Cesarean Delivery Rate Research Articles

Is a rising cesarean delivery rate explained by late birth trend? A decomposition analysis of health insurance claims data (2013-2022) from South Korea.

To analyze the factors influencing the increase in the cesarean delivery (CD) rate in South Korea and test the hypothesis on advanced maternal age driving the trend. The present study is a population-based retrospective observational study utilizing administrative data from the Korean National Health Insurance Service. We analyzed a total 3 416 517 births from 2013 to 2022 covered by the national health insurance. The CD rate and contribution of demographic variables to changes in CD rates were calculated using Das Gupta's decomposition method. The CD rate increased from 37.8% in 2013 to 61.6% in 2022. The decomposition analysis revealed that changes in maternal age structure contributed only 8.7% to the increase in the CD rate. When parity was added to maternal age, the explained proportion increased to 17.8%. When other factors were added to the model, such as multiple births, residential area, and income level, it did not contribute significantly to the increase in the CD rates, accounting for 19.0%, 18.6%, and 18.0%, respectively. According to our analysis, less than one-fifth of the increase in CD rate was explained by the change in maternal age. The rising CD rate in Korea should not be considered an unavoidable consequence of demographic change. Much more diverse factors, including increased risk of medical lawsuits, changes in childbirth culture, and other health system determinants, may be driving the trend.

The interplay of body mass index, gestational weight gain, and birthweight over 3800 g in vaginal breech birth: A retrospective study.

Optimal counseling of women for vaginal breech birth requires consideration of both established and emerging risk factors for adverse perinatal outcomes. Currently, rising prevalences of maternal obesity and impaired glucose tolerance challenge obstetric care. We aimed to investigate the effects of these parameters on the outcome of vaginal breech birth to improve counseling practices. A total of 361 women (without previous vaginal births) attending vaginal birth of a singleton fetus in breech presesntation between 01/2015 and 11/2021 were included in this retrospective single-center study. Data were derived from the hospital data base. We analyzed the effect of the maternal body mass index (BMI) at birth (compared to pre-pregnancy BMI), excessive weight gain, gestational diabetes, and neonatal birthweight on obstetrical and neonatal short-term outcomes (intrapartum cesarean delivery, performance of obstetric maneuvers (Løvset-, Bracht-, Veit-Smellie maneuver and Bickenbach's arm delivery), admission to the neonatal unit, Apgar score after 5 minutes<7, and arterial cord pH-value <7.10). Multivariable logistic regression was used for analysis and adjustment of variables. Overall, 246 women (68.1%) had a successful vaginal birth. Intrapartum cesarean delivery (n = 115/361; 31.9%) was independently associated with maternal BMI at birth (p = 0.0283, aOR = 1.87 (1.19-3.97)) if birthweight was ≥3800 g. The rate of intrapartum cesarean delivery was also higher in women with gestational diabetes (p = 0.0030, aOR = 10.83 (2.41-60.84)). A significantly higher risk of neonatal acidosis (arterial pH-value <7.10) was observed in women with BMI at birth ≥30 kg/m2 (p = 0.0345, aOR = 1.84 (1.04-3.22)) without affecting other outcomes. Pre-pregnancy BMI, gestational weight gain and BMI-gain did not significantly affect the obstetrical and neonatal birth outcomes. When neonatal birthweight is ≥3800 g, maternal BMI at birth (p = 0.0283; aOR = 1.87 (1.19-3.97)) is independently associated with the rate of intrapartum cesarean delivery. However, pre-pregnancy BMI and BMI-gain during pregnancy were not associated with the need for intrapartum cesarean delivery or other adverse outcomes. Consequently, BMI at the time of birth could be more informative than pre-pregnancy BMI and may improve counseling of women attempting vaginal breech birth.

Risk factors for re-hospitalization following cesarean delivery at term.

To identify the key risk factors contributing to re-hospitalization after term cesarean delivery (CD). This retrospective cohort study included women who underwent CD at term at a university-affiliated tertiary medical center (January 2021 to March 2023). The primary outcome was risk factors for re-hospitalization within 30 days post-discharge. Data on selected maternal demographic, pregnancy-related and delivery variables were extracted from electronic medical records. A multivariable logistic regression analysis was conducted to identify independent risk factors for re-hospitalization. Logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for various independent risk factors. A total of 2878 women were included in the study, of whom 76 required re-hospitalization (2.6%). The rates of high-risk pregnancies were more prevalent among those who were re-hospitalized (41 [62.1%] vs. 1148 [49.1%], P = 0.043). Furthermore, the rates of emergency CDs (42 [56%] vs. 1040 [37.8%], P = 0.001), prolonged surgery duration (17 [22.4%] vs. 292 [10.4%], P = 0.001) and hospitalization duration (14 (18.4%) vs. 273 (9.7%), P = 0.015) were significantly higher in the re-hospitalized group. Emergency CD (OR 1.90, 95% CI 1.06-3.42, P = 0.030) and prolonged surgery duration (OR 2.44, 95% CI 1.25-4.77, P = 0.016) remained significant risk factors of re-hospitalization in the multivariate analysis. The need for emergency CD and prolonged surgery duration were found as independent risk factors for re-hospitalization after CD at term.

Nondiabetic Fetal Macrosomia: Causes, Outcomes, and Clinical Management.

Fetal macrosomia (FM) is common in clinical practice and carries increased risk of adverse maternal and neonatal health outcomes. Maternal diabetes mellitus (DM) is a well-known cause of macrosomia with significant research and guidelines focusing on macrosomia in this population. Less is known about causes, prevention, and clinical management for suspected FM in individuals without diabetes. The objective of this review is to describe the risk factors associated with nondiabetic FM, review risks associated with macrosomia in pregnancy, and potential treatment considerations for this condition. Original research articles, review articles, and guidelines on macrosomia were reviewed. Risk factors for macrosomia in patients without DM include previous delivery of an infant with macrosomia, excessive pregnancy weight gain, and obesity. Maternal complications of FM include higher rates of cesarean delivery, postpartum hemorrhage, and vaginal laceration. Fetal complications include shoulder dystocia, decreased Apgar scores, and increased risk of childhood obesity. Exercise during pregnancy has been shown to reduce the risk of FM. Induction of labor prior to 39 weeks is not recommended in the setting of suspected macrosomia as there is a lack of adequate evidence to support that this decreases adverse neonatal or maternal outcomes. In addition, elective cesarean delivery for suspected macrosomia is not recommended to be considered unless estimated fetal weight is greater than 5000 g in the absence of DM. Delivery of an infant with macrosomia in patients without DM has increased maternal and fetal risks. Predicting infants who will meet criteria for macrosomia is challenging. More research is needed to identify ways to accurately estimate fetal weight, interventions to prevent macrosomia, and additional ways to mitigate risk in patients without DM who have suspected FM.

Laparotomy versus laparoscopy for the treatment of adnexal torsion during pregnancy

BackgroundAdnexal torsion (AT) is a rare emergency complication during pregnancy. Increasing evidence implies that operative laparoscopy for adnexal torsion performed during pregnancy could be safe and feasible. We procured and evaluated the surgical and obstetric outcomes between laparoscopy and laparotomy to determine the optimal approach for treating AT during pregnancy.MethodsThis was a retrospective study involving telephone questionnaire on adnexal torsion during pregnancy that occurred between July 2012 and July 2023 in the First Affiliated Hospital of Zhengzhou University. The study cohort included 155 pregnant women who underwent laparotomy or laparoscopic surgery. The clinical characteristics, surgical interventions, postoperative pathology and pregnancy outcomes were analyzed.ResultsA total of 102 patients were treated by laparoscopy, and 53 patients were treated by laparotomy. Compared with the laparotomy group, the laparoscopy group had significantly less blood loss (17.5 ml vs. 20.0 ml, p = .004), a lower incidence of delayed incision healing (1.0% vs. 11.3%, p = .011), and a shorter hospital stay (5.0 days vs. 8.0 days, p < .001). There was no significant difference between the two groups in terms of obstetric outcomes, including preterm delivery, miscarriage rate, birth weight, delivery gestation, cesarean delivery rate, or neonatal intensive care unit admission. All the pathological findings were benign except for one case of borderline mucinous cystadenoma. The most common pathological types were luteal cysts in the laparoscopy group and mature teratomas in the laparotomy group.ConclusionIn this retrospective study, compared with laparotomy, laparoscopy yielded successful outcomes, with less surgical bleeding, less delayed wound healing, and shorter hospital stays. Laparoscopy could be a promising approach for diagnosing and treating AT during pregnancy.

The association of increased incidence of congenital heart disease in newborns with maternal COVID-19 infection during pregnancy

This paper aims to examine the potential link between maternal COVID-19 infection during pregnancy and the increased risk of congenital heart disease (CHD) in newborns. A comparative analysis was conducted involving two groups: mothers infected with COVID-19 during pregnancy and a control group. Data on maternal characteristics, pregnancy-related complications, and newborn outcomes were collected and analyzed. Additionally, the annual incidence rates of CHD from 2020 to 2023 were evaluated to assess trends over time. No significant differences were found between the COVID-19 cases and the control group in terms of maternal age, BMI, gravidity, parity, use of assisted reproductive technology, adverse obstetric history, or complications during pregnancy, including diabetes mellitus, preeclampsia, and thyroid abnormalities. For newborn outcomes, there were no significant differences in sex distribution, rate of cesarean delivery, Apgar scores, or birth weight. However, a significantly higher prevalence of cardiac ultrasound abnormalities was observed in the COVID-19 group (10.08%) compared to the control group (4.13%, p = 0.012). Further analysis revealed that the majority of cardiac abnormalities in the COVID-19 group occurred in mothers infected before 8 weeks of pregnancy. The annual incidence rates of CHD showed a significant increase during the COVID-19 pandemic, with the highest rate in 2023 (5.46%) compared to previous years. Maternal COVID-19 infection during pregnancy may adversely affect the development of the newborn’s heart. This could be due to the inflammatory response caused by the viral infection or other pathological processes. The findings underscore the importance of vigilant prenatal care and early detection of cardiac abnormalities during the pandemic and suggest the need for further research to explore potential mechanisms and intervention strategies.

The Effect of Psychoeducation on Fear of Childbirth: A Literature Review

Purpose : The aim of this study is to investigate the contribution of psycoeducation to reduce FOC among primigravida and nulligravida mothers between 2015 and 2023. A literature review study was conducted to explore the effects of psychoeducation on pregnancy anxiety. Method : Systematically reviewed studies between 2015 and 2023, the researchers searched a total of 10 studies. This review uses search research from Pubmed, Science Direct and Google Scholar as sources. Result : This study found variations between primary and secondary types of fear of childbirth (FOC). A woman who experiences primary FOC, also known as childbirth anxiety (Primigravida), is newly pregnant and about to give birth for the first time. Secondary fear of childbirth is caused by trauma or a painful birth event (Nulligravida). Pharmacological and non-medical treatments such as psychoeducation were improved to relieve during labour anxiety, confidence during labour, reduction of depressive symptoms, and decrease in caesarean delivery rates. Conclusion: Psychoeducation conducted by midwives can reduce the fear of facing labour experienced by pregnant women.

Determinants of Caesarean Deliveries in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey

Caesarean section, a frequently conducted surgical procedure in obstetrics, is instrumental in safeguarding the well-being of both mothers and infants by addressing complications related to pregnancy and childbirth. While it significantly contributes to reducing maternal and infant mortality rates, its overuse can pose serious health risks. The prevalence of caesarean deliveries has surged globally, including in Bangladesh. This rise in caesarean deliveries has prompted this research to investigate the prevalence and various associated factors in the country. To achieve the study objectives, data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted from 2017 to 2018. After preprocessing the data, a total of 4,884 women were included in the study. Frequency analysis was conducted to illustrate the distribution of sociodemographic characteristics among Bangladeshi women. Chi-square tests were performed to assess their association with caesarean delivery. Furthermore, multi-level logistic regression analysis was employed to identify the variables that have a significant impact on the likelihood of caesarean delivery. The study revealed that in Bangladesh, the prevalence of caesarean section deliveries was approximately 33.1%, with the majority of these occurring in the Dhaka division, accounting for approximately 25.3%. Women aged 20 or older were 1.62 times more likely to opt for a C-section during childbirth (OR 1.62, [1.38-1.89]) compared to those under 20. Overweight or obese women had twice the likelihood of delivering via C-section. Higher socioeconomic status also increased the probability of choosing a caesarean delivery. Women who had exposure to any form of media were 57% more likely to opt for a caesarean delivery (OR 1.57 [1.31-1.87]), while not working women had a 48% higher likelihood of having a C-section. Additionally, the study found that the use of caesarean delivery was positively associated with the husband's education level, the number of children previously born, and the number of antenatal care visits. The study revealed that the rate of C-sections in Bangladesh surpasses WHO recommendations significantly. It also identified various factors driving this trend, including women's education levels, socioeconomic status, media exposure, female obesity, age at first childbirth, and husband’s education. These insights may serve as a foundation for developing strategies to regulate the caesarean delivery rate. Urgent policy directives are essential within Bangladesh's healthcare system, coupled with vigilant monitoring of clinical indications for C-sections, to mitigate the adverse effects of unnecessary procedures. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 31−44

Maternal and neonatal outcomes of congenital syphilis at a tertiary care center in Turkey; a retrospective observational study

Background Maternal syphilis (MS) can lead to significant maternal morbidity and neonatal morbidity and mortality if inadequately treated. This study is aimed to retrospectively analyse the maternal and neonatal outcomes of pregnant women diagnosed with MS at our clinic. Materials and Methods We accessed the medical records of 64 cases diagnosed with MS between 2020 and 2022 from our hospital database and the perinatology clinic archives in this retrospective observational study. Case distributions by years, sociodemographic characteristics, and maternal and neonatal outcomes were recorded. Results The distribution of MS cases was 16 (25.0%) in 2020, 20 (31.25%) in 2021, and 28 (43.75%) in 2022. The mean age of the patients was 26.4 ± 6.3 years, mean BMI was 23.36 ± 3.14, the smoking rate was 31.25%, and the majority of patients were educated to primary level (37.5%). Most were housewives (43.75%), lived in urban areas (43.75%), and had lower-level incomes (68.75%). In addition, 43.75% received adequate maternal treatment, the caesarean delivery rate was 43.25%, 31.25% had preterm births, and the mean birth weight was 2956.36 + 514.46 g. CS was largely diagnosed during delivery or the postpartum period (43.75%). Fifty percent of patients were in the latent stage, gestational hypertension and preeclampsia were present in four case each (6.25%), and gestational diabetes mellitus in eight (12.5%). Twenty babies (31.25%) were admitted to the neonatal intensive care unit, eight (12.5%) had congenital anomalies, 12 had foetal growth restriction (18.25%), stillbirth was present in four (6.25%) case, and early neonatal death in four (6.25%). Conclusions Delayed diagnosis and inadequate treatment of MS can lead to significant maternal and neonatal morbidity and mortality. Well-planned antenatal care services should be provided for all expectant mothers in order to reduce these adverse outcomes.

Analysis of Birth Statistics, Examination of Caesarean Rates and Caesarean Indications; Retrospective Study

Purpose This study investigated cesarean delivery rates and indications for cesarean delivery among patients who gave birth in our clinic between 2019 and 2022. Materials and Methods For the study, the data of 16,559 patients who gave birth between 2019 and 2022 in the Obstetrics and Gynecology clinic of a Training and Research Hospital were retrospectively analyzed. The mode of delivery, gender information, fetal birth weight, vaginal delivery, and cesarean section rates and indications for cesarean section were analyzed. Results Among the patients who gave birth in our clinic between January 01, 2019, and December 31, 2022, 58.1% delivered vaginally, and 41.9% delivered by cesarean section. According to the four-year average, 48.5% of the babies born were girls, and 51.5% were boys. The most common indication for cesarean section was previous uterine surgery. The rate of primary cesarean section among cesarean deliveries was 47%. The most common indications for primary cesarean section were fetal distress, breech presentation, and non-progressive labor. Conclusion In our clinic, the four-year average cesarean delivery rate was 41.9%. Although this rate is below the national average of 53%, it is above the Ministry of Health's target rate of 35% in Turkey. When evaluated specifically for our province, we think this is mainly due to the lack of obstetrician-gynecologists in the districts and the high number of referrals to our hospital. Nevertheless, considering these results, it is clear that more comprehensive studies are needed to reduce cesarean section rates.

Complex interplays: Asthma management and maternal‑fetal outcomes in pregnancy (Review).

Asthma, a common chronic respiratory condition, poses unique challenges in pregnancy, impacting both maternal and fetal health. Of note, 8-13% of pregnant women suffer from asthma, a condition that can worsen, stabilize, or improve during pregnancy. These fluctuations necessitate a nuanced management strategy to ensure the health of both the mother and fetus. Adverse outcomes, such as preeclampsia, gestational diabetes and increased cesarean delivery rates are associated with poorly controlled asthma. From a fetal perspective, the risks include preterm birth and a low birth weight. Physiological changes in pregnancy, such as an increased tidal volume and altered drug metabolism due to increased blood volume, complicate the management of asthma. The safety of asthma medications during pregnancy remains a significant concern, with ongoing research into their teratogenic effects. Recent advancements in treatment include the development of biologics and the increased use of personalized medicine, integrating pharmacogenomics and immunological profiling to tailor treatments to individual needs. Digital health tools have also emerged, enabling improved patient monitoring and management. The present review highlights the complex interplay between asthma management and pregnancy outcomes, advocating for comprehensive care approaches that consider the dynamic physiological changes during pregnancy. It underscores the need for ongoing research into the safety of medication and innovative therapeutic strategies to improve health outcomes for pregnant women with asthma and their babies.

Hereditary Hemorrhagic Telangiectasia: Pregnancy and Delivery-Specific Considerations and Outcomes.

Prior studies have evaluated maternal outcomes in patients with hereditary hemorrhagic telangiectasia (HHT), yet pregnancy- and delivery-specific data remain limited. This study aims to evaluate pregnancy and delivery outcomes in patients with HHT. This retrospective cohort study used the Nationwide Readmissions Database to identify patients with HHT diagnosis on delivery between 2010 and 2021. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included nontransfusion SMM, preterm birth, stillbirth, prelabor rupture of membranes or preterm prelabor rupture of membranes, cesarean delivery, respiratory bleeding, cerebrovascular complications, patient disposition, and length of stay. Trends in the prevalence of HHT at delivery were assessed with logistic regression. Logistic regression analyses, adjusting for age, payer, zip code income, hospital size, and teaching status, were also used to produce adjusted relationships between HHT status and outcomes. The cohort of 21,698,861 delivered pregnancies corresponded to a national estimate of 44,325,599. Of those, 612 (national estimate: 1,265; 2.8 per 100,000) had a diagnosis of HHT. A steady rise in the HHT diagnosis rate during pregnancy from 2010 to 2021 (1.7 per 100,000 in 2010, 3.8 per 100,000 in 2021, p < 0.001 for trend) was seen. Patients with HHT were significantly more likely to experience SMM compared with patients without HHT (7.8 vs. 1.7%, adjusted relative risk [aRR]: 4.49 [95% confidence interval, CI: 3.06, 6.58]). Rates of preterm birth (14.2 vs. 8.5%, aRR: 1.57 [95% CI: 1.22, 2.03]), cesarean delivery (41.0 vs. 32.9%, aRR: 1.23 [95% CI: 1.07, 1.41]), respiratory bleeding (2.1 vs. <0.1%, aRR: 94.44 [56.64, 157.46]), and cerebrovascular complications (0.9 vs. <0.1%, aRR: 22.89 [9.89, 52.96]) were higher in patients with HHT than non-HHT patients. There was no difference in stillbirth rates between groups. Patients with HHT have higher rates of SMM and adverse delivery outcomes when compared with the baseline population. · There was a steady rise in the rates of HHT during pregnancy from 2010 to 2021.. · Patients with HHT are more likely to experience SMM.. · Patients with HHT are more likely to have a preterm delivery and cesarean delivery..

Fetomaternal Outcome in Pregnancy with Gestational Thrombocytopenia

Introduction: Gestational thrombocytopenia, a common hematological disorder in pregnancy, poses risks to both maternal and neonatal health. This study aims to evaluate the fetomaternal outcomes in pregnancies complicated by gestational thrombocytopenia compared to those with normal platelet counts. Methods: This prospective cohort study was conducted over 12 months at Jalalabad Ragib-Rabeya Medical college hospital sylhet Bangladesh. It included 100 pregnant women diagnosed with gestational thrombocytopenia (platelet count &lt;150,000/µL after 20 weeks of gestation) and 100 matched controls with normal platelet counts. Maternal data included demographic information, obstetric and medical history, mode of delivery, incidence of pre-eclampsia, postpartum hemorrhage, and need for platelet transfusions. Fetal outcomes assessed were birth weight, Apgar scores, preterm birth rates, NICU admissions, and neonatal thrombocytopenia. Data were analyzed using t-tests for continuous variables and chi-square tests for categorical variables, with multivariate logistic regression to identify predictors of adverse outcomes. Result: The gestational thrombocytopenia group showed higher, though not statistically significant, rates of cesarean delivery (30% vs. 25%, p=0.453), pre-eclampsia (15% vs. 12%, p=0.540), and postpartum hemorrhage (18% vs. 10%, p=0.110). Platelet transfusions were required more frequently in the gestational thrombocytopenia group (8% vs. 2%, p=0.052). Fetal outcomes revealed lower mean birth weight (2950g vs. 3050g, p=0.145), higher preterm birth rates (14% vs. 10%, p=0.371), and more NICU admissions (20% vs. 12%, p=0.132) in the gestational thrombocytopenia group. Notably, neonatal thrombocytopenia was significantly more prevalent in the gestational thrombocytopenia group (10% vs. 2%, p=0.017). Conclusion: Gestational thrombocytopenia is associated with increased risks of certain maternal and neonatal complications. Vigilant monitoring and management are essential to improve outcomes in affected pregnancies. Further research is needed to develop targeted interventions and improve antenatal care practices.

CESAREAN AUDIT: USING ROBSON’S 10 GROUP CLASSIFICATION AT C. U. SHAH MEDICAL COLLEGE AND HOSPITAL

Objective: The World Health Organization (WHO) has expressed concern over the rising cesarean section (CS) rate, particularly in middle-and high- income countries. The reasons behind this increase are still debated, but the WHO declared that there is no justification for a rate higher than 10–15%. The Robson classification system, advocated by WHO and FIGO, can help assess and compare CS rates. Study Design and Methods: The Gynecology Department at C.U. Shah Medical College and Hospital conducted an observational study on pregnant patients hospitalized for labor pain between January 2020 and December 2022, with a focus on CS patients. The study used Robson’s 10-group categorization technique to extract maternal features and categorize cesarean performances. Results: Between January 2020 and December 2022, C. U. Shah Medical College and Hospital delivered 4967 patients, of whom 1,572 underwent a CS section. 46.3% were nulliparous, and 53.7% were multipara. 78.31% of patients arrived at full term, with 98.8% having single conceptions. 94.8% of the cases had a cephalic presentation, 4.4% had a breech presentation, and 0.81% had a transverse position. Conclusions: Robson classification is a useful technique for analyzing cesarean delivery (CS) rates, aiding in identifying corrective methods to reduce burden on healthcare systems, and promoting accurate labor monitoring, fetal scalp electrodes, and prenatal education.

6900 Fetal Abdominal Obesity in Women Exhibiting One Abnormal Value on Diagnostic Testing for Gestational Diabetes Mellitus

Abstract Disclosure: W. Kim: None. S. Park: None. Y. Kim: None. Background: Fetal abdominal obesity (FAO) was already observed at the time of diagnosis of GDM in our previous study. We investigated whether fetuses of women with hyperglycemia milder than GDM showed accelerated abdominal growth, leading to adverse pregnancy outcomes. Methods: We retrospectively reviewed the medical records of 7,569 singleton pregnant women who were universally screened using a 50-g glucose challenge test (GCT) and underwent a 3-h 100-g oral glucose tolerance test (OGTT) if GCT result was ≥140mg/dL. GDM, one value abnormality (OVA), and normal glucose tolerance (NGT, NGT1: GCT negative, NGT2: GCT positive &amp; OGTT negative) were diagnosed using Carpenter-Coustan criteria. With fetal biometry data measured simultaneously with 50-g GCT, relative fetal abdominal overgrowth was investigated by assessing the fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference(AC) per actual GA by the last menstruation period(LMP), biparietal diameter (BPD) or femur length(FL), respectively. FAO was defined as FAOR ≥90th percentile Results: The FAORs of GA-AC/GA-LMP and GA-AC/GA-BPD were significantly higher in OVA subjects compared to NGT subjects but not in NGT2 subjects. Although the frequency of FAO in OVA (12.1%) was between that of NGT (9.6%) and GDM (18.3%) without statistically significant difference, the prevalence of large for gestational age at birth and primary cesarean delivery rates were significantly higher in OVA (9.8% and 29.7%) than in NGT (5.1% and 21.5%, p&amp;lt;0.05). Particularly, among OVA subjects with FAO, the prevalence (33.3% and 66.7%) was significantly higher than in those without FAO (9.7% and 24.2%, p&amp;lt;0.05). Conclusion: The degree of fetal abdominal growth acceleration in OVA subjects was intermediate between that of NGT and GDM subjects. OVA subjects with FAO at the time of GDM diagnosis were strongly associated with adverse pregnancy outcomes. Presentation: 6/2/2024

Obstetric and neonatal outcomes in women with Ankylosing spondylitis - an evaluation of a population database

BackgroundAnkylosing Spondylitis (AS) is a systemic chronic rheumatic disease characterized by involvement of the axial skeletal and sacroiliac joints. Although this disease is not rare amongst women of reproductive age, data regarding pregnancy outcomes have demonstrated conflicting results. We therefore aimed to compare pregnancy and perinatal outcomes between women who suffered from AS to those who did not.MethodsA retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Included in the study were all pregnant women who delivered or had a maternal death in the US between 2004 and 2014. Women with an ICD-9 diagnosis of AS before or during pregnancy were compared to those without. Pregnancy, delivery, and neonatal outcomes were compared between the two groups using multivariate logistic regression models adjusting for potential confounders.ResultsA total of 9,096,788 women were inclusion in the analysis. Amongst them, 383 women (3.8/100,000) had a diagnosis of AS and the rest were controls. Women with AS, compared to those without, were more likely to be older; Caucasian; from higher income quartiles; suffer from thyroid disorders, and have multiple pregnancies (p < 0.001, all). After adjusting for confounders, patients in the AS group, compared to those without, had a higher rate of cesarean delivery (CD) (aOR 1.47, 95% CI 1.14–1.91, p = 0.003); gestational diabetes (aOR 1.55, 95% CI 1.02–2.33, p = 0.038); and placenta previa (aOR 3.6, 95% CI 1.6–8.12, p = 0.002). Regarding neonatal outcomes, patients with AS, compared to those without, had a higher rate of small-for-gestational-age (SGA) neonates (aOR 2.19, 95% CI 1.22–3.93, p = 0.009); and intrauterine fetal death (IUFD) (aOR 3.46, 95% CI 1.11–10.83, p = 0.033).ConclusionWomen diagnosed with AS have an increased risk of obstetric complications, including CD, as well as an increased risk of SGA and IUFD.

Vaginal Uncomplicated Delivery Rate as a Quality Indicator Compared to Cesarean Delivery Rate: A Quantitative Analysis of a Population Database

ObjectivesThe objective of this study is to compare the vaginal uncomplicated delivery (VUD) rate, defined as all vaginal deliveries (including forceps and vacuum) without an adverse maternal or neonatal labour outcome, to the cesarean delivery (CD) rate, as a performance indicator. MethodsThis is a retrospective cohort analysis from a provincial database of all term deliveries by an obstetrician in a single year, excluding diagnoses preventing active labour. Most obstetricians in this jurisdiction practice consultative obstetrics, focused on supporting primary maternity care. We investigated the association of adverse delivery (AD), measured by the adverse outcome index, with CD and VUD rates. ResultsWe report 16 620 deliveries by 210 obstetricians, with a vaginal delivery rate of 39.6%, of which 36.6% were operative vaginal delivery. The overall AD rate was 9.9%, and the overall VUD rate was 34%. While the CD and VUD both correlated with the mode of delivery, only the VUD rate was correlated to the AD rate. ConclusionsQuality assurance in obstetrics must balance the needs of 2 patients based on limited data. Our data shows the shortcomings of the prevailing performance indicator, CD rate, which does not correlate with birth outcomes for the pregnant patient or infant. The VUD rate provides an alternative that assesses both mode of delivery and labour outcomes. Shifting the quality lens to focus on the VUD rate will provide a better metric that measures optimal outcomes for pregnant people and their babies.

Timing of induction of labor in suspected macrosomia: retrospective cohort study, systematic review and meta-analysis.

Large-for-gestational age (LGA) is associated with several adverse maternal and neonatal outcomes. Although many studies have found that early induction of labor (IOL) in case of a LGA fetus reduces the incidence of shoulder dystocia, no current guidelines recommend this particular clinical strategy, owing to concerns about increased rates of Cesarean delivery (CD) and neonatal complications. The purpose of this study was to assess whether the timing of IOL in LGA fetuses affected maternal and neonatal outcomes in a single center, and to combine these results with evidence reported in the literature. This study comprised two parts. The first part was a retrospective cohort study that included consecutive patients with a singleton pregnancy and an estimated fetal weight ≥ 90th percentile on ultrasound between 35 + 0 and 39 + 0 weeks' gestation, who were eligible for normal vaginal delivery. The second part of the study was a systematic review of the literature and meta-analysis, including the results of our cohort study as well as those of previous studies that compared IOL with expectant management in patients with a LGA fetus. The perinatal outcomes of the study were CD, operative vaginal delivery, shoulder dystocia, brachial plexus palsy, anal sphincter injury, postpartum hemorrhage, Apgar score, umbilical artery pH, admission to the neonatal intensive care unit, use of continuous positive airway pressure, intracranial hemorrhage, need for phototherapy and bone fracture. Of the 547 patients included in this retrospective cohort study, 329 (60.1%) underwent IOL and 218 (39.9%) experienced spontaneous labor. Following covariate balancing, the odds of CD were significantly higher in the IOL group compared with the spontaneous-labor group. This difference only became apparent beyond 40 weeks' gestation (hazard ratio, 1.90; P = 0.030). The difference between the IOL and spontaneous-labor groups for the rate of shoulder dystocia was not statistically significant (hazard ratio, 1.57; P = 0.200). Seventeen studies, in addition to our own results, were included in the systematic review and meta-analysis, giving a total population of 111 300 participants. Although there was no significant difference in the rate of CD between IOL and expectant management after pooling the results of included studies, the risk for shoulder dystocia was significantly lower in the IOL group (odds ratio (OR), 0.64 (95% CI, 0.42-0.98); I2 = 19% from 12 studies) when considering only IOL performed before 40 + 0 weeks. When the studies in which IOL was carried out exclusively before 40 + 0 weeks were removed from the analysis, the risk for CD in the remaining studies was significantly higher in the IOL group (OR, 1.46 (95% CI, 1.02-2.09); I2 = 56%). There were no statistically significant differences between the IOL and expectant-management groups for the remaining perinatal outcomes. Nulliparity, history of CD and low Bishop score, but not method of induction, were independent risk factors for intrapartum CD in patients that underwent IOL for LGA. The timing of IOL in patients with suspected macrosomia significantly impacts on perinatal adverse outcomes. IOL has no impact on rates of shoulder dystocia but increases the odds of CD when considered irrespective of gestational age; in contrast, IOL may decrease the risk of shoulder dystocia without increasing the risk of other adverse maternal outcomes, in particular CD, when performed before 40 + 0 weeks (GRADE: low/very low). © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Impact of vaginism on mode of delivery and obstetrical outcomes

IntroductionAccording to ICD 10, vaginism is defined as the presence of spasm of the pelvic floor muscles surrounding the vagina, causing occlusion of the vaginal opening. Intromission is impossible or painful. Vaginism, whose prevalence is estimated at 1%, is often diagnosed during pregnancy follow-up, when clinical examination is difficult or impossible. However, few studies report obstetrical complications and pregnancy outcomes associated with this pathology. ObjectiveEvaluate the impact of vaginism on mode of delivery and obstetrical complications. Materials and methodsComparative, monocentric, retrospective study at the Montreuil maternity hospital between January 2019 and January 2024 that included all singleton deliveries in cephalic presentation at term. Vaginism was defined as an involuntary contraction of the pelvic muscles that made clinical examination during pregnancy impossible. Mode of delivery (caesarean section during labour, operative delivery, spontaneous vaginal delivery) and obstetric complications (episiotomy, OASIS, complex tear, Postpartum haemorrhage (PPH) due to tear) were compared between patients with vaginism and a control group, in univariate analysis and multivariate logistic regression with adjustment for maternal age, BMI, maternal origin, gestational age, high obstetrical and medical risk level, diabetes with or without insulin use, pregnancy complications, Robson group and birthweight. A propensity score adjustment with matching 1 case to 3 controls was conducted. ResultsDuring the study period, 13,469 patients were included, among which 440 patients had vaginism. In univariate analysis, patients with vaginism had a higher rate of caesarean section (16,8% versus 9,4%, p < 0.001), operative delivery (29,3% versus 13,3%, p < 0.001), episiotomy (12,5% versus 5.3 %, p < 0.001), OASIS (3.4 % versus 1.0 %, p < 0.001), complex tear (17,5% versus 7,7%) and PPH due to tear (2,5% versus 1,1%, p = 0,009).After adjustment, vaginism appeared to be an independant risk factor for cesarean section with a psaOR of 1.38 [1.02–1.85], operative delivery psaOR 2.39 [1.83–3,10], OASIS psaOR 2,19 [1.10–4,27], and complex tear psaOR 1,39 [1,02–1,87] ConclusionVaginism appears to be an independent risk factor for cesarean section, operative delivery, OASIS, and complex tear. Further studies should evaluate the impact of early and appropriate follow-up during pregnancy on adverse obstetrical outcomes.

Adverse obstetric outcomes in cases of meconium-stained amniotic fluid complicated with intrapartum fever.

Meconium-stained amniotic fluid (MSAF) often signifies colonization of the amniotic sac by microorganisms. This study investigated additional adverse obstetric outcomes associated with MSAF in deliveries complicated by maternal intrapartum fever (IF). This retrospective study included all singleton pregnancies from 2014 to 2020, with intrapartum maternal fever ≥ 38°C during a trial of labor. In accordance with departmental protocol, all patients received intravenous antibiotic therapy consisting of ampicillin and gentamicin in the absence of allergies to these medications. Subsequent antibiotic therapy was adjusted based on the culture results. Antibiotic treatment was discontinued postpartum after 48h without fever. Swab cultures were obtained immediately postpartum from both the maternal and fetal sides of the placenta. Maternal and fetal outcomes, along with positive placental cultures, were compared between participants with MSAF&IF and those with clear amniotic fluid &IF (control group). In comparison to the control group (n = 1089), the MSAF&IF group (n = 264) exhibited significantly higher rates of cesarean delivery (CD) (p = 0.001), CD due to non-reassuring fetal heart rate (p = 0.001), and cord pH ≤ 7.1 (p = 0.004). Positive swab cultures from the placental maternal and fetal sides were more prevalent among the MSAF&IF group (23.1% vs. 17.6%, p = 0.041 and 29.2% vs. 22.9%, p = 0.032, respectively). Placental cultures yielding gastrointestinal pathogens and extended spectrum beta-lactamase were notably more common in the MSAF&IF group compared to controls (p = 0.023). However, there was no significant difference between groups regarding the rate of group B streptococcus positive placental cultures. Women experiencing IF and MSAF during labor face an elevated risk of CD compared to those with IF alone. The presence of MSAF heightens the risk of positive placental cultures, particularly with gastrointestinal and extended spectrum beta-lactamase pathogens.