Delivery In Multiparous Women Research Articles

Evaluation of the risk factors for antepartum hemorrhage in cases of placenta previa: a retrospective cohort study.

ObjectiveThe aim of this study was to examine the risk factors for antepartum hemorrhage (APH) in women with placenta previa.MethodsIn this retrospective cohort study, we analyzed the medical records of 233 women with singleton pregnancies presenting with placenta previa whose deliveries were performed at our hospital between January 2009 and July 2018.ResultsOf the 233 women included in this study, 130 (55.8%) had APH. In the APH group, the gestational age and neonatal birth weight were significantly lower compared with the no hemorrhage group. Maternal age <30 years and multiparity were identified as significant risk factors for APH in both the univariate and multivariate analyses. Focusing on the previous route of delivery in multiparous women, the risk of APH was significantly higher in multiparous women who had experienced at least one vaginal delivery compared with nulliparous women (adjusted odds ratio (OR): 3.42 [95% confidence interval: 1.83–6.38]).ConclusionWe showed that women with placenta previa who were under 30 years old and who had a history of vaginal delivery may be at significant risk of experiencing APH.

A retrospective study of risk factors for stress urinary incontinence 1year after delivery in multiparous women.

Stress urinary incontinence (SUI) is a common postpartum disorder. In this study, we aim to identify the risk factors for SUI in multiparous women 1year after delivery. A retrospective cohort study was conducted in multiparous women who gave birth from January 2016 to March 2018 in Peking University Third Hospital. We interviewed all of the participants with the help of The International Consultation on Incontinence questionnaire short form (ICI-Q-SF) 1year after delivery by telephone to identify symptoms of SUI. Univariate and multivariate analyses were applied to assess the potential risk factors of SUI. A decision tree was used to assess the prevalence of SUI in the different subgroups. A total of 172 multiparous women were recruited. The prevalence of SUI was 30.2% (52/172) 1year after delivery. In univariate analysis, maternal age ≥ 35 years, SUI after the first delivery, GDM and birth exclusively by vaginal delivery increased the risk for SUI 1year after delivery. Multivariate analysis indicated that SUI after the first delivery (OR: 3.937, 95% CI: 1.764-8.787), gestational diabetes mellitus (GDM) (OR: 3.754, 95% CI: 1.599-8.810) and age ≥ 35 years (OR: 2.964, 95% CI: 1.208-7.274) were independent risk factors for SUI 1year after delivery. A decision tree showed that participants who had SUI after the first delivery and patients with GDM were more likely to have SUI than patients without GDM (73.3% vs. 50%). For multiparous women, SUI after the first delivery, GDM and age ≥ 35 years increase the risk of SUI 1year after delivery.

Interpregnancy Body Mass Index Change and Risk of Intrapartum Cesarean Delivery.

This study aimed to examine the association between interpregnancy body mass index (BMI, kg/m2) change and intrapartum cesarean delivery in multiparous women without a history of cesarean delivery. We conducted a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks' gestation or greater at MedStar Washington Hospital Center from January 2009 to June 2018. We excluded women who had a history of cesarean delivery, prelabor cesarean delivery, and contraindications for vaginal delivery. Interpregnancy BMI change was calculated by the change of early pregnancy BMI measured in the office. Women were categorized according to the interpregnancy BMI change (BMI loss more than 2 kg/m2, BMI change ± 2 kg/m2, and BMI gain more than 2 kg/m2). The primary outcome was an intrapartum cesarean delivery. Multivariable logistic regression was performed to calculate adjusted odds ratio (aOR) with 95% confidence interval (CI) after adjusting for predefined covariates. Of 2,168 women who were analyzed, 258 (12%), 1,192 (55%), and 718 (33%) had interpregnancy BMI loss more than 2 kg/m2, BMI change ± 2 kg/m2, and BMI gain more than 2 kg/m2, respectively. Women with BMI gain more than 2 kg/m2 compared with those with BMI change ± 2 kg/m2 had increased odds of intrapartum cesarean delivery (7.4 vs. 4.5%; aOR: 1.78; 95% CI: 1.10-2.86) and cesarean delivery for arrest disorders (3.1 vs. 1.1%; aOR: 3.06; 95% CI: 1.30-7.15). Women with BMI loss more than 2 kg/m2 compared with those with BMI change ± 2 kg/m2 had similar rates of cesarean delivery. Compared with interpregnancy BMI change ± 2 kg/m2, interpregnancy BMI gain 2 kg/m2 was associated with increased odds of intrapartum cesarean delivery. · BMI gain between pregnancies was associated with intrapartum cesarean delivery.. · BMI loss between pregnancies was not associated with intrapartum cesarean delivery.. · Our study suggests that at least maintaining weight between pregnancies is beneficial..

Restrictive versus Routine Episiotomy: A Multicenter Randomized Controlled Trial

Background: Episiotomy is an incision made during vaginal childbirth to widen the vagina. Episiotomy is recommended only for some patients based on 'restrictive episiotomy policy'. It remains debatable whether restrictive episiotomy could be extrapolated to Asian women due to limited data. Methods: This randomized controlled trial compared routine and restrictive episiotomies among Thai women when a vaginal birth was anticipated. Participants were singleton, term-pregnant women with a cephalic presentation. Randomization was stratified by study site and parity. Primary outcome was severe perineal laceration. Secondary outcomes included vaginal laceration, cervical laceration, and pregnancy outcomes. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to indicate between-group differences. Findings: 1502 and 1504 women were randomly assigned to restrictive and routine episiotomy respectively. There was no difference in severe perineal laceration between the groups (RR 0·72; 95% CI 0·46-1·12). Restrictive episiotomy resulted in more intact perineum in multiparous women (RR 3·09; 95% CI 2·10-4·56). Restrictive episiotomy increased risk of vaginal laceration in either the primiparous (RR 1·96; 95% CI 1·62-2·37) or multiparous women (RR 2·21; 95% CI 1·77-2·75) but did not lead to more suturing. There were comparable risks of cervical laceration, postpartum hemorrhage, wound complication, birth asphyxia, and admission to neonatal intensive care unit. Interpretation: Restrictive episiotomy results in more intact perineum after delivery in multiparous women. Risks of maternal and neonatal outcomes were comparable between the two practices. These results strengthen the certainty of the existing Cochrane review findings in supporting the use of restrictive episiotomy. Trial Registration: The trial registration number of the protocol for this study was TCTR20150212001. Funding Statement: Thailand Research Fund. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval was obtained from the ethical committees (HE581111). This study was conducted and reported according to the CONSORT Statement.

A Randomized Trial of Foley Balloon Induction of Labor Trial in Multiparas (FIAT-M).

Background The optimal method of labor induction is not known. It is important to determine the safest and efficient method to minimize the length of labor, hospital stay, cost, and adverse outcomes. Objective This study aims to determine if induction of labor with simultaneous use of oxytocin and Foley balloon versus the sequential use of Foley balloon followed by oxytocin decreases the time to delivery in multiparous women. Study Design We conducted a randomized controlled trial of multiparous women who presented for induction of labor at Mount Sinai from December 2013 to April 2016. Patients were admitted for induction with indications determined by their provider. Women with a nonanomalous, singleton fetus ≥ 24 weeks in vertex presentation with intact membranes were offered participation. Exclusion criteria included the history of uterine surgery, unexplained vaginal bleeding, latex allergy, or contraindication to vaginal delivery. Participants were randomized to either simultaneous (oxytocin and Foley balloon) or sequential (oxytocin after the expulsion of Foley balloon) induction group. The primary outcome was the time from induction to delivery. Secondary outcomes included mode of delivery, estimated blood loss (EBL), postpartum hemorrhage (PPH), chorioamnionitis, and composite neonatal outcome. Maternal and neonatal outcomes were collected via chart review. Analyses were done on an intention-to-treat basis. Results A total of 142 patients were enrolled; 75 in the simultaneous and 67 in the sequential group. There were no differences in baseline characteristics in the two groups. There was no difference in median time to delivery between groups (10.7 vs. 10.6 hours, p = 0.44). There was no difference in the rate of cesarean delivery, EBL, PPH, chorioamnionitis, or composite neonatal outcome. Conclusion Simultaneous use of oxytocin and Foley balloon for induction of labor does not decrease time to delivery in multiparas.

Epidural analgesia during labour: a retrospective cohort study on its effects on labour, delivery and neonatal outcome

to evaluate the impact of epidural analgesia (EA) on labor delivery and neonatal status. retrospective, observational, cohort study comprising 5593 pregnant women who met the inclusion criteria (singleton pregnancy cephalic presentation, 37-42 weeks of gestation). Out of them, 2496 had EA and 3097 constituted the control group. incidence of labor complications and operativd deliveries in women who received EA, neonatal status assessed by Apgar score in 1- and 5-minute, and cord pH values. Labor complications were more frequently observed in the epidural group, with an almost 1.5-fold higher incidence in nulliparous (16.32% vs. 11.29%) and 1.4-fold in multiparous women (9.86% vs. 7.08%). Stepwise logistic regression confirmed that EA is a significant risk factor for labor complications in nulliparous women (OR 1.27, 95% CI 1.03-1.58) and for forceps delivery in multiparous women (5.20, 95% CI 3.31-8.177). Also, EA is an important risk factor for both, low cord arterial pH <7.10 (OR 1.98, 95% CI 1.28-3.09, p=0.0023) and low Apgar score at 7 minute (OR=4.55, 95% CI 2.35-8.80, p<0.0001). Crucially there was no difference in the incidence of a low Apgar score at 5 minutes. EA constitutes an independent risk factor for operative vaginal delivery in multiparous women, but has no effect on the incidence of cesarean sections, either in nulliparous or multiparous women. EA also increases the risk of labor complications, low 1-minute Apgar score and low umbilical cord pH, but is not associated with low 5-minute Apgar score.

Delivery route following elective induction of labor at term: analysis of 807 patients.

BackgroundThe purpose of this study is to compare mode of delivery for both nulliparous and multiparous women at term that underwent elective induction of labor to those who arrived in spontaneous labor.MethodsMedical records of 807 deliveries were reviewed. There were 566 labor patients and 241 elective induction patients.ResultsWomen who underwent elective induction of labor were more likely to undergo cesarean delivery compared to those women who arrived in spontaneous labor (41.1% versus 9.9%, P = 0.001). This was true for both nulliparous women (49% versus 31%, P < 0.0001), and multiparous women (22.7% versus 1.6%, P < 0.0001). The rate of operative vaginal delivery was also increased in the elective induction of labor group (8.4% versus 3.6%, P < 0.0001). Operative vaginal delivery was statistically significant in multiparous women (21% versus 4.1%, P < 0.0001), but not in nulliparous women (10.1% versus 9.8%, P = NS).ConclusionElective induction of labor at term is associated with an increased risk of cesarean section in both nulliparous and multiparous women. There is also an increased risk of an operative vaginal delivery in multiparous women who underwent elective induction of labor.

660: Cesarean birth after vaginal: risk factors for primary cesarean delivery in multiparous women

660: Cesarean birth after vaginal: risk factors for primary cesarean delivery in multiparous women

Effect of parity and advanced maternal age on obstetric outcome

Objectives To examine the effect of parity on obstetric outcome in women aged 40 years or older. Methods A retrospective cohort of 16 427 singleton pregnancies delivered between 1998 and 2001 was studied. Obstetric outcomes in women aged 40 years or older versus women younger than 40 years were compared for both nulliparous and multiparous women. Results Of the 15 727 pregnancies (95.7%) that satisfied the inclusion criteria, 606 (3.9%) were in women aged 40 years or older. Advanced age was independently associated with cesarean delivery, birth and spontaneous preterm labor before 37 weeks, and low birth weight neonates in nulliparous women, but only with preterm birth before 37 weeks and cesarean delivery in multiparous women. Conclusion Obstetric outcome in women aged 40 years or older was influenced by parity. Cesarean delivery and preterm birth before 37 weeks were independently associated with older age irrespective of parity. Advanced age is a risk factor for preterm birth.

Elective induction with cervical ripening increases the risk of cesarean delivery in multiparous women

Elective induction with cervical ripening increases the risk of cesarean delivery in multiparous women

Elective Induction With Cervical Ripening Increases the Risk of Cesarean Delivery in Multiparous Women

Elective Induction With Cervical Ripening Increases the Risk of Cesarean Delivery in Multiparous Women

Diurnal rhythms of labor and delivery in women: Modulation by parity and seasons

OBJECTIVES: Our purpose was to evaluate in women the diurnal (24 hour) rhythms of the onset of labor and time of delivery and their modulation by parity and seasons. STUDY DESIGN: A retrospective analysis was performed on 15,910 at term deliveries of single fetuses with noninduced labor. RESULTS: A diurnal rhythm of labor onset, with peak frequency at 8 pm and 9 am was observed in nulliparous women but not in multiparous women. No diurnal rhythm of labor length was detectable. A diurnal rhythm of delivery, with peak values at 2 pm was evident in nulliparous but not in multiparous women. In nulliparous women the two acrophases of the diurnal rhythm of labor onset were closer in summer (10 hours) than in winter (13 hours). The acrophase of the diurnal rhythm of delivery progressively shifted to earlier hours from winter (5 pm) to summer (1 pm). CONCLUSIONS: These data show the attenuation of the diurnal rhythms of labor and delivery in multiparous women and their modulation by seasons. (Am J Obstet Gynecol 1998;178:140-5.)