C-section Rate Research Articles

A scoping review of the payment mechanisms in childbirth of country members and non-members of the Organisation for Economic Cooperation and Development

Payment mechanisms serve to put into operation the function of purchasing in health. Payment mechanisms impact the decisions that healthcare providers make. Given this, we are interested in knowing how they affect the generalized increase of C-section rates globally. The objective of this review is to describe existing payment mechanisms for childbirth in countries members of the Organization for Economic Co-operation and Development (OECD) and non-members. We conducted a scoping review following the five methodological steps of the Joanna Briggs Institute. The search was conducted by researchers independently, achieving inter-reliability among raters (kappa index, 0.96). We searched electronic databases, grey literature, and governmental and non-governmental websites. We screened on three levels and included documents published in the last ten years, in English and Spanish. Results were analyzed considering the function of the reimbursement mechanism and its effects on providers, payers, and beneficiaries. Evidence from 34 countries was obtained (50% OECD members). Sixty-four percent of countries report the use of more than one payment mechanism for childbirth. Diagnosis-Related Groups (47.6%), Pay-for-performance (23.3%), Fee-for-service (16.6%) and Fixed-prospective systems (13.3%) are among the most frequently used mechanisms. Countries use payment mechanism architecture to improve maternal-perinatal health indicators. Therefore, it is necessary to explore the best combination of mechanisms that improve the provision of health care and welfare of the population in the field of sexual and reproductive health.

Early gestational diabetes mellitus (GDM) is associated with worse pregnancy outcomes compared with GDM diagnosed at 24-28 weeks gestation despite early treatment.

Gestational diabetes mellitus (GDM) is associated+ with adverse pregnancy outcomes compared with women with normal glucose tolerance in pregnancy. The WHO recommends screening at 24-28 weeks gestation for GDM. Women who are diagnosed before 24-28 weeks gestation have a longer intervention period which may impact positively on pregnancy outcomes. This study aimed to examine pregnancy outcomes of women with GDM diagnosed <24 weeks gestation compared with those diagnosed at 24-28 weeks in a large Irish cohort. A retrospective cohort study of 1471 pregnancies in women with GDM diagnosed using IADPSG criteria between September 2012 and April 2016 was conducted. At GDM diagnosis, women were classified as early GDM <24 weeks or standard GDM 24-28 weeks gestation. Women with early GDM had a significantly greater risk of pregnancy-induced hypertension (12.4% vs. 5.3%; P < 0.05), post-partum haemorrhage (8.7% vs. 2.4%; P < 0.05) and post-partum glucose abnormalities (32% vs. 15.6%; P < 0.05). Their offspring had a greater risk of pre-maturity (10.9% vs. 6.6%; P < 0.05), stillbirth (1.4% vs. 0.5%; P < 0.05), large for gestational age (19.1% vs. 13.4% P < 0.05) and need neonatal intensive care (30.7% vs. 22.1%; P < 0.05) compared with offspring of women with standard GDM. Rates of C-section and pre-maturity were still higher in the early GDM group when the two groups where compared based on their post-natal OGTT. Early GDM women and their offspring are at greater risk of an adverse pregnancy outcome compared with those diagnosed at 24-28 weeks. In view of the abnormal post-natal glucose findings, early GDM may reflect a more advanced state in diabetes pathogenesis.

SUN-630 Insulin Pumps Versus Multiple Daily Injections in Type 1 Diabetic Pregnancies

Background: Pregnancy is associated with physiological increased resistance to insulin, leading to increased insulin requirements for diabetic women. Poor glycemic control in pregnancy is associated with neonatal and maternal complications. Insulin has been traditionally administered subcutaneously through multi daily injections (MDIs) however, use of insulin pumps or continuous subcutaneous insulin infusion (CSII) has become more widespread. As glycemic control has direct influence on perinatal and maternal outcomes, comparing MDIs and CSII in pregnant women with Type 1 Diabetes Mellitus (DM1) is of interest. Aim: To investigate whether there is a difference in birth weights in infants born from DM1 mothers who use CSII compared to MDIs. Methods and Results: This is a retrospective cohort study of women diagnosed with DM1 on either MDIs or CSII whose pregnancies were followed at our institution. The following data was collected on chart review: age, years since DM1 diagnosis, BMI and weight gain at each trimester, total daily insulin dose at delivery, presence of retinopathy or nephropathy, gestational age at delivery, delivery method, presence of hypertension, pre-eclampsia or eclampsia, birth weight, sex of infant and neonatal complications. Preliminary analysis of our currently available data demonstrates that in age-matched groups of women on MDI (N=44) compared to CSII (N=8), there was no significant difference in infant birth weights (3491g ± 760 vs. 3554g ± 666, respectively). There was also no significant difference in neonatal complications (jaundice, hypoglycemia, shoulder dystocia, macrosomia, respiratory distress or prematurity). Women on CSII had been diagnosed with DMI for a significantly longer period of time (20 vs. 14 years) and were on higher total daily doses of insulin per body weight at time of delivery (p<0.05). Despite this, there was no significant difference in weight gain during pregnancy between the groups. There was also no significant difference in the presence of hypertension, pre-eclampsia, eclampsia or in C-section rates. Discussion: Given the paucity of studies and the increasing use of pump technology among diabetic women, there remains a need for further research comparing the effects of MDIs and pumps on birthweights as well as other neonatal and maternal outcomes.

Labor Induction Outcomes With Outpatient Misoprostol for Cervical Ripening Among Low-Risk Patients [OP03-6C

INTRODUCTION: Labor induction is becoming increasingly common. The objective of this study is to evaluate the effect of outpatient misoprostol for cervical ripening on inpatient time-to-delivery and maternal and neonatal outcomes. METHODS: We conducted an IRB approved retrospective cohort study of 10,467 patients (559 outpatient, 9,908 inpatient) who received misoprostol for cervical ripening at Kaiser Permanente Northern California hospitals between 2012 and 2017. Time-to-delivery and maternal and neonatal outcomes after misoprostol administration were analyzed with standard statistical tests. RESULTS: Patients induced with misoprostol in the outpatient and inpatient settings were comparable in demographics and predominantly nulliparous (70.3% and 64.3%, respectively). Patients who received outpatient misoprostol were more likely to have a cervical dilation of 3cm on admission (39.5% vs 9.7%, P &lt; .0001). The outpatient misoprostol cohort had a shorter time between admission and delivery (20.6 [interquartile range (IQR) 12.4-31.7] vs 27.5 [IQR 19.2-37.4] hours, P &lt; .0001), with no difference in mode of delivery or neonatal outcomes. Patients who received outpatient misoprostol were more likely to have a C-section for failure to progress in labor (14.0% vs 11.2%, P=.04), however the overall C-section rate was not significantly different between groups. Patients who received outpatient misoprostol had a higher rate of chorioamnionitis and a trend towards a lower maternal blood transfusion (14.3% vs 10.6%, P=.01; 0.7% vs 1.8%, P=.06, respectively). CONCLUSION: Outpatient misoprostol reduced inpatient time-to-delivery by a median of 7 hours with no significant differences in maternal or neonatal outcomes. An outpatient misoprostol protocol has the potential to decrease inpatient burden on Labor and Delivery.

Unexpected Adverse Medical & Surgical Health Conditions in Neonates after Elective Cesarean Sections within the Context of the Influence of Local Socidemographic Factors in Babylon

Background: Caesarean section was first introduced to reduce the risks of normal delivery, and is recommended only when the lives of the mother and fetus are compromised, as it is associated with certain risks. However, some women’s perceptions may be influenced by local culture. According to international statistics , the rate of C-section is increasing globally, and in Iraq it is 2-3 times higher than other nations. More than 1/3 of women in Babylon choose C-section voluntarily, believing it is safer, healthier, and less painful.Aim of the Study: Identify the unexpected medical and surgical conditions of newborns by elective cesarean delivery in Al-Hillah city, and assess the association between the actual gestational age at birth and decision by which elective caesarean sections were done as influenced by local sociodemographic factors and perceptions; that resulted in those conditions.Methodology: This study is a cross sectional study conducted in Al-Hilla General Teaching Hospital from the beginning of March 2018 until the end on August 2018, and included a total of 150 neonates born via elective cesarean section who had unexpected medical and surgical conditions.Results: Mean maternal age was (26.27±9.56) year ranging from (16-43). Seventy percent of them had timing of < 39 weeks of gestation, and 36.7% had actual gestational age at birth of < 37 weeks. Almost half the them chose C-section for being safe. Respiratory compromise was the commonest medical complication among mothers. There was significant relationship between decision basis and actual gestational age at birth, as well as between maternal age and medical and surgical complications (P-value<0.05).Conclusion: Neonates born after elective cesarean delivery in Al-Hillah city have significantly higher rates of respiratory morbidity and longer length of hospital stay, with increased risk of certain medical and surgical complications. The unexpected medical complications are inversely related to gestational age at which elective cesarean section is timed.

Assessing the impact of C-section at first birth on the second birth

Taking data from the China Fertility Survey 2017 for nine provinces in southwestern and south-central China, we calculated differences in C-section rates among women of different ages, and with different types of hukou and different levels of education. We used the Cox proportional hazards model and a binary logistic regression method to examine the impact of C-section at the first birth on the intention of having a second child and actually giving birth to a second child under the Universal Two-child Policy. This study comes to the following conclusions: (1) the C-section rate is generally high among women, especially among those who are older, have non-agricultural hukou, or have a junior college or above education level; (2) similar to the research findings of scholars in other countries, women having C-section at first birth are 16–20% less likely to have a second child than women having no C-section at first birth; and (3) women having C-section at first birth are less inclined to have a second child.

Verba volant, scripta manent: breastfeeding information and health messages provided to parents in the neonatal discharge summary in the Lazio Region, Italy.

We aimed to evaluate the contents of the neonatal discharge summary (NDS), an important communication tool that should contain evidence-based information. A quali-quantitative study of NDSs delivered from 29 hospitals of Lazio (Italy) in 2014 and 2017 was conducted. We used content analysis to assess the written information and logistic regression to estimate the association between outcomes (compliance with the International Code, health messages, and information on neonatal screenings) and some hospital's characteristics. NDSs conforming to International Code were associated with low rate of C-section (p < 0.05). Hospitals belonging to Local Health Authorities (p < 0.05) and with a lower prevalence of C-section (p < 0.05) had a greater attitude to promote infant health. The year of collection was associated with information on neonatal screenings (p < 0.05). An effort is required by hospitals to reduce their level of medicalization, in clinical practice and prescriptive attitudes, which affects the NDSs delivered to parents.

The impact of the obstetrical risk insurance scheme in Mauritania on maternal healthcare utilization: a propensity score matching analysis.

In Mauritania, obstetrical risk insurance (ORI) has been progressively implemented at the health district level since 2002 and was available in 25% of public healthcare facilities in 2015. The ORI scheme is based on pre-payment scheme principles and focuses on increasing the quality of and access to both maternal and perinatal healthcare. Compared with many community-based health insurance schemes, the ORI scheme is original because it is not based on risk pooling. For a pre-payment of 16–18 USD, women are covered during their pregnancy for antenatal care, skilled delivery, emergency obstetrical care [including caesarean section (C-section) and transfer] and a postnatal visit. The objective of this study is to evaluate the impact of ORI enrolment on maternal and child health services using data from the Multiple Indicator Cluster Survey (MICS) conducted in 2015. A total of 4172 women who delivered within the last 2 years before the interview were analysed. The effect of ORI enrolment on the outcomes was estimated using a propensity score matching estimation method. Fifty-eight per cent of the studied women were aware of ORI, and among these women, more than two-thirds were enrolled. ORI had a beneficial effect among the enrolled women by increasing the probability of having at least one prenatal visit by 13%, the probability of having four or more visits by 11% and the probability of giving birth at a healthcare facility by 15%. However, we found no effect on postnatal care (PNC), C-section rates or neonatal mortality. This study provides evidence that a voluntary pre-payment scheme focusing on pregnant women improves healthcare services utilization during pregnancy and delivery. However, no effect was found on PNC or neonatal mortality. Some efforts should be exerted to improve communication and accessibility to ORI.

Cesarean Section and Maternal-fetal Mortality Rates in Nigeria: An Ecological Lens into the Last Decade.

Background or Objectives:Despite the global decline in maternal mortality within the last decade, women continue to die excessively from pregnancy-related complicationsin developing countries. We assessed the trends in maternal mortality, fetal mortality and cesarean section (C-Section) rates within 25 selected Nigerian hospitals over the last decade.Methods:Basic obstetric data on all deliveries were routinely collected by midwives using the maternity record book developed for the project in all the participating hospitals. Trends of C-Section Rates (CSR), Maternal Mortality Rates (MMR), Fetal Mortality Rates (FMR) and Spontaneous Vaginal Delivery rates (SVD) were calculated using joinpoint regression models.Results:The annual average percent change in CSR was 12.2%, which was statistically significant, indicating a rise in CSR over the decade of the study. There was a noticeable fall in MMR from a zenith of about 1,868 per 100,000 at baseline down to 1,315/100,000 by the end of the study period, representing a relative drop in MMR of about 30%. An average annual drop of 3.8% in FMR and 1.5% drop in SVD over time were noted over the course of the study period.Conclusion and Global Health Implications:We observed an overall CSR of 10.4% and a significant rise in CSR over the 9-year period (2008-2016) of about 108% across hospital facilities in Nigeria. Despite the decrease in MMR, it was still high compared to the global average of 546 maternal deaths per 100 000 livebirths. The FMR was also high compared with the global average. The MMR found in this study clearly indicates that Nigeria is far behind in making progress toward achieving the Sustainable Development Goal 3 (SGD 3) which aims to reduce the global MMR to less than 70 per 100 000 live births by 2030.

The Challenges and Achievements in the Implementation of the Natural Childbirth Instruction Program: A Qualitative Study.

Background:The natural childbirth instruction program, which aims to reduce the cesarean section (C-section) rates in the country and pay attention to demographic policies, has achieved significant accomplishments in the short time span since it was implemented throughout the country. In the present study, the advantages and challenges of the implementation of this program have been analyzed.Materials and Methods:This qualitative study carried out with the participation of 32 knowledgeable individuals who were selected using purposeful sampling and snowball sampling methods among the personnel of Kerman University of Medical Sciences, and it's affiliated educational (university) hospital. The data were collected through semi-structured interviews based on the research objectives, review of texts, and experts' experiences. Data analysis was performed using content analysis method in MaxQDA software.Results:Data analysis provided the 5 main categories of implementation instructions' strengths, implementation instructions' defects, implementation instructions' achievements, implementation instructions' challenges and threats, and suggestions.Conclusions:Accountability in the system that provides health care services for pregnant mothers in public hospitals has been created through the implementation of the natural childbirth promotion package. If managerial barriers and executive and legal inefficiencies are followed up and suitable measures are taken for solving the intra-system conflicts, we can hope that the package, which has been one of the most serious efforts made by the Ministry of Health over the past decades to reduce cesarean delivery, will achieve significant accomplishments.

Влияние витамина D на течение беременности и здоровье новорожденных и детей раннего возраста: современный взгляд на проблему

This paper reviews the effects of vitamin D deficiency on pregnant women and newborns. It was demonstrated that vitamin D deficiency in pregnant women is associated with higher risks of threatened preterm labor, placental insufficiency, preeclampsia, gestational diabetes, bacterial vaginosis, and impaired uterine contractility as well as higher rate of C-sections. Vitamin D insufficiency in newborns is associated with inadequate bone mineralization and also results in metabolic disorders, hypocalcemic seizures, bronchopulmonary dysplasia, necrotic enterocolitis, sepsis, mental and developmental disorders, and higher risks of various (infectious, allergic etc.) disorders. Optimal vitamin D dosing regimen in pregnant women and newborns is discussed.KEYWORDS: pregnancy, vitamin D, vitamin D insufficiency, newborn, complications of pregnancy, preeclampsia, gestational diabetes.FOR CITATION: Zakharova I.N., Mal’tsev S.V., Zubkov V.V. et al. Effect of vitamin D on the pregnancy and the health of newborns and infants: state-of-the-art. Russian Journal of Woman and Child Health. 2020;3(3):174–181. DOI: 10.32364/2618-8430-2020-3-3-174-181.

Mums Go Online: Is the Internet Changing the Demand for Healthcare?

We study the effect of internet diffusion on childbirth procedures performed in England between 2000 and 2011. We exploit an identification strategy based on geographical discontinuities in internet access generated by technological factors. We show that broadband internet access increased Cesarean-sections: mothers living in areas with better internet access are 2.3 percent more likely to have a C-section than mothers living in areas with worse internet access. The effect is driven by first-time mothers who are 6.1 percent more likely to obtain an elective C-section. The increased C-section rate is not accompanied by changes in health care outcomes of mothers and newborns. Health care costs increased with no corresponding medical benefits for patients. Heterogeneity analysis shows that mothers with low income and low education are those more affected: thanks to the internet, they progressively close the C-section gap with mothers with higher income and education. We show evidence documenting the growing importance of the internet as a source of health related information, and we argue that patient's access to online information is changing the relationship between health care providers and patients.

1108: Validating self-report hospital C-section rates collected in a pregnancy mobile application

To compare hospital-level, patient-reported mode-of-delivery data collected within a pregnancy mobile app to data reported by state health departments. Data from 100,221 users of the pregnancy mobile app, covering 2,830 hospitals in all 50 states, and data from 28 state health departments, covering 1,664 hospitals, were included in the study. Patient-reported delivery data, including mode of delivery were collected from mobile app users and aggregated by state and hospital of delivery. Users who reported multiple gestation births, as well as hospitals with fewer than 10 births reported in the app, were omitted from the dataset. Data were matched and compared to hospital-level data provided by the 28 state health departments. Of the 2,830 hospitals in the pregnancy mobile app dataset, 1,130 (40%) hospital names and their corresponding states matched to state-provided hospital delivery data in 28 states. The mean hospital C-section rate in the pregnancy app dataset was 30.6% and the mean hospital C-section rate in the state health department dataset was 31.2% (p = 0.13). There is no difference between hospital C-section rates calculated based on self-report method of delivery data from pregnancy mobile app users and hospital C-section rates provided by state health departments. The results validate digitally collected, self-reported mode-of-delivery data.

PREVALENCE AND INDICATION AND OUTCOME OF CESAREAN SECTION IN JUGAL HOSPITAL, HARARI REGIONAL STATE, ETHIOPIA, 2019: A RETROSPECTIVE STUDY

Background: Rising rates of cesarean delivery is becoming a concern to developing countries. Though cesarean section is a lifesaving surgical intervention, the rise in rates has resulted in significant health problems of mothers and newborns. Objective: The aim to undertaking this research is to know the prevalence, indications and outcome of cesarean section delivery In Jugal Hospital, Harari regional state, Ethiopia.Methods: Hospital based record review cross-sectional study was conducted in Jugal Hospital, Harar, Ethiopia from September 1, 2015 to September 1, 2019. Trained data collector and the principal investigator collected data employing a pre-tested extraction format. After checking the filled extraction format for completeness, data was entered, cleaned and analyzed using SPSS software Version 20.Results: In five years’ time (2015-2019), there were 6,111 deliveries, of which 1,817 were delivered by cesarean section which gives the overall rate of 29.7%. The most common indications for cesarean section were Cephalo-pelvic Disproportion (CPD) 323 (17.78%) followed by fetal distress 292(16.07%) and the least indication was pre-eclampsia 9(0.5%) and the most cause of prenatal death was birth asphyxia 38% followed by prematurity34%.Conclusion: In this study, there is a steady increase in the rates of cesarean delivery in five years’ time, the overall rate of C-section in Jugal Hospital was 29.7%. This rate is higher than the World Health Organization standard. Policies and efforts aimed at decreasing the unnecessary cesarean sections should be promoted and implemented at each health facility.

Labor induction at full-term and post-term pregnancies.

Induction of labor is an intervention in the obstetrics, which aim is to achieve cervical ripening and stimulate contractions of uterus before beginning of labor. The purpose of our study was to evaluate efficacy of combinations of vaginal misoprostol, intracervical dinoprostone and Foley catheter at term with regard to mode of delivery and rate of emergency C-sections due to birth asphyxia. 403 singleton pregnant women, who underwent pharmacological labor induction at term, were reviewed. Patients were divided into 2 main cohorts due to beginning of induction algorithm: vaginal misoprostol (66) or intracervical dinoprostone (337) consisting of 3 subgroups - PGE2 alone (184), PGE2+Foley catheter (125), PGE2+Foley catheter+PGE1 (28). Comparison of maternal age, presence of cervical dilation and parity revealed no major differences between cohorts. Effectiveness of labor induction with misoprostol, dinoprostone and dinoprostone followed by Foley catheter were respectively 90.9%, 51.3%, and 82.8%. Addition of PGE1 was effective in 83% of patients with negative response to PGE2 followed by Foley catheter. ere was no statistically significant difference in rate of C-sections between dinoprostone and misoprostol cohorts, C-section due to birth asphyxia were insignificantly more frequent in PGE1 than in PGE2 cohort. Efficacy in the subgroup administered only dinoprostone was significantly higher in 40th than in 41th (p = 0.016). Intracervical dinoprostone seems to be safer, but less effective in labor induction than vaginal misoprostol. Following PGE2 by other methods increased efficacy of induction in this cohort.

Neonatal outcomes of multiple versus single very preterm infants.

Neonatal morbidity and mortality differ between very preterm infants that result from single and those that result from a multiple order pregnancy. The aim of our study was to assess and compare the neonatal morbidity and mortality of multiple versus single very preterm infants. Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 at 11 level III perinatal centers after a surveilled pregnancy, were analyzed and compared. Statistical analysis was performed using IBM SPSS® statistics 25 and a p-value < 0.05 was considered statistically significant. A total of 494 infants delivered from 410 women were enrolled in the study; 320 (64.8%) infants resulted from single gestation and 174 (35.2%) resulted from multiple order gestation (153 double, 21 triple). Multiples were associated with a higher maternal age, a greater use of medically assisted reproduction techniques, higher C-section rates, more frequent full cycle use of antenatal corticosteroids, higher gestational age with adequate birth weight, spent less days on oxygen therapy, presented less prevalence of BPD and cPVL, needed less surgical closure of PDA and had a lower length of stay in NICU. Abruptio placenta, hypertensive disorders of pregnancy and preeclampsia were more frequent in single pregnancies. The multivariate analysis by logistic regression adjusted to gestational age and confounding variables did not show any significant difference on the outcomes of multiples compared to singles. The results of our study support the scientific evidence that, with the current practices, the neonatal morbidity and mortality of very premature infants are not different between those resulting from single and multiple gestations.

1253 A Descriptive Analysis of Anomalous Ectopic Pregnancies

Study Objective The majority of ectopic pregnancies implant in the fallopian tube; however, 10% implant in non-tubal locations including the abdominal cavity, cervix, ovary, interstitium of the fallopian tube, broad ligament, uterine cornua, and cesarean section scar. The objective of this study is to describe the characteristics and history of patients presenting with anomalous ectopics encountered at North Shore University Hospital/Long Island Jewish (NSUH/LIJ) from 2016 to 2018. Design A descriptive analysis of the anomalous ectopics encountered at NSUH/LIJ from 2016 to 2018. Setting Patients presented to the emergency room and were treated medically or in an operating room setting at NSUH/LIJ. Patients or Participants 55 women of reproductive age presented to NSUH/LIJ with pelvic pain and a positive bHCG and were determined to have an ectopic pregnancy in a non-tubal location. Interventions Patients with heterotopic, ovarian, cervical, cesarean section scar and interstitial ectopics were primarily treated via minimally invasive laparoscopic excision. Those with cesarean section scar and cervical ectopics were managed with methotrexate and intracervical balloons. Measurements and Main Results The incidence of patients with anomalous ectopics was 13.6%. The average age at diagnosis was 35. 74.5% in this cohort reported to be never smokers. 74.5% reported having previous abdomino-pelvic surgery. 74.5% did not use ART prior to their presenting diagnosis. The breakdown of ectopics was- Cesarean scar (27.3%), Cornual (23.6%), Interstitial (20.0%), Cervical (16.4%), Heterotopic (5.5%), Abdominal (3.6%), and Ovarian (3.6%). Conclusion Anomalous ectopic pregnancies in the NSUH/LIJ population of patients are 3.6% more prevalent than that reported by current data. Although these patients did not report use of ART in association with the anomalous pregnancy, many of these patients reported having previous abdominopelvic surgeries. C-section scar ectopics were the most prevalent, which may be secondary to the higher rate of c-sections in the last decade.

Differences in Cesarean section rates by fetal sex among Chinese women in the United States: Does Chinese culture play a role?

To investigate whether elements of Chinese culture, such as son preference, influence women’s mode of child delivery, this paper analyzes how fetal sex affects C-section rates among Chinese mothers compared with Japanese mothers in the United States. It uses birth certificate data from 1990 to 2000, a period when women were routinely able to learn the sex of the fetus during pregnancy. Compared with Japanese mothers, Chinese mothers were 1 percentage point more likely to undergo C-section when giving birth to boys than when giving birth to girls. This result is robust to the addition of a rich set of controls and the restriction of the sample to infants without congenital diseases or anomalies at birth. The effects are concentrated in subgroups that are more likely to prefer sons—specifically, where both parents are Asian or where mothers are first-generation immigrants. The findings offer valuable insights for health professionals into culturally driven pregnancy behaviors among Chinese women, potentially enabling them to offer more culturally appropriate healthcare as they support women in making a healthy transition to motherhood.

TRANSIENT TACHYPNEA OF THE NEWBORN

Transient tachypnea of the newborn is a mild breathing problem. It affects babies during the first hours of life. Tachypnea means fast breathing rate, and usually affects term newborns, more likely those delivered by C-section. The problem usually goes away without treatment in 3 days or less. Only a small number of all newborn babies get this breathing problem. Your baby's healthcare provider may use a chest X-ray to help diagnose the problem. On X-ray, the lungs look streaked and overinflated. The symptoms of this breathing problem may be similar to other more serious respiratory problems. These include lung infection (pneumonia) or premature lungs (respiratory distress syndrome). Often transient tachypnea of the newborn is diagnosed when symptoms go away in the first few hours to days of life. The Aim of this study was to evaluate and describe the frequency and course of perinatal and postnatal factors in neonates experiencing transient tachypnea during the first hours of life and to determine risk factors for complications of this condition.Methods: This was prospective opservational study during the period of six months in 2019, at the University Clinic for Gynecology and Obstetrics in Skopje. In the evaluation process were included newborn children born later than 34 gestational weeks, admitted to the Neonatal Department. The correlation between gestational age and need of oxygen support was determined, and the overall outcome of those newborns presented. If necessary, X-ray of lungs was performed.Results: In this study 2268 newborns were evaluated, born as late preterm (35th and 36th gestational age) and term newborns. None of the evaluated newborns was admitted to the Intensive Neonatal Care Unit. The C-section rate in the facility during this period for the evaluated newborns was 38,5%. Transient tachypnea was detected in 178 newborn babies, 65/178 were late preterm and 113/178 were term newborns. The proportion of preterm/term newborns was 246/2022. The accurate diagnosis has to be confirmed with X-ray in 30% of all of them presenting unclear signs of respiratory problems. The condition was resolved by its own in 83%, and the other have developed symptoms of more severe respiratory diseases, as respiratory distress syndrome in premature infants, congenital pneumonia, or respiratory condition of extra-pulmonary origin. Discussion: Transient tachypnea of the newborn occurs in approximately 1 in 100 preterm infants and 3.6-5.7 per 1000 term infants. It is most common in infants born by Cesarian section without a trial of labor after 35 weeks' gestation. It is self-limiting condition and the symptoms are resolved spontaneously, excluding some cases which could be complicated. The likelihood of complications is 1-2%.Conclusion: Transient tachypnea is very common cause of respiratory condition in neonates. Fortunately, the prognosis is very good, but when managing transient tachypnea of the newborn, it is imminent to observe for development of respiratory fatigue and signs of clinical deterioration that may suggest some other diagnoses.

Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

BackgroundWomen of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona.MethodsRetrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed.ResultsA total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found.ConclusionsMaternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.