Cesarean Delivery Outcomes Research Articles

Impact of maternal muscle strength on cesarean delivery outcomes: a comparative study of nulliparous women.

This study explored the correlation between maternal muscle mass and strength and the mode of delivery in childbirth. Specifically, it focused on full-term nulliparous pregnant women, analyzing ultrasonographic measurements of the quadriceps femoris muscle together with serum myostatin levels and muscle strength as determined by a handgrip test. The aim was to discern whether these factors could influence the likelihood of delivering vaginally or via cesarean section. This study included 86 healthy nulliparous women at term, categorizing them into two groups based on their mode of delivery: vaginal delivery (58 women, Group 1) and cesarean section (28 women, Group 2). Comparative analyses of demographic information, delivery characteristics, ultrasonographic measurements of the quadriceps femoris, limb circumferences, handgrip strength, and serum myostatin concentrations were conducted. The findings revealed that women in Group 1 had less gestational weight gain but greater handgrip strength compared to Group 2. Additionally, women who underwent cesarean section due to nonprogressive labor had greater arm and calf circumferences relative to those who had vaginal deliveries. The data of this study suggest a trend whereby lower maternal muscle strength and mass are associated with a decreased likelihood of vaginal delivery in pregnant women.

Association Between Maternal Co-morbidities and Cesarean Delivery Outcomes: A Retrospective Study

Background: The rate of cesarean delivery is increasing worldwide despite alarming potential risks. Objectives: This study aimed to evaluate the relationship between maternal co-morbidities and adverse outcomes of cesarean sections. Methods: This study was conducted at Alzahra Hospital in Rasht, Iran, during 2023. Demographic data of pregnant women, their co-morbidities, and cesarean outcomes, defined as mortality or complications including postoperative ICU admission and the first-minute neonate’s Apgar score, were recorded. The relationship between maternal co-morbidities, the number of co-morbidities, cesarean section outcomes, and the first-minute neonate’s Apgar score were analyzed. The data were analyzed using SPSS version 21. The Kolmogorov–Smirnov test, chi-squared test, and two independent t-tests were used. Results: The data from 246 women were analyzed. Gestational diabetes mellitus (36.2%) was the most common co-morbidity. More than 90% of babies had an Apgar score of 7 - 10. Regarding the relationship between maternal co-morbidities and unwanted outcomes, no statistically significant association was found except for hypertensive disorders (P = 0.003). Apgar scores were not affected by maternal co-morbidities (P = 0.183). No cases of mortality were reported. Conclusions: Despite a notable number of maternal co-morbidities, limited adverse outcomes with no mortality were documented, emphasizing the role of cohesive teamwork in improving outcomes.

Rural-urban and racial differences in cesarean deliveries before and during the COVID-19 pandemic in South Carolina

ProblemUnnecessary cesarean delivery increases the risk of complications for birthing people and infants. BackgroundExamining the intersectionality of rural and racial disparities in low-risk cesarean delivery is necessary to improve equity in quality obstetrics care. AimTo evaluate rural and racial/ethnic differences in Nulliparous, Term, Singleton, Vertex (NTSV) and primary cesarean delivery rates before and during the COVID-19 pandemic in South Carolina. MethodsThis retrospective cohort study used birth certificates linked to all-payer hospital discharge data for South Carolina childbirths from 2018 to 2021. Multilevel logistic regressions examined differences in cesarean outcomes by rural/urban hospital location and race/ethnicity of birthing people during pre-pandemic (January 2018–February 2020) and peri-pandemic periods (March 2020–December 2021), adjusting for maternal, infant, and hospital characteristics among two low-risk pregnancy cohorts: 1) Nulliparous, Term, Singleton, Vertex (NTSV, n = 65,974) and 2) those without prior cesarean (primary, n = 167,928). FindingsBlack vs. White disparities remained for NTSV cesarean in adjusted models (urban pre-pandemic aOR = 1.34, 95 %CI 1.23–1.46) but were not significantly different for primary cesarean, apart from rural settings peri-pandemic (aOR = 0.87, 95 %CI 0.79–0.96). Hispanic individuals had higher adjusted odds of NTSV cesarean only for rural settings pre-pandemic (aOR = 1.28, 95 %CI 1.05–1.56), but this disparity was not significant during the pandemic (aOR = 1.13, 95 %CI 0.93–1.37). Discussion and conclusionObserved rural and racial/ethnic disparities in cesarean delivery outcomes were present before and during the COVID-19 pandemic. Strategies effective in reducing racial disparities in primary cesarean may be useful in also reducing Black vs. White NTSV cesarean disparities.

A RETROSPECTIVE STUDY ON FETOMATERNAL OUTCOME IN SECOND STAGE CESAREAN-SECTION

Introduction:Second stage C-section are associated with poor fetomaternal outcome due to deeply engaged head ,less liquor,and thinned out LUS.This can lead to maternal morbidities like thinned out the lower uterine segment. This can lead to a high risk of maternal morbidities like an extension of the lower uterine segment incision, uterine atony, and injury to urinary bladder as well as neonatal morbidities such as birth asphyxia, NICU admission, and meconium aspiration syndrome. This study aims to observe the maternal and neonatal outcomes of cesarean delivery performed in the second stage of labor. Materials and Methods:This is a retrospective observational study conducted in a tertiary health center to study the fetomaternal outcome of all women with singleton, a cephalic fetus at term delivered by cesarean section in the second stage of labor over one year duration. Results:During this study period, there were 6200 deliveries C-section. Among emergency LSCS 50 (0.8%)were performed in the second stage of labor. Most common indication was NPOL A/W fetal distress 24 (44%)followed by Obstructed labor 10(20%). Most common Intraoperative complication noted was extension of uterine segment 8(16%) followed by atonic PPH. Postoperative maternal who had complications were prolong catheterization:25(50%), postoperative fever : 4(8%), haemorrhagic urine8(16%). In perinatal complications, meconium stained liquor: 22(44%),NNU admission8(16%), Apgar score <5 at 5 min : 8(16%), NICU admission : 12(24%), fresh stillbirth : 1(2%) were observed. Conclusion: Cesarean section in the 2nd stage of labor is associated with significantly increased maternal morbidity. Neonatal morbidity and mortality also increases. A proper judgment is required by a skilled obstetrician to take a decision for cesarean section at full cervical dilatation.

680 Impact of obesity class on unscheduled cesarean delivery outcomes

680 Impact of obesity class on unscheduled cesarean delivery outcomes

Cesarean Delivery Outcomes for Patients with Coronavirus Disease-2019 in the USA.

Coronavirus disease-2019 (COVID-19) may have increased morbidity and mortality in patients having Cesarean delivery (CD) in the USA. We performed a retrospective cohort study of patients who had CD in 2020 using the national inpatient sample. After stratification by COVID-19 status, demographics, comorbidities, complications, mortality, and costs were compared. There were 31,444,222 hospitalizations in the USA in 2020 with a mortality rate of 2.8%. Among these, 1,453,945 patients had COVID-19 and mortality was 13.2%. There were 1,108,755 patients who had CD and 15,550 had COVID-19. Patients with COVID-19 more frequently had Medicaid and were Hispanic. Patients with COVID-19 had more comorbidities including chronic hypertension, diabetes mellitus, pre-eclampsia, and eclampsia. Mortality in CD patients with COVID-19 was 30 in 10,000 patients, while for non-COVID-19 patients, it was 1 in 10,000 patients, P < 0.001. The crude odds ratio for mortality in COVID-19 patients was 32.1 (95% confidence interval = 22.9 to 44.7), P < 0.001 and the adjusted odds ratio was 29.3 (95% confidence interval = 20.7 to 41.4), P < 0.001. CD patients with COVID-19 had 30-fold higher mortality before widespread vaccination was available with Hispanic and Medicaid patients disproportionately impacted. Potential explanations for this disparity include reduced access to personal protective equipment (e.g., masks) and testing, as well as socio-economic factors. Further research is needed to understand the factors that contributed to disparities in infection and clinical outcomes among obstetric patients during the COVID-19 pandemic. In future pandemics, enhanced efforts will be needed to protect economically disadvantaged women who are pregnant.

Desirability of outcome ranking for obstetrical trials: illustration and application to the ARRIVE trial

In randomized trials, 1 primary outcome is typically chosen to evaluate the consequences of an intervention, whereas other important outcomes are relegated to secondary outcomes. This issue is amplified for many obstetrical trials in which an intervention may have consequences for both the pregnant person and the child. In contrast, desirability of outcome ranking, a paradigm shift for the design and analysis of clinical trials based on patient-centric evaluation, allows multiple outcomes-including from >1 individual-to be considered concurrently. This study aimed to describe desirability of outcome ranking methodology tailored to obstetrical trials and to apply the methodology to maternal-perinatal paired (dyadic) outcomes in which both individuals may be affected by an intervention but may experience discordant outcomes (eg, an obstetrical intervention may improve perinatal but worsen maternal outcomes). This secondary analysis applies the desirability of outcome ranking methodology to data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network ARRIVE trial. The original analysis found no substantial difference in the primary (perinatal composite) outcome, but a decreased risk of the secondary outcome of cesarean delivery with elective induction at 39 weeks. In the present desirability-of-outcome-ranking analysis, dyadic outcomes ranging from spontaneous vaginal delivery without severe neonatal complication (most desirable) to cesarean delivery with perinatal death (least desirable) were classified into 8 categories ranked by overall desirability by experienced investigators. Distributions of the desirability of outcome ranking were compared by estimating the probability of having a more desirable dyadic outcome with elective induction at 39 weeks of gestation than with expectant management. To account for various perspectives on these outcomes, a complementary analysis, called the partial credit strategy, was used to grade outcomes on a 100-point scale and estimate the difference in overall treatment scores between groups using a t test. All 6096 participants from the trial were included. The probability of a better dyadic outcome for a randomly selected patient who was randomized to elective induction was 53% (95% confidence interval, 51-54), implying that elective induction led to a better overall outcome for the dyad when taking multiple outcomes into account concurrently. Furthermore, the desirability-of-outcome-ranking probability of averting cesarean delivery with elective induction was 52% (95% confidence interval, 51-53), which was not at the expense of an operative vaginal delivery or a poorer outcome for the perinate (ie, survival with a severe neonatal complication or perinatal death). Randomization to elective induction was also advantageous in most of the partial credit score scenarios. Desirability-of-outcome-ranking methodology is a useful tool for obstetrical trials because it provides a concurrent view of the effect of an intervention on multiple dyadic outcomes, potentially allowing for better translation of data for decision-making and person-centered care.

Effects of Adding Intrathecal Epinephrine to Spinal Anesthesia on Anesthesia-Related Cesarean Delivery Outcomes: Should We Reconsider Its Use?

Intrathecal epinephrine is used to increase the duration of spinal anesthesia for amenable surgical procedures anticipated to require additional time; however, in the ambulatory setting, it is associated with a prolonged time to post-anesthesia care unit (PACU) discharge. The current study's authors hypothesized that adding intrathecal epinephrine to spinal anesthesia for cesarean delivery would be associated with a dose-dependent prolonged post-anesthesia unit length of stay. A single-center, retrospective study of patients undergoing repeat cesarean delivery under spinal anesthesia from 2011 to 2015 was conducted. Patients received spinal bupivacaine 12 mg, morphine 150 mcg, and fentanyl 15 mcg with no-epinephrine, 100 mcg, or 200 mcg of epinephrine. The primary outcome was recovery room length of stay. Secondary outcomes were surgical duration, intraoperative vasopressor use, perioperative opioids, and antiemetic use. Data were analyzed for 1,362 patients. Median recovery room stay was 123 min (interquartile range, 100 to 150) and was not different among groups. More women receiving epinephrine 200 mcg had ≥2 prior cesarean deliveries compared with no-epinephrine or 100 mcg. No significant differences in surgical duration or intraoperative opioids were identified among the groups. Median intraoperative vasopressor use was increased by 225 mcg of phenylephrine equivalents (99% CI, 25 mcg to 430 mcg) in the 100 mcg group and 250 mcg of phenylephrine equivalents in the 200 mcg group (99% CI, 75 mcg to 500 mcg) compared to no-epinephrine (P<0.001). Recovery room antiemetic and opioid analgesic administration were not different among groups. Based on the results of this study, the addition of intrathecal epinephrine for women undergoing cesarean delivery increases intraoperative vasopressor use but does not prolong PACU length of stay, reduce intraoperative opioids, or increase antiemetic requirements postoperatively. The current study also demonstrated that surgical duration times were not different among the no-epinephrine, 100 mcg, and 200 mcg epinephrine groups.

Racial Disparities in Cesarean Delivery Outcomes: Analysis of Native Hawaiians or Pacific Islanders and American Indians or Alaska Natives [ID: 1377727

INTRODUCTION: Racial disparities in cesarean delivery (CD) are well documented, but Native Hawaiians or Pacific Islanders (NHPI) and American Indians or Alaska Natives (AIAN) are underrepresented in literature. We aim to elucidate racial disparities in CD outcomes, focusing on NHPI and AIAN populations. METHODS: The National Surgical Quality Improvement Program was queried to identify CD outcomes from 2019 to 2020 in the National Surgical Quality Improvement Project (n=25,649). Multivariable logistic regression models were used to investigate the association of race and ethnicity on major and minor postoperative complications and reoperation. RESULTS: Racial minority groups were compared to non-Hispanic White people and adjusted for confounders. The NHPI patients had the highest risk of complication, at 4.6% greater risk of any postoperative complication (adjusted odds ratio [AOR] 1.046 [1.001–1.093]) and 3.2% greater risk of major complication (AOR 1.032 [1.006–1.058]). This was compared to a 3.2%, 1.9%, and 1.8% greater risk for any postoperative complication in Asian, Black, and Hispanic/Latina patients, respectively. The AIAN patients had the highest risk of reoperation of all groups, at 2.6% greater risk of reoperation (AOR 1.026 [1.015–1.037]). CONCLUSION: Across all groups undergoing CD, NHPI patients had the greatest risk of any postoperative complication, and AIAN patients had the greatest risk of reoperation. Our findings emphasize the need to further investigate these underrepresented minority groups in future obstetric research.

The Implications of Multiple Repeat Cesarean Deliveries On Maternal Morbidity

OBJECTIVE: This study aimed to assess the obstetric outcomes of cesarean delivery (CD) in a cohort of pregnant women who had a history of four or more previous CDs and compared them with those who had a history of three or fewer previous CDs. STUDY DESIGN: The cohort of this retrospective study consisted of all pregnant women who gave birth in our hospital via elective or emergency CD and who had previously undergone one or more other cesarean sections. Pregnant women who had a history of four or more CDs were included in the multiple repeat CD group, and cases who had a history of fewer than 4 CDs were enrolled in the lower-order repeat CD (comparison) group. Demographic data, medical history, clinical features, intraoperative events, and postoperative complications were recorded. RESULTS: The multiple repeat CD group comprised 63 women, and the lower-order repeat CD group (comparison group) included 1097 cases. Intraabdominal dense adhesions (28.6% versus 14.1%, p=0.002), placenta previa (11.1% versus 4.1%, p=0.009), placenta accreta spectrum (PAS) (7.9% versus 2.4%, p=0.008), bladder injury (6.3% versus 1.7%, p=0.011), intraoperative massive hemorrhage (7.9% versus 2.2%, p=0.004), uterine artery ligation (4.8% versus 1.1%, p=0.012), internal iliac artery ligation (4.8% versus 1.2%, p=0.008), cesarean hysterectomy (4.8% versus 1.5%, p=0.045), blood transfusion (12.7% versus 4.1%, p=0.001), and maternal intensive care unit (ICU) admission (14.3% versus 2.0%, p&lt;0.001) were significantly more common among women in the multiple-repeat CD group compared with the lower-order repeat CD group. CONCLUSIONS: Pregnant women having multiple repeat CDs have a significantly increased risk of dense adhesions, placenta previa, PAS, intraoperative massive hemorrhage, blood transfusion, bladder injury, additional surgical interventions, including uterine artery ligation, internal iliac artery ligation, cesarean hysterectomy, and maternal ICU admission.

Comparison of cesarean delivery outcome after robotic and laparoscopic myomectomy

ObjectiveThe aim of this study was to determine whether robotic myomectomy (RM) resulted in any measurable clinical improvement over laparoscopic myomectomy (LM) in subsequent cesarean delivery. Materials and methodsThe medical records of 273 patients who had undergone LM or RM followed by subsequent cesarean delivery for the period of September 2015 to December 2020 were retrospectively reviewed. The patients were divided into LM (n = 222) and RM (n = 51) groups. The cesarean delivery outcomes between the two groups were compared. ResultsRM had significantly more myomas removed (6.0 ± 4.8 vs. 3.6 ± 3.5, p < 0.001) and a larger size of largest myoma (7.7 ± 2.4 vs. 6.1 ± 2.4, p = 0.002) at myomectomy compared with LM. However, there were no significant differences in the groups’ surgical characteristics at cesarean section, in their pregnancy complications, or in adhesion formation. ConclusionsAlthough more and larger myomas were removed in the RM group, RM showed similar cesarean delivery outcomes and adhesion formation to LM.

The effects of timing on cesarean delivery outcomes and operative noise levels

The effects of timing on cesarean delivery outcomes and operative noise levels

HbA1c at term delivery and adverse pregnancy outcome

BackgroundThere are no obvious thresholds at which the risk of adverse pregnancy outcomes increases as a result of maternal hyperglycemia. HbA1c level which is representative of average blood glucose levels over the last 2–3 months is not as strongly predictive of adverse outcome compared to blood glucose values of oral glucose tolerance test. Data is sparse on the predictive value of HbA1c at term just prior to delivery on adverse outcome. We sought to evaluate HbA1c taken on admission for delivery at term on adverse outcomes of Cesarean delivery and large (≥ 90th centile) for gestational age (LGA) infants.MethodsA prospective cross-sectional study was conducted in a university hospital in Malaysia from December 2017-August 2018. 1000 women at term whose deliveries were imminent were enrolled. Blood were drawn and immediately sent for HbA1c analysis at our hospital laboratory. Primary outcomes were Cesarean delivery and LGA.ResultsOn crude analyses, Cesarean births (vs. vaginal births) were associated with significantly higher HbA1c (%) levels 5.4[5.2–5.7] vs. 5.3[5.1–5.6] P = < 0.001 but not for LGA vs. non-LGA 5.4[5.1–5.6] vs. 5.3[5.1–5.6] P = 0.17. After controlling for significant confounders identified on crude analysis (diabetes in pregnancy, parity, ethnicity, body mass index (BMI), previous cesarean, labor induction, Group B streptococcus (GBS) carriage and birth weight), HbA1c is independently predictive of Cesarean birth, adjusted odds ratio (AOR) 1.47 95% CI 1.06–2.06 P = 0.023 per HbA1c 1% increase. Following adjustment for significant confounders (BMI, predelivery anemia [hemoglobin < 11 g/dl] and GBS carriage), the impact of raised HbA1c level on LGA is AOR 1.43 95% CI 0.93–2.18 P = 0.101 per HbA1c 1% increase and non-significant.ConclusionRaised HbA1c level at term births in the general pregnant population is independently predictive of Cesarean delivery after adjustment for potential confounders including diabetes in pregnancy.

Fetomaternal outcomes of cesarean delivery performed in the first and second stage of labor - an analytical prospective observational study

Fetomaternal outcomes of cesarean delivery performed in the first and second stage of labor - an analytical prospective observational study

Prior vertical uterine incision: Effect on subsequent pregnancy characteristics and outcomes.

To examine characteristics and outcomes of cesarean delivery (CD) in women with a history of vertical hysterotomy. This is a comparative study that retrospectively queried the National Inpatient Sample from October 2016 to December 2018. Pregnancy characteristics and surgical outcomes of CD among 18 575 women with prior vertical uterine incision were compared to 1072 949 women with prior low-transverse incision, assessed by multivariable generalized estimating equation model and propensity score weighting. In a multivariable analysis, women who had prior vertical uterine incision were more likely to have placenta percreta (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.87-6.20), pre-labor uterine rupture (OR 2.70, 95% CI 1.52-4.80), in-labor uterine rupture (OR 2.33, 95% CI 1.55-3.51), and extreme preterm delivery <28 weeks (OR 17.8, 95% CI 15.2-20.7) in the current pregnancy, compared to those who had prior low-transverse uterine incision. In a weighted model, prior vertical hysterotomy was associated with increased surgical morbidity in current CD compared to prior low-transverse hysterotomy (10.6% vs. 4.8%, OR 2.02, 95% CI 1.81-2.26), including hemorrhage (OR 1.99, 95% CI 1.74-2.27) and hysterectomy (OR 3.67, 95% CI 2.97-4.53). Prior vertical uterine incision at CD was associated with increased risk of placenta percreta, uterine rupture, particularly before labor, and adverse outcomes in the subsequent pregnancy.

Planned vaginal and planned cesarean delivery outcomes in pregnancies complicated with pregestational type 1 diabetes \u2013 A three-year academic tertiary hospital cohort study

BackgroundFinland has the world’s highest incidence of 62.5/100000 of diabetes mellitus type 1 (DM1) with approximately 400 (1%) DM1 pregnancies annually. Pregnancies complicated by DM1 are accompanied with increased risk for perinatal morbidity and mortality. Timing and mode of delivery are based on the risk of complications, yet the data on labor induction is limited. The aim of this study was to compare delivery outcomes in planned vaginal (VD) and planned cesarean deliveries (CD) in late preterm and term DM1 pregnancies, and to evaluate the feasibility of labor induction.Materials and MethodsPregnant women with DM1, live singleton fetus in cephalic presentation ≥34 gestational weeks delivering in Helsinki University Hospital between January 1st 2017 and December 31st 2019 were included. The primary outcome were the rates of adverse maternal and perinatal outcome. The study population was classified according to the 1980-revised White’s classification. Statistical analyses were performed by IBM SPSS Statistics for Windows.ResultsTwo hundred four women were included, 59.8% (n = 122) had planned VD. The rate of adverse maternal outcome was 27.5% (n = 56), similar between the planned modes of delivery and White classes. The rate of perinatal adverse outcome was 38.7% (n = 79), higher in planned CD (52.4% vs. 29.5%;p = 0.001). The most common adverse perinatal event was respiratory distress (48.8% vs. 23.0%;p < 0.001). The rate of adverse perinatal outcome was higher in White class D + Vascular compared to B + C (45.0% vs. 25.0%, OR after adjustment by gestational age 2.34 [95% CI 1.20–4.50];p = 0.01). The total rate of CD was 63.7% (n = 130), and 39.3% (n = 48) in planned VD. Women with White class D + Vascular more often had emergency CD compared to White Class B + C (48.6% vs. 25.0%;p = 0.009). The rate of labor induction was 51%, being 85.2% in planned VD. The rate of VD in induced labor was 58.7% (n = 61) and the rate of failed induction was 14.1% (n = 15).ConclusionPlanned VD was associated with lower rate of adverse perinatal outcome compared to planned CS, with no difference in the rates of adverse maternal outcome. Induction of labor may be feasible option but should be carefully considered in this high-risk population.

Benchmarking cesarean delivery rates using machine learning-derived optimal classification trees.

To establish a case-adjusted hospital-specific performance evaluation tool using machine learning methodology for cesarean delivery. Secondary data were collected from patients between January 1, 2015 and February 28, 2018 using a hospital's "Electronic Data Warehouse" database from Illinois, USA. The machine learning methodology of optimal classification trees (OCTs) was used to predict cesarean delivery rate by physician group, thereby establishing the case-adjusted benchmarking standards in comparison to the overall hospital cesarean delivery rate. Outcomes of specific patient populations of each participating practice were predicted, as if each were treated in the overall hospital environment. The resulting OCTs estimate physician group expected cesarean delivery outcomes, both aggregate and in specific clinical situations. Twelve thousand eight hunderd and forty one singleton, vertex, term deliveries, cared for by practices with ≥50 births. The overall rate of cesarean delivery was 18.6% (n=2384), with a range of 13.3%-33.7% amongst 22 physician practices. An optimal decision tree was used to create a prediction model for the hospital overall, which defined 23 patient cohorts divided by 46 nodes. The model's performance for prediction of cesarean delivery is as follows: area under the curve 0.73, sensitivity 98.4%, specificity 16.1%, positive predictive value 83.7%, negative predictive value 70.6%. Comparisons with the overall hospital's specific-case adjusted benchmark groups revealed that several groups outperformed the overall hospital benchmark, and some practice groups underperformed in comparison to the overall hospital benchmark. OCT benchmarking can assess physician practice-specific case-adjusted performance, both overall and clinical situation-specific, and can serve as a valuable tool for hospital self-assessment and quality improvement.

Uterine incision-to-delivery time interval- is it associated with adverse perinatal outcome?

The aim of this study was to determine the association between uterine incision-to-delivery interval (UIDI) and perinatal outcomes in cesarean deliveries performed for an indication other than non-reassuring fetal status.

Inflammatory Bowel Disease in Pregnancy: Patient Characteristics and Adverse Maternal Outcomes

To examine characteristics and outcomes of pregnant individuals with inflammatory bowel disease (IBD). This is a retrospective cohort study using linked vital statistics-hospital discharge data from California (2007-2011).We utilized singleton, non-anomalous deliveries and compared demographics and outcomes of cesarean delivery (CD), preterm delivery (< 37 weeks), preeclampsia, operative vaginal delivery, postpartum hemorrhage, placenta previa, and placental abruption using chi-square test. We then performed multivariate logistic regressions controlling for age, race/ethnicity, education, and insurance status. The cohort consisted of 1,807 (0.06%) individuals with IBD and 2,807,941 (99.94%) without IBD. IBD patients were more likely to be white, older, highly educated, on private insurance, normal BMI, have attended ≥ 5 prenatal visits, live in urban areas, and speak English as their primary language (p< 0.001 for all) than those without IBD. On multivariate logistic regression, IBD patients were more likely to have a CD (aOR 1.77, 95% CI 1.59-1.97), preterm delivery (aOR 2.26, 95% CI 1.96-2.61), preeclampsia (aOR 1.29, 95% CI 1.04-1.60), or placenta previa (aOR 1.81, 95% CI 1.19, 2.77), but did not have statistically significant operative vaginal delivery (aOR 1.09, 95% CI 0.93,1.30), postpartum hemorrhage (aOR 1.16, 95% CI 0.88,1.53), or placental abruption (aOR 1.45, 95% CI 0.97, 2.20). Our cohort of IBD patients had characteristics that typically contribute to favorable birth outcomes, but they were more likely to experience CD, preterm birth, preeclampsia, placenta previa, placental abruption, and postpartum hemorrhage. After adjusting for confounders, the rates of postpartum hemorrhage, and placental abruption no longer differed between groups. These results indicate that IBD is most likely responsible for some adverse pregnancy outcomes, but further work should assess disparities that occur among IBD patients that drive adverse outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Outcomes of cesarean delivery in obstetric patients with SARS-CoV-2 infection.

SynopsisSARS‐CoV‐2 infection was not associated with increased mortality, but was associated with a modest increase in morbidity, including stillbirth, in cesarean delivery patients in Maryland, USA.