Labor Cesarean Section Research Articles

Prolonged second stage of labor and risk of postpartum hemorrhage in nullipara with epidural anesthesia and vaginal delivery: A cohort study with propensity score analysis.

To conduct an analysis using propensity score methods, exploring the association between a prolonged second stage (>3 h) and the risk of postpartum hemorrhage (PPH) in a diverse population. We conducted a prospective cohort study involving nullipara with epidural anesthesia and vaginal delivery, aged ≥18 years, presenting cephalically, and with a gestational age (GA) of ≥24 weeks at a tertiary maternity hospital in China (chictr.org.cn identifier: ChiCTR2200063094). Women undergoing emergency cesarean section in labor were excluded. The primary outcome was PPH, with secondary outcomes including severe postpartum hemorrhage and blood transfusion. We employed propensity score overlap weighting to analyze the association between prolonged second stage labor and PPH. The study included 3643 nullipara with epidural anesthesia, comprising 77 with a second stage of labor >3 h and 3566 with a second stage ≤3 h. Utilizing propensity score overlap weighting, there were no significant differences observed between the two groups regarding the risk of PPH (29.87% in >3 h group vs 17.64% in ≤3 h group; weighted odds ratio 1.01; 95% CI: 0.51-2.02). Subgroup interaction tests for PPH were not significant for assisted vaginal delivery, induction of labor, macrosomia, third-/fourth-degree perineal laceration, GA >41 weeks, twin pregnancies, episiotomy and GA >37 weeks. Sensitivity analysis did not reveal significant differences. This study did not find evidence supporting an increased risk of PPH associated with a second stage of labor lasting >3 h in our population, providing additional evidence for clinical practice.

Second Stage of Labor Cesarean Section Maternal and Fetal Outcomes

Background: Cesarean section at the second stage of labor occurs when the mother requires delivery with full dilatation of the cervix by cesarean section (CS), which poses a risk to the mother and fetus. Purpose: To study the maternal and fetal outcomes of second-stage cesarean section. Methods: This comparative study was conducted at Alhasahisa Teaching Hospital from August 2021 to January 2022. The study sample comprised 226 women who fulfilled the inclusion criteria, including 113 who delivered by second-stage cesarean section and 113 who delivered by first-stage labor cesarean section as controls. Data were collected using a questionnaire filled out by doctors after informed consent was obtained. Results: The common indications in women who delivered via second-stage cesarean section were fetal distress in 62(51.9%), obstructed labor in 26(23%), and failure to progress in 25(22.1%). In women who underwent first-stage cesarean section, the common indications were failure to progress in 85(75.2%), fetal distress in 16(14.2%), and chorioamnionitis in 12(10.6%) (p < 0.05). The reported maternal complications in women who underwent second-stage cesarean section were postpartum hemorrhage in 34(30.1%), sepsis in 11(9.7%), prolonged labor in eight (7.1%), extended tears in four (3.5%), umbilical cord prolapse in three (2.7%), and episiotomy in three (2.7%). The admission to the neonatal intensive care unit (NICU) and the causes of admission were more common among the babies of the women delivered by second-stage cesarean section than the babies of the women delivered by first-stage cesarean section (p value < 0.05). Maternal complications in women who underwent second-stage cesarean section included postpartum hemorrhage in 34(30.1%), sepsis in 11(9.7%), prolonged labor in 8(7.1%), uterine extension in 4(3.5%), umbilical cord prolapse in 3(2.7%), and episiotomy in 3(2.7%) (p < 0.05). Conclusion: Second-stage labor cesarean section showed more complications of postpartum hemorrhage, sepsis, and extended tears, as well as more fetal complications, such as admission to the neonatal intensive care unit, fresh stillbirths, low Apgar scores, and birth asphyxia.

Adverse Childbirth and Perinatal Outcomes Among Healthy, Low-Risk Pregnant Women with Abnormal Total Gestational Weight Gain.

Purpose: Little is known on the potential effects of abnormal gestational weight gain (GWG) among low-risk, healthy pregnant women with no comorbidities or gestational complications. We investigated perinatal outcomes of these pregnancies according to GWG as per the 2009 National Academy of Medicine (NAM) recommendations. Materials and Methods: A retrospective analysis of prospectively collected data of low-risk pregnant women giving birth at term between January 2016 and December 2020. Inclusion criteria were normal pregestational body mass index (pBMI) (18.5-24.9 kg/m2) and no pregestational or gestational complication. Self-reported prepregnancy weight was used to calculate pBMI; GWG was the difference between maternal weight at childbirth and prepregnancy weight. Women were classified according to the 2009 NAM guidelines for GWG: insufficient (iGWG, <11.5 kg), adequate (aGWG, 11.5-16 kg), and excessive (eGWG, >16 kg). Logistic regression analysis with aGWG as referent was performed to independently estimate dose-response associations. Results: During the study period, there were 4,127 (33.1%) births fulfilling the inclusion criteria. Fifty-two percent of women gained outside the recommended range: 33.5% had iGWG and 18.7% had eGWG. iGWG women were 40% more likely to have early-term births and small for gestational age neonates. In turn, eGWG women displayed increased odds of prolonged pregnancy (adjusted odds ratio [aOR] 1.32), cesarean section in labor (aOR 1.50), high-degree perineal tears (aOR 2.04), postpartum hemorrhage ≥1,000 mL (aOR 1.54), and large for gestational age newborns (aOR 1.83). Conclusion: Our data show that abnormal GWG independently associates with heightened risk of adverse outcomes among healthy, low-risk pregnant women with normal pBMI and no comorbidity or gestational complication.

Ultrasound Evaluation of Caesarean Scar of Prelabour and Labour Caesarean Sections: A Cross Sectional Analytical Study

Ultrasound Evaluation of Caesarean Scar of Prelabour and Labour Caesarean Sections: A Cross Sectional Analytical Study

Comparison of Breastfeeding Success by Mode of Delivery.

This article identifies how mode of delivery and the presence of labor affect the initiation and effectiveness of breastfeeding. This is a retrospective cohort study of breastfeeding success after vaginal delivery, cesarean section after labor, and scheduled cesarean section in term, singleton deliveries in nulliparous patients at a large academic institution from 2017 to 2018. Exclusion criteria included major postpartum complications requiring admission to the surgical intensive care unit or neonatal intensive care unit, general anesthesia, and major fetal anomalies. Breastfeeding success in the immediate postpartum period, defined as the first 2 to 3 days postpartum prior to hospital discharge, was measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life. Multivariable linear and logistic regression were used to assess the association between mode of delivery and markers of breastfeeding success after adjusting for potential confounders. A Tukey's post hoc analysis with pairwise comparisons was performed to assess differences in breastfeeding outcomes between vaginal delivery, scheduled cesarean section, and cesarean section after labor. A total of 2,966 women met inclusion criteria during the study period, 1,936 (65.3%) of whom underwent spontaneous vaginal delivery, 415 (14.0%) of whom delivered by scheduled cesarean section, and 615 (20.7%) of whom underwent cesarean section after labor. There were significant differences in maternal age, obesity, race/ethnicity, insurance status, gestational age at delivery, birth weight, and 1-minute Apgar's score less than 7 between vaginal delivery, scheduled cesarean section, and cesarean section after labor. There were also significant differences between indication for oxytocin, type of anesthesia, and postpartum hemorrhage between the three groups. After controlling for these factors, women who underwent vaginal delivery were more likely to have infants with decreased need for formula supplementation (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.52-1.93) and were less likely to switch from breast to formula feeding (aOR = 1.71, 95% CI: 1.04-1.31) in comparison to women who delivered via cesarean section in labor or scheduled cesarean section. The infants of these women also had an increased number of breastfeeding sessions on average (β = 0.06, p = 0.002), required fewer number of daily formula feedings (β = 0.14, p < 0.001), and experienced a smaller percentage in neonatal weight loss over the first 2 to 3 days of life (β = 0.18, p < 0.001) compared to those born after cesarean section and cesarean section after labor. These women comparatively required less time at each breastfeeding session (β = 0.06, p = 0.005), and produced fewer wet diapers and stools on average (β = 0.12, p < 0.001 and β = 0.12, p < 0.001, respectively). On post hoc analysis with pairwise comparisons, and on separate sensitivity analysis of only women who underwent cesarean delivery, there was no difference in breastfeeding outcome measures between scheduled cesarean section and cesarean section in labor. Women who deliver by cesarean section, despite the presence or absence of labor, are less likely to maintain exclusive breastfeeding postpartum and are more likely to require formula supplementation. These women may need more support with breastfeeding after surgery in order to experience similar benefits for neonatal growth and weight gain. · Women who deliver by cesarean section are less likely to maintain exclusive breastfeeding.. · Women who deliver by cesarean section are more likely to require formula supplementation.. · Women may need more support with breastfeeding after cesarean delivery..

Perinatal predictors of clinical instability at birth in late-preterm and term infants

To identify characteristics associated with delivery room clinical instability in at-risk infants. Prospective cohort study. Two perinatal centres in Melbourne, Australia. Infants born at ≥ 35+0 weeks’ gestation with a first-line paediatric doctor requested to attend. Clinical instability defined as any one of heart rate < 100 beats per minute for ≥ 20 s in the first 10 min after birth, maximum fraction of inspired oxygen of ≥ 0.70 in the first 10 min after birth, 5-min Apgar score of < 7, intubated in the delivery room or admitted to the neonatal unit for respiratory support. Four hundred and seventy-three infants were included. The median (IQR) gestational age at birth was 39+4 (38+4—40+4) weeks. Eighty (17%) infants met the criteria for clinical instability. Independent risk factors for clinical instability were labour without oxytocin administration, presence of a medical pregnancy complication, difficult extraction at birth and unplanned caesarean section in labour. Decision tree analysis determined that infants at highest risk were those whose mothers did not receive oxytocin during labour (25% risk). Infants at lowest risk were those whose mothers received oxytocin during labour and did not have a medical pregnancy complication (7% risk).Conclusions: We identified characteristics associated with clinical instability that may be useful in alerting less experienced clinicians to call for senior assistance early. The decision trees provide intuitive visual aids but require prospective validation.What is Known:• First-line clinicians attending at-risk births may need to call senior colleagues for assistance depending on the infant’s condition.• Delays in effectively supporting a compromised infant at birth is an important cause of neonatal morbidity and infant-mother separation.What is New:• This study identifies risk factors for delivery room clinical instability in at-risk infants born at ≥ 35+0 weeks’ gestation.• The decision trees presented provide intuitive visual tools to aid in determining the need for senior paediatric presence.

Second stage cesarean section and the risk of preterm birth in subsequent pregnancies.

To evaluate the risk of spontaneous preterm birth on subsequent pregnancies after second stage cesarean section. This is a retrospective cohort study. Women were included if they had their two consecutive births in Toulouse University Hospital in the study period. The first birth was a singleton livebirth at term (≥37 weeks of gestation), divided in three categories according to the mode of delivery: vaginal delivery (group A), cesarean section before the second stage of labor (group B), cesarean section during the second stage of labor (group C). The subsequent pregnancy was the first subsequent pregnancy, conducted after 16 weeks of gestation. The primary outcome was spontaneous preterm birth in the subsequent pregnancy, defined as delivery before 37 weeks of gestation. Secondary endpoints included preterm rupture of membranes in the subsequent pregnancy. Between 2003 and 2018, 7776 women (84.7%) in group A, 1263 (13.8%) in group B and 143 (1.5%) in group C were included. The adjusted odds ratio of spontaneous preterm birth before 37 weeks of gestation after second stage cesarean section was 2.4 (group C vs group A + B, 95% confidence interval: 1.2-4.8), P=0.01). The rate of preterm rupture of membranes was also significantly higher in group C (6% vs 2% in group A, P=0.009, 6% vs 3% in group B, P=0.05) with OR=3.0 (group C vs group A + B, 95% CI: 1.55-6.16, P <0.001). History of term second stage of labor cesarean section is an independent risk factor for spontaneous preterm birth and for preterm rupture of membrane in the subsequent pregnancy.

Conducción del trabajo de parto en gestantes con cesárea previa en el Hospital Central Universitario Dr. Jesús María Casal Ramos. Acarigua-Estado Portuguesa.

Objective: To estimate the safety of vaginal delivery in pregnant women at term in spontaneous labor with previous cesarean section who attended the Obstetric Emergency Service of the Dr. Jesús María Casal Ramos University Hospital, in the period January-June 2018. Methods: A prospective, descriptive, cross-sectional and non-causal correlational study was conducted in pregnant women at term with a previous caesarean section in labour. The medical records of full-term pregnant women who entered into spontaneous labor and who underwent conduction of labor were reviewed if the indication for cesarean section did not persist, recording maternal, fetal and neonatal complications. Results: We attended 245 pregnant women, with previous cesarean section, 108 patients were included of which 99 (92 %) did not present complications and of the remaining nine, 4 (44 %) presented grade I tear, 4 (44 %) grade II tear and only 1 (12 %) grade III tear. The most frequent anatomical location was vaginal in 6 (67 %), cervical in 3 (33 %); the size of the same was not described; the grade III vaginal tear was sutured, did not require blood transfusion and the product weighed 4000 kg. There were no maternal deaths or fetal complications or fetal deaths. Conclusions: Spontaneously initiated vaginal delivery in pregnant women with previous caesarean section is 92% safe. Keywords: Vaginal Birth, Prior caesarean, Interpartum interval, Labor conduction.

Urogynecology in obstetrics: impact of pregnancy and delivery on pelvic floor disorders, a prospective longitudinal observational pilot study

PurposeTo assess changes in the pelvic floor anatomy that cause pelvic floor disorders (PFDs) in primigravidae during and after pregnancy and to evaluate their impact on women’s quality of life (QoL).MethodsPOP-Q and translabial ultrasound examination was performed in the third trimester and 3 months after delivery in a cohort of primigravidae with singleton pregnancy delivering in a tertiary center. Results were analyzed regarding mode of delivery and other pre- and peripartal factors. Two individualized detailed questionnaires were distributed at 3 months and at 12 months after childbirth to determinate QoL.ResultsWe recruited 45 women, of whom 17 delivered vaginally (VD), 11 received a vacuum extraction delivery (VE) and 17 a Cesarean section in labor (CS). When comparing third-trimester sonography to 3 months after delivery, bladder neck mobility increased significantly in each delivery group and hiatal area increased significantly in the VD group. A LAM avulsion was found in two women after VE. Connective tissue weakness (p = 0.0483) and fetal weight at birth (p = 0.0384) were identified as significant risk factors for the occurrence of PFDs in a multivariant regression analysis. Urinary incontinence was most common with 15% and 11% of cases at 3, respectively, 12 months after delivery. 42% of women reported discomfort during sexual intercourse, 3 months after delivery and 24% 12 months postpartum. Although 93% of women engage a midwife after delivery, only 56% participated in pelvic floor muscle training.ConclusionConnective tissue weakness and high fetal weight at birth are important risk factors for the occurrence of PFDs. Nevertheless, more parturients should participate in postpartal care services to prevent future PFDs.

The Association of High Birth Weight with Pregnancy Outcomes: a Longitudinal Study

To explore the adverse perinatal results associated with high birth weight (HBW) and analyse other risk factors associated with these events. This was a retrospective longitudinal study of all childbirths occurring in our maternity centre during the period of 2010–2016. A comparative analysis was performed between pregnancy outcomes of newborns with weights above the 95th percentile and newborns with normal weight. In addition, a multivariate logistic regression analysis was performed to evaluate the risk factors associated with the identified adverse perinatal events. The perinatal results of 31,576 deliveries were analysed. When the two groups were compared, the group of pregnancies with HBW newborns showed higher frequencies of maternal diabetes, induction of labour, stalled labour caesarean section, severe perineal tears, and type 3 or greater neonatal resuscitation and a higher maternal age (p < 0.05). The multivariate regression analysis identified HBW as an important risk factor for stalled labour caesarean section and severe perineal tears, with odds ratios (ORs) of 3.6 (95% confidence interval (CI), 3.08–4.2) and 2.06 (95% CI, 1.33–3.19), respectively. Other risk factors such as induction of labour, gestational diabetes and instrument-assisted delivery (p < 0.001) were identified. Deliveries of newborns with weights above the 95th percentile presented poorer perinatal results compared to deliveries of normal weight newborns. This study identified additional relevant risk factors associated with stalled labour caesarean section and severe perineal tears. These findings could be useful to provide adequate advice to pregnant women.

Characteristics of Women in the Reproductive Age Delivering by Cesarean Section in Ghana

Maternal mortality is a major contributor to the number of deaths that occur among women of childbearing ages (15–49). It is usually higher for women in developing countries than those in developed countries, principally due to ante-partum, intra-partum, and post-partum complications. The major cause of maternal mortality is unsafe delivery. Pregnant women at the delivery point can either deliver per vaginum or by cesarean section, depending on the circumstances surrounding the pregnancy. While many women deliver vaginally, cesarean delivery is appropriate for obstetric emergencies. This study, therefore, seeks to examine the characteristics of women in their reproductive age delivering via elective cesarean section in Ghana. The study used data from the 2017 Ghana Maternal Health Survey (GMHS). A sample of 11,309 women was used for the study. Binary logistic regression models were used to examine the relationship between delivery by cesarean section and the independent variables. A little over 12% of the respondents (12.4%) delivered through cesarean section. The results showed significant associations with age, place of residence, religion, level of education, frequency of reading newspaper or magazine, wealth index (richest), and delivery by cesarean section. The study concludes that the overall cesarean section rate was 12.4%. The results show that there is a significant association between delivery by cesarean section and maternal age, wealth index, level of education, place of residence, religion, and frequency of reading newspaper or magazine. However, given the complex role of cesarean section in labor and delivery care in low- and middle-income countries, these factors should be taken into cognizance in considering cesarean delivery among women in Ghana. It is also imperative to understand why high proportions of women seek CS without any maternal and fetal indication.

Anaesthetic management of obstetric and nonobstetric emergencies during pregnancy

Background: Obstetric anaesthesia is considered to be one of the higher risk areas of anesthetic practice. The present study is done to know the various anesthetic techniques in management of obstetric emergencies and their complications. Materials & Methods: This was a descriptive study of 100 pregnant patients coming for emergency surgeries. Intraoperative complications such as hypotension, bradycardia, failed spinal, high spinal, seizures, difficult intubation and aspiration were recorded. Results: 78% of the obstetric emergencies were lower segment caesarean section, 16% was surgery for ectopic pregnancy, 3% hysterectomy for postpartum hemorrhage, 1% bartholin cyst excision, 1% I and D and 1% cervical encirclage. 90% of caesarean sections received subarachnoid block. 8% of cases received general anaesthesia and 2% of case subarachnoid block was converted to general anesthesia. 17 cases previous caesarean section in labour, in 13 cases thick meconium stained liquor with foetal distress, in 6 cases failure to progress, in 5 cases cephalopelvic disproportion, in 5 cases premature rupture of membranes and in 4 cases breech presentation in labour. Hypotension was present in 20 cases, bradycardia in 2 cases and failed spinal in 2 cases. Conclusion: Authors concluded that single shot subarachnoid block is the most common method of anaesthesia for emergency caesarean sections. Chickenpox is a worldwide disease and is no respecter race or class. The incidence increases in spring & winter months in the temperate zones. In the tropics, the peak incidence is during winter and early spring. The disease in fact started is helping the virus to spread rapidly.

Can the Progression Angle before Labor Help to Predict Cesarean Section?

Objective: The aim of this study was to predict cesarean section on a single visit at term using a combination of maternal history and ultrasound markers, including some new markers such as the progression angle used to assess intrapartum progress. Study Design: This was an observational prospective cohort study of singleton term pregnancies that included 575 women. The maternal history and ultrasound markers were obtained on a single visit at 37–38 weeks’ gestation. Multivariable logistic regression was used for prediction of cesarean section. Results: Five hundred and seventy-five women were examined at a median gestational age of 38.3 weeks (range: 35.6–41.6) and a cesarean section was performed on 104 women (18%) – 24 for a fetal indication and 80 for a maternal indication. The risk of cesarean section increased with a previous cesarean section, assisted reproduction techniques, a higher estimated fetal weight, and a greater cervical length, and decreased with a greater maternal height, multiparity, and a wider progression angle. The detection rate for a 20% false positive rate was 69.9% for all cesarean sections, 54.2% for those with a fetal indication, and 77.2% for those with a maternal indication. Conclusions: Assessment at 37–38 weeks’ gestation of ultrasound markers such as the cervical length, progression angle, and estimated fetal weight, in combination with the maternal history, can predict a cesarean section in labor. Cesarean section for a maternal indication is better predicted than cesarean section for a fetal indication.

Breastfeeding Success After Vaginal Delivery Versus Scheduled Cesarean Section [21F

INTRODUCTION: The objective of this study is to identify how labor affects initiation and effectiveness of breastfeeding postpartum. METHODS: This is a retrospective cohort study of breastfeeding success after vaginal delivery, cesarean section after labor, and scheduled cesarean section in term, singleton deliveries in nulliparous patients at a large academic institution from 2017-2018. Breastfeeding success in the immediate postpartum period was measured by the presence of breastfeeding, the need for formula supplementation, and the neonatal percentage in weight loss over the first 2-3 days of life. This study was approved by the IRB at the Icahn School of Medicine at Mount Sinai. RESULTS: A total of 500 women met inclusion criteria during the study period, 339 (68%) of whom underwent spontaneous vaginal delivery (SVD), 71 (14%) of whom underwent cesarean section after labor, and 90 (18%) of whom delivered by scheduled cesarean section. Women who underwent SVD were more likely to have decreased need for formula supplementation in comparison to women who delivered via cesarean section in labor or scheduled cesarean section (57.7% vs. 75.4% and 78.5%, p<0.05), require fewer number of daily formula feedings on average (1.8+2.3 vs. 2.3+2.2 and 2.7+2.6, p<0.05), and experience a smaller percentage in neonatal weight loss over the first 2-3 days of life (4.9+2.0 vs. 7.1+2.3 and 6.4+2.8, p<0.05). CONCLUSION: Women who deliver by cesarean section may need more support to maintain exclusive breastfeeding postpartum than patients after vaginal delivery.

Classification of Primary Caesarean Sections in Labor and its Usefulness for Analysis of Slovenian Perinatal Data.

ObjectiveTo determine the usefulness of a novel classification of indications for caesarean section (CS) in labour in recognizing differences in clinical practice in different maternity units.MethodsData from the National Perinatal Information System (NPIS) for 2013 and 2014 were used to classify indications for CS in nulliparous women with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses within 14 Slovenian maternity units into foetal distress and different sub-groups of dystocia according to use and dosage of oxytocin. Chi-square test was used for statistical comparison between units (P≤0.05 significant).ResultsThere were 13,572 deliveries and 1,567 (12.0%) CS in nulliparous patients with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses in Slovenia during the study period. Rates of CS in this group of women differed significantly among different maternity units (from 4.1% to 20.9%; P<0.001) suggesting significant differences in clinical practice. The most common indication for CS was cephalopelvic disproportion, which was diagnosed with different frequency in different units (from 11.2% to 45.9%; odds ratio 6.72; 95% confidence interval 3.10– 14.71; P<0.001).ConclusionsIt is possible to use NPIS data to retrospectively classify indications for CS. Such classification reveals significant differences among maternity units and could allow for a meaningful analysis of CS rates in different hospitals leading to evidence-based initiatives to decrease the incidence of primary CS.

Demographic changes and effects on the mode of delivery: a retrospective analysis of a large birth registry containing 27,729 singleton deliveries in a level I center.

To characterize and understand the demographics (age and body mass index, BMI) of a cohort of women who delivered at a single institution over an 11-year period. The purpose of this analysis is to look for effects over time of demographic characteristics on mode of delivery. Retrospective analysis of singleton deliveries between 2004-2014, n = 27,729; level 1 perinatalcenter, universityhospital setting. Data were extracted from the digital birth registry. All statistical analyses were done using R version 3.5.1. Variables analyzed were: age, BMI, and mode of delivery (in the current and any prior pregnancies). Mean age increased from 31.1 ± 5.2years in 2004 to 31.5 ± 5.0years in 2014 (p < 0.001, eta2 = 0.0006). Mean BMIbeforepregnancy increased from 23.7 ± 4.5 to 24.7 ± 5.2kg/m2. Mean BMIatdelivery increased from 28.5 ± 4.7 to 29.6 ± 5.2 kg/m2 (p < 0.001, eta2 = 0.0049). Regarding maternal age, patients with elective Cesarean section (CS) (32.5 ± 5.3years), emergency CS (31.6 ± 5.6years) and CS in labor (31.4 ± 5.3years) were older compared to those with spontaneous (31.0 ± 5.2years) or instrument-assisted vaginal delivery such as vacuum (31.0 ± 5.0years) and forceps (30.2 ± 5.4years). Among the multiparous patients, the mode of delivery in prior pregnancies is the variable with the greatest effect on the mode of delivery in any subsequent pregnancies. The mode of delivery was: spontaneous (55.5%), vaginaloperative including vacuum and forceps (8.8%), and Cesarean section (35.7%). Increase of age and BMI over years is significant, but very small and in a range which seems not clinically relevant. Previous births have the strongest effects on mode of delivery in the current pregnancy.

External cephalic version after previous cesarean section: A cohort study of 100 consecutive attempts

ObjectiveExternal cephalic version is commonly not performed in women with a previous cesarean section. Fear of uterine rupture and cesarean section in labor are prominent. The risks, however, of these are unclear. This study aims to document the safety and efficacy of external cephalic version in women with a prior cesarean section in a series of 100 consecutive attempts, and to perform a literature of the existing literature. Study designThis is a retrospective cohort study of prospectively collected data of external cephalic version attempts in women at term with a previous cesarean section, and a literature review of previously published series. External cephalic version was performed by one of 3 experienced operators, with salbutamol tocolysis if appropriate, using ultrasound to visualize the fetal heart and place of fetal parts. Results100 women with a prior cesarean section underwent external cephalic version over a 16-year period in one institution. 68% had no previous vaginal delivery. The external cephalic version success rate was 50%, and 30 (63.8%) of these subsequently delivered vaginally. There were no cases of uterine rupture or other complications. A literature review of series containing a total of 549 cases revealed no cases of uterine rupture or perinatal death. ConclusionsExternal cephalic version in women with a prior cesarean section is safe but enables a vaginal birth in only about a third of women.

Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section. In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000-2011 from Norway and Denmark were included [Ten-group classification system (Robson) group 1]. In this case-control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi-square test and logistic regression were used to estimate associations and interactions. The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway. Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset.

Perinatal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Perinatal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Maternal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre

Maternal morbidity associated with full cervical dilatation versus early labour caesarean sections. An audit from a regional Australian centre