Frequency Of Cesarean Delivery Research Articles

Birth mode and infectious morbidity risks in Qom children of Argentina.

Cesarean delivery may increase childhood infectious morbidity risks via altered birth exposures and subsequent immune, microbial, and epigenetic development. Many Latin American indigenous populations experience dual burdens of infectious and chronic diseases, and are particularly vulnerable to rising rates of cesarean delivery and associated adverse outcomes. The Qom/Toba are an indigenous population in Argentina experiencing rapid lifestyle transitions. We hypothesized that cesarean delivery would be associated with increased risk of infectious symptoms in Qom children after adjusting for gestational and nutritional factors. We conducted a secondary analysis of birth records and monthly anthropometric and illness data collected previously from 90 Qom children (aged 1-55 months). We tested for additive effects of birth mode on risk of gastrointestinal (GI) and respiratory illness (RI) in mixed-effects logistic regression models adjusting for child weight-for-age (WAZ), weaning, and gestational and maternal age. Cesarean deliveries accounted for 46% of births and were associated with maternal age < 20 and ≥ 30 years, gestational age < 39 weeks, and prenatal complications. GI and RI risks were reduced in association with cesarean delivery, greater WAZ, weaning, maternal age ≥ 30 years, and gestational age < 39 weeks. The relationship between cesarean delivery and reduced infectious risks may reflect statistical confounding with relatively rapid postnatal growth and greater adiposity. Postnatal growth trajectories may be important mediators of long-term morbidity risks associated with cesarean delivery. The frequency of cesarean deliveries among the Qom remains concerning given traditionally high rates of fertility and adolescent pregnancy.

Labor Induction versus Expectant Management in Low-Risk Nulliparous Women

BackgroundThe perinatal and maternal consequences of induction of labor at 39 weeks among low-risk nulliparous women are uncertain.MethodsIn this multicenter trial, we randomly assigned low-risk nulliparous women who were at 38 weeks 0 days to 38 weeks 6 days of gestation to labor induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The primary outcome was a composite of perinatal death or severe neonatal complications; the principal secondary outcome was cesarean delivery.ResultsA total of 3062 women were assigned to labor induction, and 3044 were assigned to expectant management. The primary outcome occurred in 4.3% of neonates in the induction group and in 5.4% in the expectant-management group (relative risk, 0.80; 95% confidence interval [CI], 0.64 to 1.00). The frequency of cesarean delivery was significantly lower in the induction group than in the expectant-management group (18.6% vs. 22.2%; relative risk, 0.84; 95% CI, 0.76 to 0.93).ConclusionsInduction of labor at 39 weeks in low-risk nulliparous women did not result in a significantly lower frequency of a composite adverse perinatal outcome, but it did result in a significantly lower frequency of cesarean delivery. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ARRIVE ClinicalTrials.gov number, NCT01990612.)

Skin Microbiota in Obese Women at Risk for Surgical Site Infection After Cesarean Delivery

The obesity pandemic in the obstetrical population plus increased frequency of Cesarean delivery (CD) has increased vulnerability to surgical site infection (SSI). Here we characterized the microbiome at the site of skin incision before and after CD. Skin and relevant surgical sites were sampled before and after surgical antisepsis from obese (n = 31) and non-obese (n = 27) pregnant women. We quantified bacterial biomass by qPCR, microbial community composition by 16sRNA sequencing, assigned operational taxonomic units, and stained skin biopsies from incision for bacteria and biofilms. In obese women, incision site harbors significantly higher bacterial biomass of lower diversity. Phylum Firmicutes predominated over Actinobacteria, with phylotypes Clostridales and Bacteroidales over commensal Staphylococcus and Propionbacterium spp. Skin dysbiosis increased post-surgical prep and at end of surgery. Biofilms were identified post-prep in the majority (73%) of skin biopsies. At end of surgery, incision had significant gains in bacterial DNA and diversity, and obese women shared more genera with vagina and surgeon’s glove in CD. Our findings suggest microbiota at incision differs between obese and non-obese pregnant women, and changes throughout CD. An interaction between vaginal and cutaneous dysbiosis at the incision site may explain the a priori increased risk for SSI among obese pregnant women.

Variation in the Nulliparous, Term, Singleton, Vertex Cesarean Delivery Rate.

To estimate the contributions of patient and health care provider-hospital characteristics to the variation in the frequency of nulliparous, term, singleton, vertex cesarean delivery in a multi-institutional U.S. cohort. We performed a secondary analysis of the multicenter Assessment of Perinatal Excellence cohort of 115,502 mother and neonatal pairs who were delivered at 25 hospitals between March 2008 and February 2011. Women met inclusion criteria if they were nulliparous and delivered a singleton in vertex presentation at term. Hospital ranks for nulliparous, term, singleton, vertex cesarean delivery frequency were determined after risk adjustment. The fraction of variation in nulliparous, term, singleton, vertex cesarean delivery frequency attributable to patient and health care provider-hospital characteristics was assessed using hierarchical logistic regression. Of the 115,502 deliveries in the initial cohort, 38,275 nulliparous, term, singleton, vertex deliveries met inclusion criteria. The median hospital nulliparous, term, singleton, vertex cesarean delivery frequency was 25.3% with a range from 15.0% to 35.2%. The majority of hospitals (16/25) changed rank quintiles after risk adjustment; overall the changes in rank were not statistically significant (P=.53). Patient characteristics accounted for 24% of the nulliparous, term, singleton, vertex cesarean delivery variation. The analyzed health care provider-hospital characteristics were not significantly associated with cesarean delivery frequency. Although patient characteristics accounted for some of the variation in nulliparous, term, singleton, vertex cesarean delivery frequency and accounting for case mix had implications for hospital cesarean delivery rankings, the majority of the variation was not explained by the characteristics evaluated. These findings emphasize the importance of continued efforts to understand aspects of obstetric care, including case mix, that contribute to cesarean delivery variation.

Impact of introducing specific measures to reduce the frequency of cesarean delivery for non-obstetric indications.

To identify the frequency of cesarean delivery for non-obstetric indications before and after the introduction of specific measures to lower the rate of elective cesarean, and to evaluate the effectiveness of the introduced measures. In the present single-center retrospective cohort study at University Hospital Trnava, Trnava, Slovak Republic, the frequency of elective cesarean was evaluated before (January 1, 2010, to December 31, 2014) and after (January 1, 2015, to December 31, 2016) the implementation of specific measures applied in January 2015 to confirm the indications for primary cesarean delivery. The frequency of elective cesarean delivery for non-obstetric indications was compared between the two periods. Before the intervention in 2015, 229 (2.9%) of 7768 women had elective cesarean deliveries for non-obstetric indications. After implementation of the intervention, the frequency decreased to 27 (0.8%) of 3203 women (P<0.001). The frequency of cesarean delivery for non-obstetric indications was reduced significantly by introducing specific reasonable measures. These included all non-obstetric indications for cesarean delivery being approved by a leading specialist of the related department, close cooperation with professionals from other specialties, and, additionally, staff attending professional educational lectures.

Effect of individualised dietary education at medical check-ups on maternal and fetal outcomes in pregnant Japanese women.

An increased prevalence of low maternal weight and insufficient pregnancy weight gain may be responsible for an increase in low birthweight infants in Japan. We aimed to examine the effects of individualised dietary education at medical check-ups on maternal/fetal outcomes in Japanese women. Four hundred and six underweight and normal weight singleton pregnant women, who attended check-ups at an obstetric facility until ≥30 weeks gestation and delivered at 36-41 weeks gestation, were selected for analyses. Weight gain was assessed at each check-up based on the official "Dietary Guidelines for Pregnant and Lactating Women". Individual dietary advice was provided by dieticians to those with insufficient or excess weight gain status around 28 weeks gestation. The medical records from uncomplicated singleton deliveries (36-41 weeks gestation) at the same facility from 2008-2010 were used (n=792) to examine the effect of dietary education on maternal/fetal outcomes. Pre-pregnancy underweight was present in >24% of women in both the intervention and non-intervention groups. Adequate weight gain occurred more frequently in the intervention group (p<0.01). There were no significant differences in mean birthweight or the proportion of low birthweight infants. However, the proportion of extremely small for gestational age infants (birthweight <3rd percentile) was lower in the intervention group (p=0.011). There were no differences in the frequency of caesarean delivery, pregnancy induced hypertension, or infant Apgar scores <7. Dietary education during pregnancy check-ups promotes adequate maternal weight gain and helps prevent extreme fetal growth restraint.

879: Comparison of cesarean deliveries in a multicenter U.S. cohort using the WHO Robson 10-Group Classification System

The WHO endorses the Robson 10-Group Classification System (TGCS) as a method for assessing the frequency of cesarean delivery (CD) within 10 mutually exclusive groups defined by obstetric characteristics. A limitation to the TGCS is its failure to consider patient comorbidities. We sought to a) compare the frequency of CD in a large multicenter U.S. cohort using the TGCS, b) identify the TGCS groups that are primary determinants of the CD frequency, and c) evaluate the contribution of patient comorbidities to the hospital variation in CD after adjusting for TGCS classification. Secondary analysis of a multicenter observational cohort. Trained research personnel abstracted maternal and neonatal records of >115,000 pregnant women from 25 hospitals (2008-11). The TGCS (Table) was applied to the cohort and all 25 centers. The TGCS groups with the greatest contributions to the overall cohort CD frequency were identified and compared across hospitals. TGCS group selection was supported by published data. Logistic regression was used to determine the hospital variation in CD explained first by TGCS groups and second by 14 patient comorbidities (including maternal age, hypertension, and diabetes). The overall cohort CD frequency was 31.4% (individual hospital CD frequencies ranged from 19.1% to 39.3%). Only 0.5% of CDs were not TGCS-classifiable. TGCS groups 1, 2, 5, & 10 were the most frequent and accounted for 73.5% of the cohort CDs (Table). The contributions of groups 1, 2, 5 & 10 varied at each center but accounted for the majority of CD (range 66.1% to 78.5%). Individual hospital CD frequencies correlated highly with the frequency of the 4 groups combined (Figure; Spearman’s rho = 0.96). Adjusting for patient comorbidities explained an additional 1.7% of hospital CD variation after accounting for each center’s TGCS distribution. This analysis highlights the variation in the frequency of CD in the U.S. and the important contributions of TGCS groups 1, 2, 5, & 10. Although we did not account for hospital characteristics, consideration of patient comorbidities explained limited additional variation after adjusting for TGCS distribution. These findings support the utility of the TGCS for comparing the frequency of CD across hospitals and targeting interventions for CD reduction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Defining failed induction of labor

While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a "failed" inductionof labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor inductionshould continue, absent acute maternal or fetal indications for cesarean delivery, remains lacking. The objective of this study was to determine the frequency ofadverse maternal and perinatal outcomes as a function of the duration ofthelatent phase among nulliparous women undergoing labor induction. This study is based on data from an obstetric cohort of women delivering at 25 US hospitals from 2008 through 2011. Nulliparous women who had a term singleton gestation in the cephalic presentation were eligible for this analysis if they underwent a labor induction.Consistent with prior studies, the latent phase was determined to begin once cervical ripening had ended, oxytocin was initiated, and rupture of membranes had occurred, and was determined to end once 5-cm dilation was achieved. The frequencies of cesarean delivery, as well as of adverse maternal (eg, postpartum hemorrhage, chorioamnionitis) and perinatal (eg, a composite frequency of seizures, sepsis, bone or nerve injury, encephalopathy, or death) outcomes, were compared as a function of the duration of the latent phase (analyzed with time both as a continuous measure and categorized in 3-hour increments). A total of 10,677 women were available for analysis. In the vast majority (96.4%) of women, the active phase had been reached by 15 hours. The longer the duration of a woman's latent phase, thegreater her chance of ultimately undergoing a cesarean delivery (P< .001, for time both as a continuous and categorical independent variable), although >40% of women whose latent phase lasted ≥18 hours still had a vaginal delivery. Several maternal morbidities, such as postpartum hemorrhage (P < .001) and chorioamnionitis (P < .001), increased in frequency as the length of latent phase increased. Conversely, the frequencies of most adverse perinatal outcomes were statistically stable over time. The large majority of women undergoing labor induction will have entered the active phase by 15 hours after oxytocin has started and rupture of membranes has occurred. Maternal adverse outcomes become statistically more frequent with greater time in the latent phase, although the absolute increase in frequency is relatively small. These data suggest that cesarean delivery should not be undertaken during the latent phase prior to at least 15 hours after oxytocin and rupture of membranes have occurred. The decision to continue labor beyond this point should be individualized, and may take into account factors such as other evidence of labor progress.

Association Between Type of Screening for Gestational Diabetes Mellitus and Cesarean Delivery

To compare maternal and neonatal outcomes using two different testing strategies for gestational diabetes mellitus (GDM) diagnosis: the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan approaches. Specifically, we wanted to compare the rates of cesarean delivery between the two epochs. This was a retrospective cohort study of women with a singleton pregnancy delivering at 37 0/7 weeks of gestation or greater, between 2010 and 2015, in a single tertiary care center. The IADPSG testing was used for GDM diagnosis from December 2010 until July 2013 when institutional guidelines changed to Carpenter-Coustan testing. Maternal and neonatal outcomes were compared between these two different epochs using bivariable and multivariable analyses. The primary outcome was the frequency of cesarean delivery. The analysis included a total of 23,509 women: 14,074 (60%) from the IADPSG epoch and 9,435 (40%) from the Carpenter-Coustan epoch. The incidence of GDM diagnosis was higher using the IADPSG compared with Carpenter-Coustan criteria (8.3% compared with 7.5%, P=.042). The total (27.0% compared with 25.5% P=.022) as well as primary cesarean delivery rates (19.1% compared with 18.0%, P=.041) were higher during the IADPSG epoch. The rates of total (39.1% compared with 37.5%, P=.594) and primary (27.3% compared with 27.0%, P=.903) cesarean delivery among women with GDM did not differ between the two epochs. Secondary outcomes of shoulder dystocia (2.5% compared with 2.1%, P=.043) and neonatal intensive care unit admission (3.2% compared with 2.0%, P<.001) also were significantly higher in women screened during the IADPSG epoch, whereas hypertensive disease of pregnancy (6.9% compared with 7.7%, P=.018) was less frequent during the IADPSG epoch. These findings persisted after adjusting for potential confounding factors. Compared with testing using the Carpenter-Coustan criteria, the IADPSG criteria for diagnosis of GDM were associated with higher rates of GDM, cesarean delivery, shoulder dystocia, and neonatal intensive care unit admission. Obstetric care provider knowledge of GDM diagnosis might have affected decision-making regarding the route of delivery.

Association Between Time of Day of Delivery and Perinatal Outcomes [17L

INTRODUCTION: Prior work has demonstrated differences in cesarean-associated maternal morbidity based on time of delivery, but it remains unclear whether delivery mode or neonatal outcomes are associated with diurnal patterns. The objective was to determine if there is an association between delivery time and perinatal outcomes. METHODS: This is a retrospective cohort study of all nulliparous women delivering singleton, vertex, live births at ≥37 weeks gestation at a single center from 2014-15. Delivery time was dichotomized with nighttime deliveries designated as those occurring between 6pm and 6am. The primary outcome was delivery mode. Secondary outcomes included epidural use, labor augmentation, episiotomy and perineal lacerations, 5 minute Apgar &lt; 7, cord umbilical artery pH &lt; 7.0, and NICU admission. Bivariable and multivariable analyses were utilized for analyses. RESULTS: Of 7,691 women eligible for inclusion, 3,707 (48.2%) delivered during the night. Women undergoing night deliveries were marginally more likely to be undergoing induction of labor (20.1% vs 18.4%, p=0.06). Women delivering during the night were less likely to experience augmentation of labor (79.8% vs 81.6%, p=0.05) and had a higher frequency of cesarean delivery (20.6% vs 17.0%, p &lt; 0.001). They were also more likely to have neonates with a 5-minute Apgar score &lt; 7 (aOR 1.57, 95% CI 1.07-2.30) and umbilical artery pH &lt; 7.0 (aOR 1.75, 95% CI 1.17-2.61). CONCLUSION: Among nulliparous women, delivery at night is associated with greater odds of cesarean delivery, low 5-minute Apgar score, and low umbilical artery pH.

Оптимізація клінічних підходів до розродження жінок з кесаревим розтином в анамнезі

The artikle presents study allowance reducing the frequency of cesarean delivery (CD) by implementing practices vaginal birth in women after caesarean section (VBAC), with improved functional test for status uterine scar. The objective: to determine the influence of the number VBAC the overall level of the CD, the opportunity to refine prognosis for success VBAC based functional evaluation of the uterus and fetal at full-term pregnancy. Patients and methods. Was held cohort study material for hospital of 2 lewel of perinatal care for 2008-2015., in terms of introducing VBAC practices, and (2) a investigation of two groups of women for assessing perfusion in cervix and low segment of uterine Doppler influenced by contraction test. Results. Implementation VBAC institution 2 of perinatal care resulting in lower frequency in 25%. Successful attempt of VBAC have 51.6%, unsuccessful in 9.3% of the women with a uterine scar, elective repeat the CD performed in 39.1%. There is increasing lewel in the percentage of women with a history of the CD in the study cohort - from 4.1% in 2008 to 6.5% in 2014. Posted pathogenetic base for hemodynamic assessment cervics and low segment of uterine areas in contracting test as adequate modern approach to prognosis successful attempt successful attempts for the mother and fetus. Conclusions. The proposed test can objectively assess the chances of successful attempt VBAC to form arguments to try VBAC or repeat CD. Key words: cesarean section, uterine cervix, vaginal delivery, prognosos.

EFFECT OF UTERINE FIBROID ON MODE OF DELIVERY

Introduction: Uterine fibroids are the commonest benign tumors occurring in the female reproductive tract. They occur in 30%–70% of women in their Reproductive age. The fibroids incidence rises as the age increases. Its prevalence in pregnancy is 0.1%–10.7%.In such pregnancies, obstetric complication occur in 10%–30% . Studies show that in such pregnancies delivery occur at an earlier gestational . Fetal malpresentation, placenta previa, intrauterine growth restriction, labor dystocia, placental abruption, cesarean delivery , retained placenta, and postpartum hemorrhage (PPH) are common obs compications occurring in pregnancies with fibroids.&#x0D; Objective: The objective of our study is to determine the frequency of cesarean delivery in pregnancies with uterine fibroids.&#x0D; Materials and Methods: It is a Descriptive type cross sectional study which was carried out in Obstetric and Gynae unit 1 of Lahore General Hospital, Lahore for Six months from 06-08-2015 to 06-02-2016. Sample size of 100 cases was calculated with 95% confidence level, 10% margin of error and taking expected percentage of cesarean section i.e. 40% of cesarean section in patients with uterine fibroid.&#x0D; Results: In our study, 59%(n=59) were between 20-30 years while 41%(n=41) were between 31-40 years of age, mean+sd was calculated as 28.31+5.67 years. Gestational age(in weeks) of the patients was calculated . 64%(n=64) were between 34-36 weeks while 36%(n=36) were between 37-39 weeks, mean+sd was calculated as 36.83+1.75 weeks of gestation. Regarding Parity of the patients, 63%(n=63) were between 1-3 paras and 37%(n=37) were having parity between 4-5. Frequency of cesarean delivery in patients with uterine fibroids performed in 57%(n=57) cases while 43%(n=43) had normal vaginal delivery.&#x0D; Conclusion: The frequency of cesarean delivery is higher among patients with uterine fibroids. So, it is recommended that every patient who present with uterine fibroids, should be sort out for the mode of delivery. However, it is also required that every setup should have their surveillance in order to know the frequency of the problem.

Maternal outcomes of term breech presentation delivery: impact of successful external cephalic version in a nationwide sample of delivery admissions in the United States.

BackgroundWe aimed to define the frequency and predictors of successful external cephalic version in a nationally-representative cohort of women with breech presentations and to compare maternal outcomes associated with successful external cephalic version versus persistent breech presentation.MethodsUsing the Nationwide Inpatient Sample, a United States healthcare utilization database, we identified delivery admissions between 1998 and 2011 for women who had successful external cephalic version or persistent breech presentation (including unsuccessful or no external cephalic version attempt) at term. Multivariable logistic regression identified patient and hospital-level factors associated with successful external cephalic version. Maternal outcomes were compared between women who had successful external cephalic version versus persistent breech.ResultsOur study cohort comprised 1,079,576 delivery admissions with breech presentation; 56,409 (5.2 %) women underwent successful external cephalic version and 1,023,167 (94.8 %) women had persistent breech presentation at the time of delivery. The rate of cesarean delivery was lower among women who had successful external cephalic version compared to those with persistent breech (20.2 % vs. 94.9 %; p < 0.001). Compared to women with persistent breech at the time of delivery, women with successful external cephalic version were also less likely to experience several measures of significant maternal morbidity including endometritis (adjusted Odds Ratio (aOR) = 0.36, 95 % Confidence Interval (CI) 0.24–0.52), sepsis (aOR = 0.35, 95 % CI 0.24–0.51) and length of stay > 7 days (aOR = 0.53, 95 % CI 0.40–0.70), but had a higher risk of chorioamnionitis (aOR = 1.83, 95 % CI 1.54–2.17).ConclusionsOverall a low proportion of women with breech presentation undergo successful external cephalic version, and it is associated with significant reduction in the frequency of cesarean delivery and a number of measures of maternal morbidity. Increased external cephalic version use may be an important approach to mitigate the high rate of cesarean delivery observed in the United States.

Reduction in the Cesarean Delivery Rate After Obstetric Care Consensus Guideline Implementation.

To evaluate the rate of primary cesarean delivery after adopting labor management guidelines. This is a before-after retrospective cohort study at a single academic center. This center adopted guidelines from the Consensus for the Prevention of the Primary Cesarean Delivery. Nulliparous women attempting vaginal delivery with viable, singleton, vertex fetuses were included. For the primary outcome of cesarean delivery rate among induced or augmented patients, 200 consecutive women managed before guideline adoption were compared with 200 similar patients afterward. Secondary outcomes of overall cesarean delivery rate, maternal morbidity, neonatal outcomes, and labor management practices were analyzed with inclusion of intervening spontaneously laboring women. Between September 13, 2013, and September 28, 2014, 275 women preguideline and 292 postguideline were identified to include 200 deliveries after induction or augmentation each. Among women delivering after induction or augmentation, the cesarean delivery rate decreased from 35.5% to 24.5% (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.38-0.91). The overall cesarean delivery rate decreased from 26.9% to 18.8% (adjusted OR 0.59, CI 0.38-0.92). Composite maternal morbidity was reduced (adjusted OR 0.66, CI 0.46-0.94). The frequency of cesarean delivery documenting arrest of dilation at less than 6 cm decreased from 7.1% to 1.1% postguideline (n=182 and 176 preguideline and postguideline, respectively, P=.006) with no change in other indications. Postguideline, the cesarean delivery rate among nulliparous women attempting vaginal delivery was substantially reduced in association with decreased frequency in the diagnosis of arrest of dilation at less than 6 cm.

491: The efficacy of early amniotomy after ripening with Foley balloon catheter in nulliparous labor induction

To evaluate the association between early amniotomy after ripening with foley balloon catheter and duration of labor. In this retrospective cohort study, 426 nulliparous women with a singleton viable gestation undergoing cervical ripening with foley balloon catheter were compared based on timing of amniotomy after catheter removal: early (defined as artificial rupture of membranes less than 1h after foley removal) versus no artificial rupture of membranes in the first hour. Women were excluded if spontaneous rupture of membranes occurred while foley was in place. Bivariable and multivariable analyses were performed to determine whether early amniotomy was associated with vaginal delivery within 24 hours, chorioamnionitis, and other maternal and neonatal outcomes. Cox proportional hazard regression was used to compare time intervals from catheter removal to complete dilation and from catheter removal to delivery. In univariable analysis, women who underwent early amniotomy had a slightly more favorable cervical exam after foley removal (modified Bishop score of 4.9 ± 1.4 vs. 4.0 ± 1.4, p<.001) but otherwise had similar characteristics including gestational age at delivery (40.2wk ± 1.2 vs. 40.3wk ± 1.3, p=0.674). The frequency of vaginal delivery within 24h was higher in women with early amniotomy (45.5% vs. 33.3%, p=0.010) with no significant difference in the frequency of cesarean delivery (46.0% vs. 49.3%, p=0.497). The median time intervals from foley catheter removal to complete dilation (8.2h vs. 12.2h) and to delivery (10.9h vs. 14.4h) were also significantly shorter for women who underwent early amniotomy (p<.001 for both). While there was no significant difference in rate of chorioamnionitis between groups (19.0% vs. 20.3%, p=0.731), there were fewer NICU admissions for neonates of women who underwent early amniotomy (6.1% vs. 13.6%, p=0.009). In multivariate analysis, after adjusting for potential confounding factors, early amniotomy remained associated with higher odds of vaginal delivery within 24h, fewer NICU admissions, and shorter times from catheter removal to complete dilation and to delivery (Table). Early amniotomy after foley balloon catheter removal is associated with shorter duration of labor induction and fewer NICU admissions.

200: Delayed pushing is associated with increased frequency of cesarean delivery and NICU admission

200: Delayed pushing is associated with increased frequency of cesarean delivery and NICU admission

COMPARATIVE CHARACTERISTIC OF THE PREGNANCY AND DELIVERY AT THE PATIENTS AFTER PREVIOUS SURGERIES ON A UTERUS

The complex analysis of indications to cesarean delivery in the Ryazan Regional Clinical Perinatal Center during 2011-2013 is carried out. Frequency of cesarean delivery was 32.8%. Earlier undergone surgeries on a uterus made 26,4% in structure of all indications to cesarean delivery. Results of research showed that conservative conducting childbirth at pregnant women after the undergone surgeries on a uterus is an essential reserve of decrease in number of cesarean delivery. The main conditions of conservative conducting childbirth: anatomic and functional quality of a uterus; clinical compliance of the sizes of a fetus and woman's pelvis; absence of absolute contraindications to childbirth from mother and fetus.

Outcomes of women with gestational diabetes mellitus in Sweden

ObjectiveThe number of women with gestational diabetes mellitus (GDM) during pregnancy is increasing around the world and in our region in the south Sweden 1.2% of all pregnant women received the GDM diagnosis in the 90s and now it is about 2.2%. The aim of this study was to compare women with GDM 1995–99 against women with GDM 2012–13 regarding eventual differences in demographics and pregnancy outcome. Study designIn our region in Sweden, all pregnant women are tested for GDM with a 2-h 75g oral glucose tolerance test and the 2-h cut off value for GDM is ≥10.0mmol/l in capillary plasma glucose. 1995–99 there were 131 women with GDM and their medical journals were compared against the 210 women with GDM during 2012–13. The same screening and diagnostic method was uses during the whole time period. ResultsIn the 2012–13 GDM pregnancies there were more non-Scandinavian women, more women with insulin treatment during pregnancy and a higher frequency of cesarean deliveries compared to 1995. First weight of the women during GDM pregnancy 2012–13 was significantly higher than the weight of women with GDM 1995–99, 71kg (43–138; n=201) and 65kg (43–133; n=125) (p=0.008) respectively. However, there was no significant difference in weight of the mother at delivery. Birth weight of the child in GDM pregnancies 1995–99 was 3722.4g±578.2 (n=109; p=0.009), and in GDM pregnancies 2012–13 3555.6g±465.8 (n=162). ConclusionEven though women with GDM 2012–13 weigh more when they start the pregnancy there is no difference in weight at delivery compared to women with GDM 1995–99. This is also reflected on the newborn, that 2012–13 had significantly lower birth weight but with the same gestational length as 1995–1999. We believe that this is due to a more active and intense treatment of women with GDM during pregnancy together with higher frequency of cesarean delivery. Prevention of large infants is crucial to avoid complications during delivery.

The Robson ten-group classification system for appraising deliveries at a tertiary referral hospital in Brazil

ObjectiveTo evaluate the distribution of women according to the Robson 10-group classification system (RTGCS) and the occurrence of severe maternal morbidity (SMM) by mode of delivery at a tertiary referral hospital. MethodsA retrospective cross-sectional study was conducted of all women admitted to the Women’s Hospital at the University of Campinas (Campinas, Brazil) for delivery between January 2009 and July 2013. Women were grouped according to RTGCS. Mode of delivery and SMM (defined as need for admission to the intensive care unit) were assessed. ResultsAmong 12 771 women, 5957 (46.6%) delivered by cesarean. Overall, 3594 (28.1%) women were in group 1 (nulliparous, single pregnancy, cephalic, term, spontaneous labor), 2328 (18.2%) in group 5 (≥1 previous cesarean, single pregnancy, cephalic, term), and 2112 (16.5%) in group 3 (multiparous excluding previous cesarean, single pregnancy, cephalic, term, spontaneous labor). Group 5 contributed the most cesarean deliveries (1626 [27.3%]), followed by group 2 (nulliparous, single pregnancy, cephalic, term, induced labor or cesarean before labor; 1049 [17.6%]). SMM was more common among women undergoing cesarean delivery than among those delivering vaginally in groups 1–5. ConclusionThe RTGCS allowed the identification of groups with the highest frequency of cesarean delivery and an assessment of SMM. This should be considered in related health policies.

The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome

BackgroundThe increased pain at the latent phase can be associated with dysfunctional labor as well as increases in cesarean delivery frequency. We aimed to research the effect of the degree of pain at the time of epidural analgesia on the entire labor process including the mode of delivery.MethodsWe performed epidural analgesia to 102 nulliparous women on patients' request. We divided the group into three based on NRS (numeric rating scale) at the moment of epidural analgesia; mild pain, NRS 1-4; moderate pain, NRS 5-7; severe pain, NRS 8-10. The primary outcome was the mode of delivery (normal labor or cesarean delivery).ResultsThere were significant differences in the mode of delivery among groups. Patients with severe labor pain had a significantly higher cesarean delivery compared to patients with moderate labor pain (P = 0.006). The duration of the first and second stage of labor, fetal heart rate, use of oxytocin and premature rupture of membranes had no differences in the three groups.ConclusionsOur research showed that the degree of pain at the time of epidural analgesia request might influence the rate of cesarean delivery. Further research would be necessary for clarifying the mechanism that the augmentation of pain affects the mode of delivery.