The influence of prior route of delivery: Intrapartum procedures and outcomes

Abstract

OUTCOMES DAVID LAGREW, MELISSA BUSH, ANNA MCKEOWN, JAMES T. KURTZMAN, Saddleback Memorial Medical Center, Maternal Fetal Medicine, Laguna Hills, California, University of California, Irvine, OB/Gyn Maternal Fetal Medicine, Orange, California OBJECTIVE: Despite intensive debate over cesarean section rates there is a paucity of information regarding the long term effects of a uterine scar. The purpose of this study was to evaluate the risk/benefit of prior route of delivery on intrapartum procedures and outcomes. STUDY DESIGN: We analyzed prospectively collected singleton maternal and neonatal data from 1/1/1998 to 12/31/2003 in four MemorialCare hospitals into a dedicated perinatal database at delivery. The patients were then divided into groups by presence of prior delivery, prior delivery method (vaginal or cesarean) and current trial of labor (TOL). Results were compared by chi square analysis with significance at P ! .05. RESULTS: During the study period there were 60,606 births fitting the above criteria. There were 28,638(47.3%) prior vaginal and 8,920 (14.7%) prior cesarean (CS) deliveries. Compared to patients with prior vaginal deliveries, patients with prior cesarean delivery had an increased risks of cesarean for abruptio placenta (P ! .01, RR 1.7); previa (P ! .001, RR 1.8), suspected uterine rupture (P ! .001, RR 25.7), intrapartum fetal non-reassuring fetal status (P!0.001, RR 1.6), breech (P ! .001, RR 1.8) and abnormal antepartum testing (P ! .001, RR 3.1); in addition, hysterectomy (P ! .001, RR 5.4) and infant intubations (P ! .001, RR 1.6). The increased risks of suspected rupture (P! .001, RR 17.1) and hysterectomy (P! .001, RR 6.7) persisted by removing patients with TOL. Prior cesarean patients had reduced risk of thick meconium (P ! .001, RR 0.7) and shoulder dystocia (P ! .001, RR 0.2). There was no difference in the risk of emergent cesarean, 5 minute Apgar ! 7 or stillbirth. Prior cesarean patients who avoided TOL had fewer dilatation and curettages (P ! .001, RR 0.2). CONCLUSION: These data strongly confirm that the lowest risk multiparous parturient is the woman with a prior vaginal delivery. These risks and benefits should be carefully considered when counseling a patient for elective primary cesarean section who is planning future pregnancies. 329 THE PREVALENCE OF HELICOBACTER PYLORI IN THE HISPANIC POPULATION AFFECTED BY HYPEREMESIS GRAVIDARUM RICHARD LEE, VIVIEN PAN, DEBORAH WING, University of Southern California, Keck School of Medicine, Department of Obstetrics and Gynecology, Los Angeles, California, University of California, Irvine, Department of Obstetrics and Gynecology, Orange, California OBJECTIVE: To determine the prevalence of Helicobacter pylori (H pylori) seropositivity in pregnant Hispanics affected by hyperemesis gravidarum. STUDY DESIGN: This is a prospective cross-sectional study conducted over a 22 month period. Serum from pregnant Hispanics affected by hyperemesis gravidarum and unaffected Hispanics matched for age and ethnicity were tested for H pylori IgG. Hyperemesis gravaridum was defined by the presence of all of the following criteria: (1) intractable nausea and vomiting for greater than 24 hours prior to admission occuring at least three times per day; (2) three-plus ketonuria on urine dipstick; (3) weight loss of at least five pounds within three weeks of diagnosis. IgG levels specific for H pylori were determined by ELISA. Assuming the background prevalence of H pylori serum positivity in the Hispanic population is approximately 60%, 38 patients in each group were needed to detect a 30% difference in affected patients versus controls with a power of 80% and a = .05. Statistical analysis was performed using c. RESULTS: A total of 82 patients between the ages of 18 to 39 years were enrolled. Of 40 patients diagnosed with hyperemesis gravidarum, 26 (65%) were seropositive for H pylori compared to 28 of 42 (67%) unaffected controls (P = .94). There were no statistical differences in maternal age or countries of origin between the two groups. CONCLUSION: The overall prevalence of H pylori seropositivity in this patient population is 66%. In pregnant Hispanics affected by hyperemesis gravidarum, H pylori seropositivity is not increased compared to unaffected controls.