Elective Cesarean Delivery Group Research Articles

Maternal and neonatal morbidities associated with cesarean delivery without labor compared with induction of labor around term.

We aimed to compare the maternal and neonatal morbidities associated with elective cesarean delivery (CD) without labor and those associated with induction of labor (IOL) at ≥38 weeks of gestation. This retrospective observational study from 2013 to 2020 included singleton pregnancies in nulliparous women at ≥38 weeks of gestation. Maternal and neonatal morbidities associated with elective CD without labor were compared with those associated with IOL. Altogether, 395 women were recruited. Among these, 326 underwent delivery through IOL, while 69 underwent elective CD. The elective CD group exhibited higher maternal age, lower gestational age at birth, and lower neonatal birth weight than the IOL group (P<0.001). Moreover, the elective CD group exhibited longer hospital stay, higher rate of uterotonic agent usage, and lower rate of antibiotic usage after discharge. However, no differences were observed in postpartum bleeding, readmission, or number of outpatient visits (>3) after discharge between the groups. Perinatal morbidities were similar between the groups except the incidence of meconium-stained amniotic fluid. Elective CD exhibited similar rates of complications related to composite maternal morbidity when compared with IOL, but had a lower risk of complications related to composite neonatal morbidity (relative risk, 0.45; 95% confidence interval, 0.24-0.85). Elective CD and IOL had similar rates of composite maternal morbidity but the former exhibited some benefits against obstetric wound infection. The elective CD group exhibited a decreased risk of composite neonatal morbidity despite lower gestational age at birth and higher maternal age.

Short-term effects of delivery methods on postpartum pelvic floor function in primiparas: a retrospective study.

The present study sought to investigate the short-term effects of different delivery methods on postpartum pelvic floor function in Chinese primiparas. Primiparous women who delivered a full-term, cephalic, singleton infant at our hospital between January 1, 2018 and August 15, 2019 were recruited into this study. All women underwent pelvic floor function screening at 6-8 weeks postpartum. Tests included postpartum Pelvic Organ Prolapse Quantification (POP-Q) score, incidence of urinary incontinence, pelvic floor muscle (PFM) strength, and Pelvic Floor Distress Inventory Questionnaire-Short Form 20 (PFDI-20) score. A total of 284 postpartum women were recruited into the study. Of the participants, 147 had undergone vaginal delivery, 37 had undergone intrapartum cesarean delivery (ICD), and 100 had undergone elective cesarean delivery (ECD). Points Aa, Ba, Ap, and Bp showed a greater degree of prolapse in the vaginal delivery group than in the ECD group (P≤0.05). UI was less prevalent in ECD group relative to the vaginal delivery group (P≤0.05). Tonic PFM contraction was weaker in the vaginal delivery group than in the ECD and ICD groups (P≤0.05). Significant differences were also observed between the vaginal delivery group and the ECD group with respect to PFDI-20 scores (P≤0.05). Compared with vaginal delivery, ECD was strongly linked to a lower risk of pelvic organ prolapse (POP) and UI, stronger tonic PFM strength, and lower PFDI-20 scores. ECD confers relatively better protection against pelvic floor dysfunction (PFD) than does ICD.

Influence of Various Modes of Delivery on Mother-infant Bonding: A Prospective Observational Study

Background: Mother-infant bonding has tremendous implications for the child's future development. The difficulties that some mothers have in establishing an emotional bond with their newborns often referred to as impaired bonding or bonding failure are an essential focus in the postpartum period. Therefore, it is important to identify predictive factors for bonding failure and to intervene at an early stage for the better mental health care of mothers as well as infant. Objective: To determine the effect of various modes of delivery on the mother-infant bonding. Methods: Prospective observational study performed on low-risk singleton pregnancy who delivered at term. Mother-to-Infant Bonding Scale (MIBS; Taylor et al., 2005), a validated self-report test was used to measure mother's feelings towards her baby within three days of delivery and at the end of six weeks postpartum period. Total score ranges from 0 to 24. A total MIBS score of ≥ 2 is established as cut-off indicating “poor bonding”. MIBS score of 0 and 1 is considered as “good bonding”. The mean bonding score among the 3 groups was compared. Results: Elective cesarean delivery group had 112 participants, 115 were Emergency cesarean group and 107 were vaginal delivery group. Immediately after the delivery (MIBS 1), the proportion of women with poor bonding among Emergency cesarean group was 34.8% when compared to proportion of women with poor bonding among Elective cesarean (11.6%) and Vaginal delivery (13%). This was statistically significant (p-value 0.01). When we followed up these mothers at 6 weeks post-partum checkup, the MIBS scoring (MIBS-2) consistently improved among the three groups. However, proportion of women with poor bonding still remained high at 16.5% among the Emergency cesarean group. Conclusion: Mode of delivery has a significant impact on MIBS. In this study, unplanned cesarean delivery was associated with a high incidence of poor mother to infant bonding. Poor bonding was commoner in this group even at 6 weeks post-partum, compared to those undergoing a successful vaginal delivery and a planned elective cesarean delivery.

957: Women with one cesarean: Views on VBAC, ERCD and future RCT regarding mode of delivery

After one cesarean delivery (CD) the options for future delivery include vaginal birth after cesarean (VBAC) or elective repeat cesarean delivery (ERCD), albeit practice regarding this is controversial and varied worldwide. The aims of this study were: 1. to assess women’s views of their birth experience after their first CD; 2. to compare the findings between women who had an elective CD (ECD) and those who had an emergency CD (EmCD); 3. to evaluate their views on a potential future delivery; and 4. to investigate whether they would be willing to join a clinical trial of VBAC vs ERCD in a future pregnancy. This was a prospective questionnaire survey of woman who had their first CD between January and August 2018 in Galway University Hospital. Eligible participants were contacted by telephone for consent and postal surveys sent out, with review board approval (Ref No. 1804). Survey results were collected, and statistical analysis performed using Chi-Square test. There were 297 eligible women consented to participate, of which 242 (81.5%) did, and 154 (64%) surveys were returned complete. EmCD n=104 (67.5%); ECD N= 50 (32.5%) (Table 1). Satisfaction levels for mode of delivery in both groups are shown (Table 1). Women in the EmCD group were less satisfied with the information received prior to the delivery (P<0.05). Both groups were less satisfied with the postnatal counseling provided, and a similar difference observed (P <0.05). Regarding VBAC in a future pregnancy, 45 (43.3%) and 17 (34%), in the EmCD and ECD groups respectively, expressed a preference for VBAC. A lower rate of women in the EmCD expressed a preference for ERCD than those in the ECD group. Approximately 80% of women in both groups said they would consider randomization in a future pregnancy. Debriefing and counselling women after a CD is an important part of pregnancy care and can have a significant impact on a woman’s overall birth experience, as well as her view on mode of delivery in a subsequent pregnancy. A significant proportion of women in this cohort were considering VBAC for future delivery, and a majority of women stated they would consider randomization in a future RCT. These data indicate that an RCT of VBAC versus ERCD would be viewed positively by women with one previous CD in our population.

The role of elective and emergency cesarean delivery in maternal postpartum anhedonia, anxiety, and depression.

To compare levels of anhedonia, anxiety, and depression in women following elective and emergency cesarean delivery. An observational study was conducted between January 1, 2015, and May 31, 2017, among Italian women who delivered healthy neonates at term at the Policlinico Abano Terme, Italy, by vaginal, elective cesarean delivery (ElCD) or emergency cesarean (EmCD) delivery. The women completed the Edinburgh Postnatal Depression Scale (EPDS), including specific factors within each category, 2days post-delivery to measure postpartum depressive symptomatology. Of the 2234 women enrolled in the study, 1702 (76.2%) had a vaginal delivery and 532 (23.8%) a cesarean delivery, of which 264 (11.8%) were emergency and 268 (12.0%) were elective. Mean EPDS scores (P=0.075) and the number of women with EPDS scores >12 (P=0.718) were comparable among the delivery groups. However, mean anxiety factor scores were significantly higher in the ElCD group (P=0.031), and conversely, mean anhedonia factor scores were significantly higher in the EmCD group (P=0.001). Postpartum depressive symptomatology of women who have had a cesarean delivery was characterized by higher levels of anxiety after ElCD and by higher levels of anhedonia after EmCD.

The factors associated with mode of delivery in fetuses with congenital heart defects

Objective: It is not evident whether the mode of delivery (MOD) should be modified in pregnancies complicated by fetal congenital heart defects (CHDs). The question as to whether MOD of CHD infants has a significant impact on neonatal outcome remains elusive. The aim of this study was to evaluate factors associated with MOD and its impact on immediate neonatal outcomes in a cohort of late preterm or term fetuses with CHDs born in a tertiary center.Methods: This retrospective study comprised of singleton pregnancies with known fetal CHDs who delivered after 34 0/7 weeks of gestation over a 7-year period. Fetuses with chromosomal abnormality or stillbirths were excluded. Obstetric risk factors were classified as maternal medical, maternal surgical or fetal comorbidities. MOD was classified as elective cesarean delivery (CD) or attempted vaginal delivery (VD). The latter was further categorized as successful VD or intrapartum CD. The study population was stratified into four categories based on the severity of cardiac abnormalities diagnosed by fetal echocardiography. Immediate neonatal outcomes included Apgar scores and umbilical cord artery pH.Results: Of a total of 222 patients, 79.8% underwent attempted VD and 20.2% had elective CD. Of the attempted VD group, 80.2% had successful VD and 19.8% had intrapartum CD. The frequencies of maternal medical, maternal surgical and fetal comorbidities were higher in the elective CD group than in the attempted VD group and also were higher in the intrapartum CD group than in the successful VD group (p < .05 for all). Multivariate logistic regression models revealed that maternal surgical or fetal comorbidities increased the chance of elective CD and maternal medical or fetal comorbidities decreased the chance of successful VD. The severity of CHDs was not an independent factor that affected MOD. Elective or intrapartum CD did not improve immediate neonatal outcomes.Conclusion: Our results demonstrated that preexisting obstetric comorbidities were significant variables that affected the MOD in fetuses with CHD. Vaginal delivery should be attempted unless obstetric and medical contraindications accompany index pregnancy.

Elective cesarean delivery at term and the long-term risk for respiratory morbidity of the offspring.

Maternal morbidity is associated with cesarean deliveries. However, new evidence suggests that short- and long-term neonatal morbidity is also associated. This includes respiratory morbidity with conflicting results. To determine whether mode of delivery has an impact on the long-term risk for respiratory morbidity in the offspring, a population-based cohort analysis was conducted including all singleton term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via elective cesarean delivery (CD) and those delivered vaginally. Multiple gestations and fetuses with congenital malformations were excluded from the analysis as were all cases of urgent CDs. Pediatric hospitalizations involving respiratory morbidity of offspring up to the age of 18years were evaluated. A Kaplan-Meier survival curve was used to compare cumulative respiratory morbidity incidence and a Cox regression model to control for confounders. During the study period, 132,054 term deliveries met the inclusion criteria; 8.9% were via elective CDs (n= 11,746) and 91.1% (n= 120,308) were vaginal deliveries. Hospitalizations of the offspring involving respiratory morbidity were significantly more common in offspring delivered by CDs (5.2 vs. 4.3% in vaginal deliveries, p< 0.001). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory morbidity in the elective CD group (log rank p <0.001). In a Cox proportional hazards model, while controlling for maternal age, gestational age, and birthweight, CD exhibited a significant and independent association with long-term respiratory morbidity of the offspring (adjusted hazard ratio = 1.22 (CI, 1.12-1.33), p< 0.001).Conclusion: Elective cesarean delivery at term is a significant risk factor for long-term pediatric respiratory morbidity of the offspring. What is Known: • Cesarean delivery is a major surgery with known possible complications. • Cesarean delivery has possible immediate complications for the newborn including respiratory complications. What is New: • Our study shows more long term respiratory morbidity in the CD group including asthma and obstructive sleep apnea. • Different possible explanations have been proposed including exposure to maternal flora during vaginal delivery and the stress hormones secreted during contractions and delivery.

546: Singletons delivered by elective cesarean delivery at term have an increased risk of long-term endocrine morbidity

To determine whether elective cesarean delivery (CD) has an impact on the risk of long-term endocrine and metabolic morbidity of the offspring. A population-based cohort analysis was performed including all singleton term deliveries occurring between 1991-2014 at a single tertiary medical center. A comparison was performed between children delivered via a non-emergent (“elective”) CD and those delivered vaginally. Maternal thyroid disease, diabetes and hypertension, preterm deliveries, multiple gestation, and fetuses with congenital malformations were excluded. All cases of urgent CD were excluded from the analysis. Hospitalizations of the offspring up to the age of 18 years involving endocrine morbidity were evaluated. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence. A Cox regression model was used to control for confounders. During the study period 131 880 term deliveries met the inclusion criteria; 8.9% were elective non-urgent CDs (n=11 768) and 91.0% (n=120 112) were vaginal deliveries. Selected pediatric endocrine and metabolic morbidities of the offspring according to mode of delivery are presented in the Table. Crude hospitalization rate due to hypoglycemia was significantly higher in the elective CD group (p=0.023). Total endocrine and metabolic hospitalization incidence per follow up years was higher as well (HR= 1.51, 95%CI 1.13-2.03). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of endocrine and metabolic morbidity in the offspring born via CD (Figure, log rank p=0.010). In the Cox proportional hazards model, while controlling for confounders such as maternal age and birth weight, CD was noted as an independent risk factor for long-term pediatric endocrine and metabolic morbidity of the offspring (adjusted HR=1.37, 95% CI 1. 01-1.86, p=0.041). Singletons delivered by an elective CD at term are at an increased risk of long-term pediatric endocrine and metabolic morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Association of Intended Route of Delivery and Maternal Morbidity in Twin Pregnancy.

To evaluate maternal morbidity in twin pregnancies according to intended mode of delivery. We assembled a 7-year retrospective cohort (2007-2014) of women delivering viable, vertex-presenting twins at or beyond 32 weeks of gestation without contraindication to labor or uterine scar. We classified women as undergoing a trial of labor to attempt vaginal birth or choosing an elective cesarean delivery. Our primary outcome was a measure of composite maternal morbidity including death, postpartum hemorrhage, infection, major procedure, readmission for infection or reoperation, need for dilation and evacuation for hemorrhage or infection, venous thromboembolism, small bowel obstruction or ileus, or intensive care unit admission. Postpartum hemorrhage was defined as estimated blood loss greater than or equal to 1,500 mL or need for transfusion. The rate of lacerations in each group was also determined. Using logistic regression to control for confounders, we examined the odds of maternal morbidity according to intended mode of delivery. Of 2,272 twin pregnancies at or beyond 32 weeks of gestation, 1,140 (50%) met inclusion criteria with 571 (50%) electing cesarean delivery and 569 (50%) undergoing a trial of labor to attempt vaginal birth. Vaginal delivery of both twins was achieved in 74% (n=418) of women choosing a trial of labor. The rate of maternal morbidity was 12.3% in the trial of labor group compared with 9.1% in the elective cesarean delivery group (P=.08, adjusted odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.4). Postpartum hemorrhage was more common among women who attempted vaginal delivery (n=52) compared with those electing cesarean delivery (n=28) with rates of 9.1% compared with 4.9%, respectively (P<.01, adjusted OR 2.2, 95% CI 1.4-3.6) and was responsible for the difference in the composite morbidity rate between groups. When adjustment is made for potential confounders, women undergoing a trial of labor with twins experience a higher odds of maternal morbidity than those electing cesarean delivery, primarily as a result of hemorrhage. In pragmatic terms, the tradeoff for a 74% chance of vaginal delivery is a 4% absolute increase in the rate of serious postpartum hemorrhage.

Lactate in cord blood and its relation to fetal gluconeogenesis in at term deliveries

BackgroundIn the human fetus, an increased lactate and glucose level can be anticipated when hypoxia and stress are present and is likely to be a function of both anaerobic metabolism and catecholamine-mediated glycogenolysis/glycolysis. AimWe assessed if measurement of lactate in cord artery blood after vaginal and cesarean delivery may predict glucose concentration. Study designUmbilical artery cord blood lactacidemia, acidemia, and glucose concentration was tested by ‘mini-lab’ Radiometer ABL90 FLEX analyzers (Radiometer®, Copenhagen, Denmark) after vaginal delivery (VD), spontaneous (n=493) and by vacuum extractor (n=41) or by cesarean delivery (CD), elective (n=120) and emergency (n=68) in at term, vigorous neonates delivered from March to December 2012 at the 2nd level maternity ward of Policlinico Abano Terme, Abano Terme (Italy). ResultsCord blood lactacidemia and glucose levels were significantly higher in VD by vacuum extractor than in all other groups (5.32±1.96mmol/L, p=0.050 and 103.6±30.5mg/dL, p<0.001, respectively) and significantly lower in elective CD group (1.77±0.99mmol/L, p<0.001 and 69.8±13.0mg/dL, p<0.001). The cord blood lactate concentration was significantly and positively correlated with glucose levels (r=0.434, p<0.001), but significantly and negatively correlated with pH (r=−0,662, p<0.001), NaHCO3− (r=−0,802, p<0.001), and base excess (BE) (r=−0,698, p<0.001). However, in multivariate linear regression analysis, only BE, PaCO2 and cord blood lactate were significant predictive variables (R2=0.410; p<0.001) of glucose levels at birth. ConclusionCord blood artery lactate and glucose concentration are significantly and positively correlated at birth in healthy, at term vaginally and cesarean delivered neonates, but BE is the best indicator of activated fetal gluconeogenesis.

Sexual function after childbirth by the mode of delivery: a prospective study

The objective of the present study was to evaluate sexual behavior longitudinally in the postpartum period by mode of delivery. In this prospective study, five groups were defined: women who delivered vaginally without an episiotomy (n=16), women who delivered vaginally with an episiotomy (n=14), women who delivered by instrumental delivery (n=16), women who delivered by an emergent cesarean section (n=19), and women who delivered by an elective cesarean section (n=17). Sexual behavior was assessed by the female sexual function index (FSFI) questionnaire at 6, 12, and 24weeks postpartum and by the timing of resumption of sexual intercourse. The mean±SD self-reported timing of resumption of sexual activity was 4.5±1.8, 7.9±3.0, 7.3±3.4, 6.1±2.6, and 6.1±2.4weeks in the vaginal delivery without an episiotomy group, in the vaginal delivery with an episiotomy group, in the instrumental delivery group, in the elective cesarean delivery group, and in the emergent cesarean delivery group, respectively (p=0.013). The FSFI total score in the entire study group (n=82) was 14.1±10.8, 24.6±7.6, and 27.7±5.1 at 6, 12, and 24weeks postpartum, respectively (p<0.05). The FSFI total score did not differ significantly across types of mode of delivery at 6, 12, or 24weeks postpartum. The significance by delivery mode difference in the postpartum resumption of sexual activity was not accompanied by difference in sexual function scores. Specifically, elective cesarean delivery was not associated with a protective effect on sexual function after childbirth.

Geburtsleitung bei dichorialen Zwillingen am Termin bei vorangehendem Zwilling in Schädellage – eine monozentrische retrospektive Kohortenstudie

To assess neonatal outcome and delivery mode in dichorionic twin delivery at term with a cephalic-presenting first twin. A retrospective cohort study of 308 twin deliveries after 37 completed weeks of gestation with a cephalic-presenting first twin undertaken in one perinatal center with active management of second twin delivery. The neonatal outcome was measured by the Apgar score, the umbilical artery pH and the transfer into the neonatal unit. In the whole group, 57% were vaginally delivered and 43% needed a Cesarean delivery. The planned vaginal delivery group contained 71% while the planned elective Cesarean delivery group contained 29%. In the planned vaginal delivery group 80% were delivered vaginally, in 15% an emergency Cesarean was necessary, 5% had a vaginal delivery of the first twin followed by Cesarean delivery of the second twin. The neonatal outcome of the second twin shows a higher risk. There are significant differences in the rates of the second twin having lower rates of the umbilical artery pH >7.20 in the group of planned vaginal delivery. The higher risks are compensated in the group of planned elective Cesarean delivery. Planned vaginal delivery of dichorionic twins at term and active second-stage management is associated with lower rate of normal neonatal outcome. These risks should be considered in prenatal informed consent discussions with the pregnant woman.

Mode of delivery and neonatal survival of infants with gastroschisis in Australia and New Zealand

Objective The aim of the study was to examine the short-term outcome of infants with gastroschisis by route of delivery, comparing vaginal delivery vs elective and emergency cesarean delivery (CD). Methods Six hundred thirty-one infants with gastroschisis ( International Classification of Diseases, 10th Revision: Q79.3) were admitted to the Australian and New Zealand Neonatal Network during 1997 to 2005. Multivariate Cox proportional hazards regression analysis was performed to adjust for case-mix and significant baseline characteristics. Results During the study period, 631 infants with gastroschisis were admitted to the collaborating centers. Of these, 343 (54.4%) infants were delivered vaginally, whereas 288 (45.6%) were delivered by cesarean birth. Of the latter, 148 (23.4%) were elective and 140 (22.2%) were emergency. There was an increasing trend of CD from 41.1% in 1997 to 69.0% in 2005. Forty-seven (7.4%) infants died; 30 (8.7%) in the vaginal, 9 (6.4%) in the emergency, and 8 (5.4%) in the elective CD group. There was no difference in rate of proven infection, duration of ventilation, or length of neonatal intensive care unit stay between the 3 groups. After controlling for prematurity, low birth weight, and outborn birth, the risk for neonatal demise was similar in both the vaginal and CD infants (adjusted hazard ratio, 1.486; 95% confidence interval, 0.814-2.713; P = .197). Stratifying the CD (emergency vs elective) gave similar results. Conclusion Infants with gastroschisis appear to be safely delivered vaginally.

Oxidative stress as determined by glutathione (GSH) concentrations in venous cord blood in elective cesarean delivery versus uncomplicated vaginal delivery

To determine whether neonates are subject to oxidative stress by the labor process and the mode of delivery by measuring glutathione (GSH) concentrations in umbilical cord venous blood. Forty-eight women with singleton term pregnancies were prospectively recruited and classified as follows: 26 women had a spontaneous uncomplicated vaginal delivery (VD), and 22 women had an elective cesarean delivery (CD). GSH concentration in umbilical venous blood samples was determined by a spectroscopic method. Umbilical cord venous blood GSH levels were significantly lower in the elective CD group than in the VD group (2.2 and 2.7 mM, respectively, P = 0.0003). There was a significantly negative correlation between cord blood pO(2) and GSH levels; however, the negative correlation was significantly higher in the elective CD group (P < 0.05). Neonates delivered by CD were exposed to a higher oxidative stress as determined by GSH levels compared to those who had an uncomplicated VD.

Indications for cesarean deliveries in Norway

Objective: The purpose of this study was to investigate the indications for cesarean deliveries in Norway, related to type of operation, parity, and gestational age. Study Design: This was a prospective survey that used information provided by clinicians at 24 maternity units. Two thousand seven hundred seventy-eight cesarean deliveries were included, which represents 69.7% of all cesarean deliveries in Norway during the study period. Results: The cesarean delivery rate varied by maternal and gestational age, parity, and hospital of delivery. Seven indications accounted for 77.7% of the operations: fetal stress (21.9%), failure to progress (20.7%), previous cesarean delivery (8.9%), breech presentation ≥34 weeks of gestation (8.4%), maternal request (7.6%), preeclampsia (6.2%) and failed induction (4.0%). Of the total deliveries, 64.3% were emergency operations. Conclusion: Accurate information about indications for cesarean deliveries in Norway has been obtained. Two thirds of all deliveries were emergency operations; the most important indications were fetal stress and failure to progress. In the elective cesarean delivery group, the two most important indications were previous cesarean delivery and maternal request. (Am J Obstet Gynecol 2003;188:864-70.)