2 July 2013; Page 77-83 DOI: http://dx.doi.org/10.3329/jemc.v3i2.16128

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Influence of delivery mode on maternal mental status one month after delivery at a perinatal center in Japan: A cross-sectional study

F1000Research ◽

10.12688/f1000research.20677.1 ◽

2019 ◽

Vol 8 ◽

pp. 1755

Author(s):

Shunji Suzuki

Keyword(s):

Cesarean Section ◽

Mental Status ◽

Depression Scale ◽

Cross Sectional Study ◽

Elective Cesarean Section ◽

Delivery Mode ◽

Cross Sectional ◽

Delivery Modes ◽

Emergency Cesarean ◽

Elective Cesarean

Background: Maternal mental status has been thought to be affected by the delivery modes. We examined the influence of delivery modes on the mental status of women who delivered at our institute in Japan. Methods: Data were collected from the medical charts of 645 primiparous women without a history of mental disorders who delivered singleton babies and underwent a 1-month postpartum check-up at our institute from September 2018 to June 2019. The maternal mental status was examined based on the scores of the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-Infant Bonding Scale (MIBS). Results: The rate of high scores of the EPDS and the MIBS in women choosing elective cesarean section were higher than in women with vaginal delivery and emergency cesarean section. Conclusion: A fulfilling birth-plan and birth-review may also be necessary for women choosing elective cesarean section.

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Long-term risks of stress and urgency urinary incontinence after different vaginal delivery modes

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.10.034 ◽

2019 ◽

Vol 220 (2) ◽

pp. 181.e1-181.e8 ◽

Cited By ~ 2

Author(s):

Riikka M. Tähtinen ◽

Rufus Cartwright ◽

Robin W.M. Vernooij ◽

Guri Rortveit ◽

Steinar Hunskaar ◽

...

Keyword(s):

Urinary Incontinence ◽

Vaginal Delivery ◽

Urgency Urinary Incontinence ◽

Delivery Modes

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Vaginal Delivery Could Affect on Lactose Content of Human Milk

Current Pediatric Reviews ◽

10.2174/1573396317666211206123648 ◽

2021 ◽

Vol 17 ◽

Author(s):

Leila Zeynali ◽

Roghayyeh Nourizadeh ◽

Azizeh Farshbaf Khalili ◽

Mohammad Bagher Hosseini ◽

Asef Khalili ◽

...

Keyword(s):

Cohort Study ◽

Cesarean Section ◽

Human Milk ◽

Vaginal Delivery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Delivery Mode ◽

Sociodemographic Characteristics ◽

Mature Milk ◽

Milk Samples

Objective: The macronutrients of human milk are considered as essential nutritional sources in the first few months of a newborn’s life. The present study aimed to investigate the effect of delivery mode on the macronutrients of human milk. Methods: This retrospective cohort study was conducted on 102 women who gave birth by cesarean section or vaginal delivery between September 2019 and November 2019. The participants were requested to provide their milk samples on day 15±1 after childbirth. Results: There were no significant differences between the two groups (cesarean and vaginal delivery) regarding the sociodemographic characteristics and intake of fat, carbohydrate, protein, and energy. The lactose level was significantly higher in women who gave birth by vaginal delivery [adjusted mean difference, 1.2 (95% CI 0.02- 1.82)]. For other macronutrients, there were no statistically significant differences between the two groups. Conclusion: The vaginal delivery might influence the mature milk lactose level.

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Influence of delivery mode on maternal mental status one month after delivery at a perinatal center in Japan: A cross-sectional study

F1000Research ◽

10.12688/f1000research.20677.2 ◽

2020 ◽

Vol 8 ◽

pp. 1755

Author(s):

Shunji Suzuki

Keyword(s):

Cesarean Section ◽

Mental Status ◽

Depression Scale ◽

Cross Sectional Study ◽

Elective Cesarean Section ◽

Delivery Mode ◽

Cross Sectional ◽

Delivery Modes ◽

Emergency Cesarean ◽

Elective Cesarean

Background: Maternal mental status has been thought to be affected by the delivery modes. We examined the influence of delivery modes on the mental status of women who delivered at our institute in Japan. Methods: Data were collected from the medical charts of 645 primiparous women without a history of mental disorders who delivered singleton babies and underwent a 1-month postpartum check-up at our institute from September 2018 to June 2019. The maternal mental status was examined based on the scores of the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-Infant Bonding Scale (MIBS). Results: The rate of high scores of the EPDS and the MIBS in women choosing elective cesarean section were higher than in women with vaginal delivery and emergency cesarean section. Conclusion: Mental health care may be necessary for women choosing elective cesarean section.

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