Caesarean Section Odds Ratio Research Articles

841 Outcomes among women undergoing elective induction of labor compared to expectant management by maternal BMI

To assess whether obstetric outcomes among women undergoing elective induction of labor vary based on maternal body mass index. We conducted a retrospective cohort study of singleton, non-anomalous, term deliveries in California between 2007-2011 to assess maternal and neonatal outcomes among nulliparous women undergoing elective induction of labor at 39 weeks compared with expectant management and further stratified by maternal pre-pregnancy body mass index (BMI). We defined elective induction of labor as induction of labor without medical indication and women with planned cesarean sections were excluded. Chi-squared and multivariable logistic regression analyses, controlling for maternal race/ethnicity, age, parity, education, and insurance status, were employed for statistical comparisons. In the cohort of 572,113 women, 6% were electively induced and 94% were expectantly managed. While rates of cesarean section are associated with increasing BMI, we found that women in the elective induction group were less likely to have a cesarean section than women who are expectantly managed across all BMI categories (aOR<1) (Table 1). Women with BMI 35-39.9 and BMI ≥40 had the lowest aOR for cesarean section (0.79 and 0.71, respectively). Rates of operative vaginal deliveries were higher in the elective induction group compared to expectant management across all BMI categories (aOR>1). Rates of shoulder dystocia were highest in women with BMI ≥40 (aOR 2.06, 95% CI 1.18-3.58). Rates of NICU admission and respiratory distress syndrome were lower in the elective induction group compared to expectant management, with no significant trends when stratified by BMI. In women undergoing elective induction of labor compared to expectant management, some obstetric outcomes vary when stratified by maternal pre-pregnancy BMI. As maternal BMI increases, managing with elective induction of labor is associated with lower adjusted odds ratio for cesarean section.

Factores de riesgo de placenta previa en mujeres embarazadas en un hospital de República Dominicana

Introducción: la hemorragia obstétrica es una de las causas de morbilidad y mortalidad materna más común en todo el mundo. La placenta previa es un factor de riesgo importante para la hemorragia obstétrica. El propósito de este estudio es determinar los factores de riesgo relacionados con placenta previa en mujeres embarazadas en Santo Domingo.&#x0D; Métodos: los casos fueron mujeres cuyos partos fueron complicados con placenta previa y los controles fueron partos sin placenta previa. Se analizaron 16 casos y 76 controles. Se condujo análisis estadístico y se calculó razón de probabilidades (OR).&#x0D; Resultados: se demostró relación entre placenta previa con antecedente de dos o más abortos con un OR = 5.3; con cesárea previa OR = 3.02, que aumentaba con más de 2 cesáreas con un OR = 5.91, con embarazo ectópico previo y antecedente de placenta previa. Las pacientes con placenta previa y antecedente de cirugía tuvieron un mayor riesgo de requerir una histerectomía. Las mujeres con placenta previa y antecedentes de cesáreas múltiples (2 o más) tuvieron un mayor riesgo de padecer placenta acreta con un OR = 18.&#x0D; Discusión: nuestro estudio sugiere que abortos múltiples, cesárea previa, múltiples cesáreas anteriores, antecedente de placenta previa y antecedente de embarazo ectópico son factores de riesgo de desarrollar placenta previa.

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.

Is sonographically measured cervical length at 37 weeks of gestation associated with intrapartum cesarean section? A prospective cohort study.

Cesarean section rates continue to increase globally. Prediction of intrapartum cesarean section could lead to preventive measures. Our aim was to assess the association between sonographically measured cervical length at 37 weeks of gestation and cesarean section among women planning a vaginal birth. The population was women with a low-risk pregnancy or with gestational diabetes. This was a prospective cohort study conducted in a tertiary referral hospital in Sydney, Australia. In all, 212 women with a low-risk pregnancy or with gestational diabetes were recruited including 158 nulliparous and 54 parous women. Maternal demographic, clinical and ultrasound characteristics were collected at 37 weeks of gestation. Semi-Bayesian logistic regression and Markov chain Monte Carlo simulation were used to assess the relation between cervical length and cesarean section in labor. Rates of cesarean section were 5% (2/55) for cervical length ≤20 mm, 17% (17/101) for cervical length 20-32 mm, and 27% (13/56) for cervical length >32 mm. These rates were 4, 22 and 33%, respectively, in nulliparous women. In the semi-Bayesian analysis, the odds ratio for cesarean section was 6.2 (95% confidence interval 2.2-43) for cervical length 20-32 mm and 10 (95% confidence interval 4.8-74) for cervical length >32 mm compared with the lowest quartile of cervical length, after adjusting for maternal age, parity, height, prepregnancy body mass index, gestational diabetes, induction of labor, neonatal sex and birthweight centile. Cervical length at 37 weeks of gestation is associated with intrapartum cesarean section.

The first 50 live births after autologous oocyte vitrification in France.

The study aims to describe the newborn health parameters of the 50 first children conceived after autologous oocyte vitrification in France. The 50 children born after autologous oocyte vitrification/warming cycle (VAO children) have been retrospectively compared with 364 children conceived by micromanipulation using freshly recovered non-vitrified oocytes (ICSI children). Children included in the study were born between 2011 and 2015. Maternal characteristics (age, body mass index, smoking habits), obstetric outcomes (diabetes, hypertension, placenta previa, parity, mode of delivery), and perinatal outcome (twinning, sex, birth weight, macrosomia, birth defects) were analyzed. The generalized estimating equation for correlated data was performed to evaluate perinatal outcomes and caesarean section. No statistically significant difference was found between VAO children and ICSI children, even after adjusting confounding factors (low birth weigh odds ratio (OR) 0.8, 95 % confident interval (CI) 0.3-2.2, adjusted (AOR) 0.5, 95 % CI 0.2-1.7; large for gestational age OR 1.5, 95 % CI 0.3-7.0, AOR 1.6, 95 % CI 0.3-7.5; birth defects OR 0.4, 95 % CI 0.1-3.2, AOR 0.5, 95 % CI 0.1-3.7; caesarean section OR 1.8, 95 % CI 0.9-3.4, AOR 1.8, 95 % CI 0.9-3.7). According to our results, newborn health parameters of children conceived in our center by micromanipulation using vitrified/warmed autologous oocytes seem not to be different from children born after micromanipulation on freshly recovered oocytes.

Counseling for fetal macrosomia: an estimated fetal weight of 4,000 g is excessively low.

Because of the known complications of fetal macrosomia, our hospital's policy has been to discuss the risks of shoulder dystocia and cesarean section (CS) in mothers with a sonographic estimated fetal weight (SEFW) ≥ 4,000 g at term. The present study was performed to determine the effect of this policy on CS rates and pregnancy outcome. We examined the pregnancy outcomes of the macrosomic (≥ 4,000 g) neonates in two cohorts of nondiabetic low risk women at term without preexisting indications for cesarean: (1) SEFW ≥ 4,000 g (correctly suspected macrosomia) and (2) SEFW < 4,000 g (unsuspected macrosomia). There were 238 neonates in the correctly suspected group and 205 neonates in the unsuspected macrosomia group, respectively. Vaginal delivery was accomplished in 52.1% of the suspected group and 90.7% of the unsuspected group, respectively, p < 0.001. There was no difference in the rates of shoulder dystocia. The odds ratio for CS was 9.0 (95% confidence interval, 5.3-15.4) when macrosomia was correctly suspected. The policy of discussing the risk of macrosomia with SEFW ≥ 4,000 g to women is not justified. A higher SEFW to trigger counseling for shoulder dystocia and CS, more consistent with American College of Obstetrics and Gynecology (ACOG) guidelines, should be considered.

Elective Induction of Labor and the Risk of Cesarean Section in Low-risk Parous Women

Objective To estimate the association between elective induction of labor and cesarean section in low-risk parous women, and to assess whether the association is influenced by induction method. Design Cohort study. Setting University hospital in Sweden. Population Parous women without pregnancy complications or previous cesarean section, and with a planned vaginal term (37–41 weeks), singleton birth, in vertex position were included. Methods Information was collected from a local database containing prospectively entered antenatal and delivery data. Odds ratios for cesarean section were calculated using generalized estimating equations logistic regression and adjusted for parity, maternal age, gestational length, birthweight, use of epidural anesthesia and year of birth. Main outcome measures Emergency cesarean section. Results Among 7973 pregnancies that fulfilled the inclusion criteria, 343 (4%) had an elective induction of labor. Intravenous oxytocin was administered in 5% of these inductions, amniotomy was performed in 62%, and a cervical ripening agent was used in 33%. Electively induced labor more than doubled the risk of cesarean section compared with spontaneous labor onset (OR 2.5, 95% CI 1.4–4.2) and this risk was more than tripled when cervical ripening was used (OR 3.6, 95% CI 1.7–7.6). Conclusions In low-risk parous women, electively induced labor has an increased risk of emergency cesarean section compared with spontaneous onset labor. This risk increase is more pronounced if cervical ripening agents are required. Women need to be counseled about these risks before elective induction of delivery is decided.

Elective induction of labor and the risk of cesarean section in low‐risk parous women: a cohort study

To estimate the association between elective induction of labor and cesarean section in low-risk parous women, and to assess whether the association is influenced by induction method. Cohort study. University hospital in Sweden. Parous women without pregnancy complications or previous cesarean section, and with a planned vaginal term (37-41weeks), singleton birth, in vertex position were included. Information was collected from a local database containing prospectively entered antenatal and delivery data. Odds ratios for cesarean section were calculated using generalized estimating equations logistic regression and adjusted for parity, maternal age, gestational length, birthweight, use of epidural anesthesia and year of birth. Emergency cesarean section. Among 7973 pregnancies that fulfilled the inclusion criteria, 343 (4%) had an elective induction of labor. Intravenous oxytocin was administered in 5% of these inductions, amniotomy was performed in 62%, and a cervical ripening agent was used in 33%. Electively induced labor more than doubled the risk of cesarean section compared with spontaneous labor onset (OR 2.5, 95% CI 1.4-4.2) and this risk was more than tripled when cervical ripening was used (OR 3.6, 95% CI 1.7-7.6). In low-risk parous women, electively induced labor has an increased risk of emergency cesarean section compared with spontaneous onset labor. This risk increase is more pronounced if cervical ripening agents are required. Women need to be counseled about these risks before elective induction of delivery is decided.

Emergency cesarean sections can be predicted by markers for stress, worry and sleep disturbances in first‐time mothers

To identify predictors as free-text markers for mental ill-health from an electronic perinatal record (EMR) system and the association with emergency cesarean section (CS) in nulliparous women. This was a population-based study using an EMR system, set in the catchment area of Malmö University Hospital in Sweden. Of 10,662 nulliparous women presenting with a singleton cephalic baby for vaginal delivery between 2001 and 2006, 6,467 women with complete EMRs were selected. A free-text search of markers for mental ill-health was carried out, and results were analysed by multivariate logistic regression. Eleven markers for mental ill-health were tested with Cohen's kappa for agreement and used as exposure variables. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for emergency CS, and adjusted for maternal age, diabetes, epidural anesthesia and gestational weeks <37 and >41 by a multivariate logistic regression model with vaginal delivery as the reference. Three markers identified from the EMR system reached statistically significant associations with an increased risk for emergency CS in nulliparous women: stress, adjusted OR 1.66 (95% CI 1.34-2.06); sleep, adjusted OR 1.57 (95% CI 1.14-2.16); and worry, adjusted OR 1.41 (95% CI 1.10-1.79). Free-text words in medical records that indicated stress, sleep disturbances or worry predicted increased adjusted OR for emergency CS in first-time mothers. Recognizing pregnant women's reporting of their mental health status could have a predictive bearing on delivery outcomes.

Obstetrical Management of the Older Gravida

In developed countries, an increase in the average age of the gravida has been documented. The mean age of primiparous women in Austria rose from 25 years in 1991 to 28 years in 2008. In Germany in 2006, most gravidas were between the ages of 30 and 34 years whereas in the 1970s, most babies were born to women aged 20-24 years. Delayed childbearing and increased maternal age are associated with increased obstetrical and perinatal complications and, therefore, require adjustments in obstetrical management. Increasing maternal age is associated with pre-existing maternal risk factors such as diabetes mellitus, hypertension, myomas or obesity. In addition to lower fecundability and higher rates of chromosomal aberrations, higher rates of spontaneous early abortion are also common complications in early pregnancy among older women. In ongoing pregnancies, complications such as gestational diabetes, hypertensive disorders and low birth weight are associated with increasing maternal age. Furthermore, gravidas of advanced age are at a higher risk for stillbirth and perinatal morbidity and mortality. At delivery, increased maternal age is associated with an increased rate of malpresentation and represents an independent odds ratio for cesarean section. Owing to these facts, obstetric management in the older gravida needs to be adapted in order to manage the possible complications.

Pregnancy outcome in congenital dyserythropoietic anemia type I

Congenital dyserythropoietic anemia type I (CDA I) is a rare inherited disease characterized by moderate to severe macrocytic anemia and abnormal erythroid precursors with nuclear chromatin bridges and spongy heterochromatin. Moderate to severe maternal anemia is a recognized independent risk factor for low birth weight (LBW) and complicated delivery. The aim of the study was to review the outcome of pregnancies in women with CDA I. The clinical and laboratory records of 28 spontaneous pregnancies in six Bedouin women with CDA I were reviewed. The results were compared with findings from a retrospective review of a large population-based registry including all pregnancies in Bedouin women during the same 15-yr period. Eighteen pregnancies in women with CDA I (64%) were complicated. One pregnancy was aborted spontaneously in the first trimester and one resulted in a non-viable fetus (stillborn at 26 wk). Cesarean section (CS) was performed in 10 pregnancies (36%). Eleven of the 26 newborns (42%) had a LBW: six were born prematurely and five were small for gestational age. The odds ratio for CS in women with CDA I compared with healthy Bedouin women was 4.5 [95% confidence interval (CI) 1.2-10.3], and for a LBW infant, 5.5 (95% CI 2.4-12.3). Careful follow-up was associated with significantly better fetal outcome (P = 0.05). Pregnancies in women with CDA I are at high risk for delivery-related and outcome complications. To improve fetal outcome, women with CDA I should be carefully monitored during pregnancy.

El intervalo intergenésico: un factor de riesgo para complicaciones obstétricas y neonatales

Objective To determine the impact of the interval between pregnancies on maternal-foetal morbidity. Materiads Method A cohort study carried out from 1st May until 31st December 2002 in the Gynaecology and Obstetric Department of the Metropolitan Hospital Complex (Social Security) in Panama. We included patients with previous pregnancies, and who were admitted with spontaneous abortion, and patients of any gestational age who were admitted because of pregnancy termination. We excluded primigravidas, patients with a disease existing before pregnancy, and those with incomplete records. We correlated obstetric pathologies, neonatal outcome, and the interval between pregnancies. Statistical analysis was made with EPI-INFO 2002, Chi-square. The odds ratio (OR) had a confidence interval (CI) of 95% and p < 0.05. Results A total of 1044 patients were analysed, the average age was 29.7 ± 5.14 years and 8.1% were multiparous patients. The average interval between pregnancies was 45 ± 31.7 months. The obstetrical and neonatal pathologies associated with the interval between pregnancies were pre-eclampsia, gestational diabetes, placental abruption, stillbirth, foetal distress, premature delivery, placenta previa, admission to NICU, apgar score and perinatal death. We found that the period between 25 and 48 months had a protective factor against the development of obstetric and neonatal complications. A period ≤ 24 months is a risk factor for the development of premature delivery, OR 13 (95% CI, 9-18), a higher number of admissions to NICU, OR 5.7 (95% CI, 3-9), and perinatal death OR 3.2 (95% CI, 1.3-8). An interval between pregnancies o ≥ 49 months is a risk factor for the development of pre-eclampsia OR 29 (95% CI, 19-45), placental abruption OR 3.6 (95% CI, 1.2-11) and caesarean section OR 10.1 (95% CI, 6-17). Conclusions An interval between pregnancies ≤ 24 months and = 49 months are associated with an increase in obstetric and neonatal complications, thus the period between 25 and 48 months is optimal to prevent maternal-foetal complications.

Supportive nurse-midwife care is associated with a reduced incidence of cesarean section

Our purpose was to examine whether care by a certified nurse-midwife, including personal labor support, was associated with a reduced risk of cesarean delivery. A retrospective cohort study comparing 3551 physician-managed patients with 1056 certified nurse-midwife-managed patients in a university hospital with a mixed socioeconomic and ethnic population was performed. Regression analysis was used to estimate the risk of labor abnormalities, diagnosis of fetal distress, and cesarean delivery in patients delivered by a certified nurse-midwife vs a physician and to control for maternal age, race, parity, fetal size, and delivery year. Subjects included were women having at least five prenatal visits who were delivered of term, singleton, liveborn infants without congenital anomalies with occiput presentation. Odds ratio for cesarean section for women delivered by certified nurse-midwives versus those delivered by physicians was 0.71 (95% confidence interval 0.55, 0.91). Midwifery care was associated with a lower risk of abnormal labor (adjusted odds ratio 0.70, 95% confidence interval 0.60, 0.83) and diagnosis of fetal distress (adjusted odds ratio 0.50, 95% confidence interval 0.32, 0.77). This work demonstrates that labor abnormalities and diagnosis of fetal distress are less frequent in patients cared for by nurse-midwives, and there is an association with a lower incidence of cesarean section.