Frequency Of Cesarean Delivery Research Articles

The Importance of Fetal Station in the First Stage of Labor.

This study aimed to examine the relationship of fetal station in the first stage of labor to labor curves and cesarean delivery rates among women presenting in spontaneous labor. Labor curves for patients with nonanomalous singletons who presented in spontaneous labor to our hospital's Obstetric Triage Unit with intact membranes from January 1, 2012, to August 31, 2016 were reviewed. Cervical exams and time of exam were obtained for each patient from presentation to triage until delivery. Station for each presentation and cervical dilation was estimated using a random effects model and the slope of cervical station change was calculated to estimate the change in dilation by hour. Perinatal outcomes, including cesarean delivery rates, were examined according to fetal station at initial presentation. Factors known to affect labor curves-epidural analgesia, infant birthweight, maternal habitus, and parity-were also examined. There were 8,123 patients presented in spontaneous labor with intact membranes. For patients presenting at 6-cm dilation, the rate of change of labor was significantly different when identified to have a station greater than 0 (+1 and more caudad) when compared with those with -1 and more cephalad station (both p < 0.001). This relationship persisted when analyzed according to epidural analgesia, birthweight, maternal habitus, and parity. The frequency of cesarean delivery was significantly higher for women presenting in spontaneous labor with negative fetal station (p < 0.05). When stratified across all dilation (3-9 cm), this trend remained significant (p < 0.001). In the first stage of labor, advanced fetal station was significantly associated with differing rates of labor progression, and positive fetal station was significantly less likely to result in cesarean delivery. Physical examination, including station, remains a critical element in labor management. · Fetal station is important in labor management.. · Fetal station at initial exam is related to time to delivery.. · Positive fetal station at initial exam is less likely to result in cesarean delivery..

Comparison of Umbilical Cord Arterial Blood Gas and Neonatal Outcomes in Women with and without Meconium-Stained Amniotic Fluid During Labor

Introduction: Meconium-stained amniotic fluid (MSAF) may increase maternal and neonatal complications. The favorable mode of delivery is controversial in women with MSAF. This study aimed to compare umbilical cord arterial blood gas (ABG) and neonatal outcomes in deliveries complicated by meconium and clear amniotic fluid during the active phase of labor. Materials and Methods: This observational study was performed on 144 term pregnant women (72 with MSAF and 72 with clear amniotic fluid) during the active phase of labor with ruptured membranes admitted to Al-Zahra and Taleghani hospitals in Tabriz, Iran, from June 2019 to June 2020. A checklist was used to record the ABG and neonatal outcomes. Results: The frequency of cesarean delivery in the MSAF group (25%) was significantly higher than in the women with clear amniotic fluid (20%) (P = 0.006). There was no statistically significant difference between the groups regarding pH, base excess, PCO2, 1- and 5- minute Apgar scores, and neonatal intensive care unit (NICU) admission of the newborn due to MSAF (P&gt; 0.05). There was no incidence of hypoxic-ischemic encephalopathy, sepsis, and seizure. Conclusion: Given the non-significant difference between two groups of women with and without MSAF during labor in terms of neonatal outcomes and umbilical cord ABG, it seems that MSAF alone is not an indication for cesarean delivery. Thus, vaginal delivery is recommended in pregnant women with MSAF.

Characteristics and outcomes of socioeconomically disadvantaged pregnant individuals with adult congenital heart disease presenting to a Cardio-Obstetrics Program

Outcomes of individuals with adult congenital heart disease (ACHD) who are socioeconomically disadvantaged and cared for in a cardio-obstetric programs are lacking. To describe clinical characteristics, maternal pregnancy outcomes and contraceptive uptake of individuals with ACHD in an urban cardio-obstetric program. Retrospective data were collected for individuals with ACHD seen in the Maternal Fetal Medicine-Cardiology Joint Program at Montefiore Health System between 2015-2021 and compared by modified World Health Organization (mWHO) class I,II vs. mWHO ≥II/III. Over 90% of individuals with ACHD were pregnant at the time of referral. mWHO I,II (n=77, 62.4% Black or Hispanic/Latina) had a total of 94 pregnancies and mWHO ≥II/III (n=49, 49.0% Black or Hispanic/Latina), a total of 56 pregnancies. Over 25% of individuals in each group had a body mass index ≥30 (p=0.78), as well as very low summary socioeconomic scores. mWHO ≥II/III were more likely to be anticoagulated in the first trimester than mWHO I, II (10.7% vs. 0.0%, p=0.002) and throughout pregnancy (14.3% vs 3.2% p=0.02). mWHO ≥II/III were more likely to require arterial monitoring during delivery than mWHO I, II (14.3% vs. 0.0%, p=0.001) or delivery under general anesthesia (8.9% vs. 1.1%, p=0.03), but had a comparable frequency of Cesarean delivery (35.8% vs. 41.3%, p=0.68). There were no in-hospital maternal deaths. There was no difference in the type of contraception recommended by mWHO class, however, mWHO ≥II/III were more likely to receive long acting types or permanent sterilization (35.6% vs 54.6%, p=0.045). In a socioeconomically disadvantaged cohort with ACHD from a historically marginalized community, those with mWHO ≥II/III had more complex antepartum and intrapartum needs, but similar maternal and obstetric outcomes as mWHO I,II. The multidisciplinary approach offered by a cardio-obstetrics program may contribute to successful outcomes in this high-risk cohort and these data are hypothesis generating.

The Association of the Inflammatory Index of the Maternal Diet with the Type of Delivery, Maternal Nutritional Status, and the Lipid Profile of Human Milk.

Objective: To evaluate the association of the dietary inflammatory index adjusted for energy (E-DII®) with the evolution of maternal body mass index and human milk lipid (HM) profile in the first 6 months postpartum. Methods: This is a cohort study with 260 Brazilian women (19-43 years old) in the postpartum period. Sociodemographic, gestational, and anthropometric data of the mother were obtained in the immediate postpartum period and in the six monthly meetings. A food frequency questionnaire was applied at baseline and used to calculate the E-DII score. Mature HM was collected, analyzed by gas chromatography coupled with mass spectrometry and the Rose Gottlib method. Generalized estimation equation models were built. Results: Women with >E-DII showed lower adherence to physical activity during pregnancy (p = 0.027), higher frequency of cesarean delivery (p = 0.024), and higher body mass index over time (p < 0.001). At the end of the 6th month, 35 women remained in the study. As for HM, 151 analyses were performed, detecting in the 3rd collection greater fat (%) among those with >E-DII (4.27 ± 1.98 vs. 3.75 ± 2.48; p = 0.003). Conclusion: Diets with >E-DII can impact the type of delivery, change the evolution of maternal nutritional status, and the stability of the lipid profile of HM.

Evolution of cesarean sections in Colombia and its association with the legal standing of the institutions where deliveries take place

To describe how the frequency of cesarean section has evolved in Colombia since 1998, both in overall terms as well as discriminated according to the legal standing of the healthcare providers (IPSs) where delivery takes place, and to estimate the size of the association between the legal standing of the institutions and the performance of cesarean sections between 2015 and 2017. A cross-sectional cohort study that describes the frequency of cesarean deliveries between 1998 and 2020, plus an analytical component to estimate the association between the legal nature and the route of delivery between 2015 and 2017, based on the birth records of the Colombian National Statistics Administrative Department (DANE). The prevalence ratio was used as an estimator of this association. In 1998, the proportion of cesarean deliveries was 25.7 %; it increased to 46.4 % by 2015 and then dropped to 44.6 % by 2020. After 1998, the proportion of cesarean sections in public hospitals increased from 26.2 % to 42.9 % by 2014, while in private providers it increased from 45.0 % to 57.7 % by 2013. The prevalence ratio of cesarean sections in private versus public institutions was 1.57 (95 % CI: 1.56-1.57). After a long period of sustained growth, there is now a reduction in the proportion of cesarean sections in the country. In public health care institutions, these procedures increased in greater proportion during most of the study period, while in private healthcare providers they are carried out at a higher frequency in all subgroups of women. It will be necessary to evaluate in the future, using more robust methodologies, whether the decrease in the frequency of cesarean section is a real or secular trend.

Clinical Equivalence of Polyglycolic Acid Suture and Polyglactin 910 Suture for Subcutaneous Tissue Closure After Cesarean Delivery: A Single-Blind Randomized Study.

The global rise in frequency of cesarean delivery raises the concern to minimize the post-operative complications, in order to improve the maternal and neonatal health. Closure of subcutaneous tissue following cesarean section closes dead space, hence reduces the wound complications. No previous study has compared the clinical equivalence of polyglycolic acid suture with polyglactin 910 suture for subcutaneous tissue closure following cesarean section. Therefore, this study compared the incidence of subcutaneous abdominal wound disruptions within the first 6 weeks of subcutaneous tissue closure with either of the sutures. A single-blind, prospective, randomized study was conducted in two centres between February and November, 2021. Primiparous or multiparous women (18-40 years) with a singleton pregnancy requiring cesarean section were randomized to polyglycolic acid suture (Truglyde®) (n=54) and polyglactin 910 suture (Vicryl®) (n=54) group. The primary endpoint, incidence of subcutaneous abdominal wound disruptions within 6 weeks of cesarean delivery was evaluated. In addition, the secondary endpoints, incidence of post-operative subcutaneous abdominal wound disruptions for the study period, skin disruption, surgical site infection (SSI), seroma, hematoma, intraoperative handling, operative time, hospital stay, suture removal, microbial deposits on sutures, pain, time taken to resume normal activities, and adverse events were recorded. Non-significant difference in the incidence of subcutaneous abdominal wound disruptions, skin disruption, SSI, seroma, hematoma, intraoperative handling characteristics, operative time, pain, duration of hospital stay, suture removal, microbial deposits, time taken to return to day-to-day activities, and adverse events were observed between the two treatment groups. Following cesarean section, subcutaneous tissue closure using polyglycolic acid suture or polyglactin 910 suture was not associated with incidence of subcutaneous abdominal wound disruptions. Additionally, non-significant differences regarding secondary endpoints between the groups suggested the clinical equivalence of the sutures. CTRI/2020/12/029737; Registration date: 11/12/2020.

THE PREVALENCE OF CESAREAN AND THE EFFECTING FACTORS DURING THE COVID-19 PANDEMIC

In terms of the clinical picture during pregnancy and perinatal outcomes, there is an insufficient amount of data in the literature regarding the effects of COVID-19 infection, which is spreading rapidly worldwide. In this study, we aimed to determine the frequency of cesarean deliveries in during the pandemic, as well as to show the effect of COVID-19 positivity and certain other variables on cesarean section delivery. The sample of this cross-sectional study consists of 956 women who gave birth in a state hospital. In this study, the prevalence of cesarean section was found to be 33.2%. Also, compared to the general population the rate of cesarean delivery was found to be 2.1 times higher in women whose incomes were less than their expenses, 2.2 times higher in those with health insurance, 13.6 times higher in those who were COVID-19 positive, and 1.6 times higher in those who did not receive regular prenatal care. This study showed that COVID-19 infection and negativities related to the social determinants of well-being significantly increased the prevalence of cesarean section during the pandemic period. Governments should take more serious steps toward reducing healthcare inequalities, especially in terms of maternal and infant health.

A Retrospective Analysis of the Effects of Second - Stage Labor Arrest on Postpartum Women’s Stress Urinary Incontinence

Background: Stress Urinary Incontinence (SUI), has been always linked to normal vaginal delivery (NVD) or operative vaginal delivery (OVD). Many women get concerned about this issue before giving birth and tend to deliver by cesarean delivery. However, the increased frequency of cesarean deliveries poses health concerns especially in the absence of solid risk factors. Methods: This is a retrospective observational cohort study conducted at Rafic Hariri University Hospital (RHUH) between 2011 and 2013. Forty primiparous women undergoing cesarean delivery were involved. They were evenly divided into 2 groups. The first involved those who underwent elective cesarean delivery and those with failure to progress. The second group involved women who underwent cesarean delivery for arrested second stage of labor. Statistical analysis was performed using the statistical program SPSS version 20. Results: The prevalence of SUI in group 1 was 25% compared to 35% in group 2. Cesarean delivery was not found to have any protective role against SUI in group 1 patients and the frequency of SUI in selective cesarean patients was nearly the same as those performing cesarean for failure to progress. However, patients undergoing cesarean for arrested second stage of labor &gt; 2hours had a significant higher frequency of SUI as compared to patients undergoing cesarean delivery for arrested second stage of labor &lt; 2hours. Conclusion: Cesarean delivery cannot be proposed to women who fear to suffer from SUI post-partum. However, it should be done if the cervix fully dilated for &gt; 2hours in order to decrease the risk of SUI

Indications and rate of cesarean section after induction of labor.

Introduction: Frequency of cesarean delivery has exceeded 10 to 15 percent whichis optional by World Health Organization. Not necessarily required cesarean deliveries might be related to augmented danger of neonatal as well as maternal mortality.Objectives: To assess indications and rate of cesarean section after induction oflabor at Liaquat University Hospital, Jamshoro.Methodology: This descriptive study was carried at Liaquat University of Medicaland Health Sciences (LUMHS), Jamshoro at Department of Obstetrics and Gynecology. All pregnant ladies aged between 18 to 35 years who were undergoing inductioneither at term or after term were included.Results: Labor induced by prostaglandin in 41.7%, by Foley’s in 23.5% while in34.8% women, both aforementioned procedures used for augmenting labor. Subsequent to induction of labor, cesarean section was needed in 28.3%. Bishop scorewas from 0 to 5 in 43% &amp; ≥ 6 in 57%. Cesarean section performed in 29.5% laborinduced women. In 40% of labor induced women, the ground behind performingcesarean section was fetal distress while in 34% was extended labor.Conclusion: C-section needed in 28.3% labor induced ladies. Fetal distress and prolong labor are most common indications for C-section.&#x0D; Keywords: Cesarean section, Indications, Induction, Labor.

Comparison of Cesarean Deliveries in a Multicenter U.S. Cohort Using the 10-Group Classification System.

We sought to (1) use the Robson 10-Group Classification System (TGCS), which classifies deliveries into 10 mutually exclusive groups, to characterize the groups that are primary contributors to cesarean delivery frequencies, (2) describe inter-hospital variations in cesarean delivery frequencies, and (3) evaluate the contribution of patient characteristics by TGCS group to hospital variation in cesarean delivery frequencies. This was a secondary analysis of an observational cohort of 115,502 deliveries from 25 hospitals between 2008 and 2011. The TGCS was applied to the cohort and each hospital. We identified and compared the TGCS groups with the greatest relative contributions to cohort and hospital cesarean delivery frequencies. We assessed variation in hospital cesarean deliveries attributable to patient characteristics within TGCS groups using hierarchical logistic regression. A total of 115,211 patients were classifiable in the TGCS (99.7%). The cohort cesarean delivery frequency was 31.4% (hospital range: 19.1-39.3%). Term singletons in vertex presentation with a prior cesarean delivery (group 5) were the greatest relative contributor to cohort (34.8%) and hospital cesarean delivery frequencies (median: 33.6%; range: 23.8-45.5%). Nulliparous term singletons in vertex (NTSV) presentation (groups 1 [spontaneous labor] and 2 [induced or absent labor]: 28.9%), term singletons in vertex presentation with a prior cesarean delivery (group 5: 34.8%), and preterm singletons in vertex presentation (group 10: 9.8%) contributed to 73.2% of the relative cesarean delivery frequency for the cohort and were correlated with hospital cesarean delivery frequencies (Spearman's rho = 0.96). Differences in patient characteristics accounted for 34.1% of hospital-level cesarean delivery variation in group 2. The TGCS highlights the contribution of NTSV presentation to cesarean delivery frequencies and the impact of patient characteristics on hospital-level variation in cesarean deliveries among nulliparous patients with induced or absent labor. · We report on the cesarean delivery frequencies in a multicenter U.S. . · NTSV gestations (groups 1 and 2) are a primary driver of cesarean deliveries.. · Patient characteristics contributed most to hospital variation in cesarean deliveries in group 2..

Maternal Outcome of Primigravida Patient with Term Pregnancy with Engaged Versus Unengaged Foetal Head at Onset of Labour

Objective: To assess the maternal outcome of primigravida patient with term pregnancy with engaged versus unengaged foetal head at onset of labour Design of the Study: It was a cohort study. Study Settings: The study was conducted at Department of Obstetrics &amp; Gynecology Rashid Latif Medical College, Lahore from January 2021 to June 2021. Material and Methods: This study involved 160 primigravida at term (as per dating scan) aged between 18-35 years who were divided into cases (women with unengaged fetal head) and controls (those with engaged fetal head). Outcome variable were frequency of cesarean delivery, low birth weight, poor APGAR score at 1 and 5 minutes and NICU admission which were noted and compared between the groups. Results of the Study: The mean age of the patients was 23.9±3.8 years while the mean gestational age was 39.0±1.3 weeks. The frequency of poor APGAR score at 1 minute (25.0% vs. 5.0%; p-value&lt;0.001; 95%CI RR=5.00) and cesarean delivery (38.8% vs. 16.3%; p-value=0.001; 95%CI RR=2.39) was significantly higher in women with unengaged fetal head at term. However, there was no statistically significant difference between the groups in terms of poor APGAR score at 5 minutes (5.0% vs. 2.5%; p-value=0.405; 95%CI RR=2.00), NICU admission (10.0% vs. 8.8%; p-value=0.786; 95%CI RR=1.14) and low birth weight (7.5% vs. 3.8%; p-value=0.303; 95%CI RR=2.00). Conclusion: In the present study, unengaged fetal head at term was associated with poor APGAR score at birth and increased risk of cesarean delivery which advocates that women with unengaged fetal head at term should be considered as high risk so that anticipated management may improve the fetomaternal outcome Keywords: Primigravida, Unengaged Fetal Head, Fetomaternal Outcome

The Association of Twin Chorionicity with Maternal Outcomes.

Our objective was to investigate the association between maternal outcomes and twin chorionicity in a large, contemporary obstetric population. Retrospective cohort study was conducted at a single, large tertiary care center. Prenatal and inpatient records for all individuals with twin gestations were reviewed from 2000 to 2016. Patients with monoamniotic twins, higher-order multiples reduced to twins, multiple sets of twins in the study period, or undetermined chorionicity were excluded. Patients with monochorionic twins were compared with those with dichorionic twins. The co-primary outcomes were gestational diabetes mellitus and hypertensive disorders of pregnancy. Secondary outcomes included cesarean delivery, preterm delivery, postpartum hemorrhage, and other maternal outcomes. Bivariate and multivariate analyses were performed to assess associations of chorionicity with maternal outcomes. Of the 2,979 patients eligible for inclusion, 2,627 (88.2%) had dichorionic twin gestations and 352 (11.8%) had monochorionic twin gestations. Patients with monochorionic twins were less likely to self-identify as non-Hispanic White and to have conceived via assisted reproductive technology but were more likely to be publicly insured, multiparous and have prenatal care with a maternal-fetal medicine provider. Neither gestational diabetes mellitus (6.8% monochorionic vs. 6.2% dichorionic, p = 0.74; adjusted odds ratio [OR] 1.06, 95% confidence interval (CI) 0.60-1.86) nor hypertensive disorders of pregnancy (21.9% monochorionic vs. 26.3% dichorionic, p = 0.09; adjusted OR 0.99, 95% CI, 0.71-1.38) differed by chorionicity. Of the secondary maternal outcomes, patients with monochorionic twins experienced a lower frequency of cesarean delivery (46.0 vs. 61.8%, p < 0.001), which persisted after multivariate analyses (adjusted OR 0.60, 95% CI 0.46-0.80). There were no differences in preterm delivery, preterm premature rupture of membranes, hemorrhage, hysterectomy, or intrahepatic cholestasis of pregnancy. The odds of gestational diabetes mellitus and hypertensive disorders of pregnancy do not appear to differ by twin chorionicity. · Hypertensive disorders of pregnancy do not differ by twin chorionicity.. · Gestational diabetes mellitus does not differ by twin chorionicity.. · Maternal outcomes are similar for individuals with monochorionic and dichorionic twin gestations..

Retrospective evaluation of the impact of second-stage labor arrest on stress urine incontinence in postpartum women

Background: Stress Urinary Incontinence (SUI), has been always linked to normal vaginal delivery (NVD) or operative vaginal delivery (OVD). Many women get concerned about this issue before giving birth and tend to deliver by cesarean delivery. However, the increased frequency of cesarean deliveries poses health concerns especially in the absence of solid risk factors.

Cerebroplacental ratio for prediction of adverse intrapartum and neonatal outcomes in a term uncomplicated pregnancy

BackgroundFetal hypoxia is one of the major causes of high perinatal morbidity and mortality rates. Doppler ultrasound tests such as cerebroplacental ratio (CPR) evaluation are commonly used to assess blood flow disturbances in placento-umbilical and feto-cerebral circulations. A low cerebroplacental ratio has been shown to be associated with an increased risk of stillbirth regardless of the gestation or fetal weight. We conducted this study to assess the fetal cerebroplacental ratio in prediction of adverse intrapartum and neonatal outcomes in a term, uncomplicated pregnancy to reduce fetal and neonatal morbidity and mortality.ResultsIt was found that neonates with CPR ≤1.1 had significantly higher frequencies of cesarean delivery (CS) for intrapartum fetal compromise compared to those with CPR >1.1 (p=0.043). Neonates with CPR ≤1.1 had significantly lower Apgar score at 1 min and 5 min than those with CPR >1.1 (p=0.004) and (p=0.003), respectively. Neonates with CPR ≤1.1 had significantly higher rates of NICU admission than those with CPR <1.1 (p=0.004).ConclusionThe cerebroplacental ratio shows the highest sensitivity in the prediction of fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies at term. The cerebroplacental ratio index is useful in clinical practice in antenatal monitoring of these women in order to select those at high risk of intra- and postpartum complications.

Outpatient Cervical Ripening With Misoprostol in Low-Risk Pregnancies.

ObjectiveTo determine if outpatient cervical ripening with daily misoprostol can reduce admission to delivery time in women with low-risk pregnancies at 39 or more weeks of gestation.Study designThis is a retrospective cohort study of a convenience sample of low-risk pregnancies that underwent elective outpatient cervical ripening compared to matched controls for parity (nulliparous vs. parous) and gestational age. Time from admission to delivery, induction agents, presence of tachysystole, mode of delivery, length of hospitalization, neonatal intensive care unit (NICU) admission, and low Apgar scores were compared.ResultsFifty-six patients who underwent outpatient cervical ripening with daily dosing of misoprostol were compared to 56 patients matched for parity and gestational weeks who underwent inpatient cervical ripening/induction of labor with misoprostol. We found the time from admission to delivery in the outpatient cervical ripening cohort was significantly lesser than the inpatient cohort (17.5 ± 11.5 hours outpatient vs. 26.6 ± 15.6 hours inpatient, P=0.001). More patients (N=18, 32%) were able to deliver within 12 hours of admission in the outpatient induction group compared to the inpatient group (N=8, 11%, P=0.010). There were no differences in frequency of cesarean delivery, uterine tachysystole with or without fetal heart rate changes, NICU admission, low Apgar scores, or low umbilical artery pH values between the two groups.ConclusionOutpatient cervical ripening with misoprostol may be a feasible alternative to inpatient cervical ripening in low-risk pregnancies, may help improve patient experience, and reduce the operational burden that elective induction confers upon labor and delivery units.

Ultrasound investigation in pregnant women with diabetes mellitus

Introduction. Ultrasound (US) has been used in obstetrics for more than 30 years and is considered to be reliable, simple, quick in results, painless and cheap method. The aim: to optimize the use of US in childbirth in pregnant women with diabetes and determine the outcome of childbirth, taking into account the condition of the fetus and newborn. Materials and methods. 52 pregnant women, among them 32 with diabetes mellitus (pre-gestational diabetes was in 20 persons and 12 persons had gestational diabetes) have been examined. The average age of pregnant women in the main group was 29.8 ± 5.4 years, in the control group - 25.7 ± 4.3 years. All women in the main and control groups were primiparous. The gestation period in the main group was 39.1 ± 0.5 weeks [38.0; 39.6], in the control group - 39.5 ± 0.7 [38.4; 40.5] weeks. Clinical-laboratory and instrumental examinations were made. Control group consisted of 20 physiologically pregnant women. To determine the condition and size of the fetus and its progress in labor, immediately at the end of the first and during the second staage of labor, transabdominal and transperineal US and Doppler examination were performed with device HD 11 XE Phillips (USA). Results. Pregnant women with diabetes are more likely to have a pathological second stage of labors due to macrosomia and problems with the birth of the fetus, as evidenced by the lack of increased angle of progress and decreased head-perineal distance. The data obtained indicate the prospects of using ultrasound in childbirth as an objective non-invasive method for predicting the likelihood of vaginal birth, which will reduce operative delivery and perinatal pathology. Conclusions. The use of ultrasound in childbirth in women with diabetes and diabetic fetopathy can determine the possibility of complications in the promotion of the fetus, including clinical narrow pelvis, shoulder dystocia, the occurrence of distress, as evidenced by the Apgar scale and CLS. Intraparietal ultrasound helps to guide the plan of childbirth, reduce the frequency of cesarean delivery, perinatal morbidity and mortality, and birth trauma.

Perinatal outcomes in women with cystic fibrosis: Data from the Italian Cystic Fibrosis Registry.

Data from the Italian Cystic Fibrosis Registry concerning pregnancies in the period 2010-2015 were used to investigate the association between the preconception clinical status and perinatal outcomes of women with cystic fibrosis (CF). The assessed clinical variables were genotype, age at the time of conception, body mass index (BMI) and the percentage of predicted forced expiratory volume in the first second (ppFEV1 ). The analyzed outcomes were gestational age, birthweight and the frequency of cesarean deliveries. A generalized linear mixed model (GLIMMIX) was used to evaluate the association between type of delivery and age at the time of becoming pregnant, BMI, ppFEV1 and gestational age. Robust multivariable regression was used to evaluate the relation between gestational age and age at the time of becoming pregnant, BMI and ppFEV1 . Multivariable linear regression was performed to verify association between birthweight and BMI, and ppFEV1 . Complete information concerning mother and child was available for 56 completed pregnancies. Median age at the time of conception was 30.8years (range: 18.7-42.3); median BMI was 21.5kg/m2 (range: 16.5-26.8); and median ppFEV1 was 73.9 (range: 30-128). In all, 31 women (55.36%) had a genotype consisting of two CF-causing variants. Eight were homozygous for the F508del mutation (14.28% of the total). The median duration of pregnancy was 37weeks (range: 31-41) and the frequency of prematurity (<37weeks of gestational age) was 28.30%. Median birthweight was 2910g (range: 1300-3650). The overall frequency of cesarean sections was 63.64%. A low preconception ppFEV1 was associated with prematurity (p=0.014), and birthweight was positively related to ppFEV1 (p=0.04). There was no association between the clinical variables or gestational age and the type of delivery. Maternal preconceptional respiratory function correlates with the duration of pregnancy and the birthweight of newborns. Cesarean deliveries are also frequent among young women with CF with normal respiratory function.

Differences in obstetrical care and outcomes associated with the proportion of the obstetrician’s shift completed

Understanding and improving obstetrical quality and safety is an important goal of professional societies, and many interventions such as checklists, safety bundles, educational interventions, or other culture changes have been implemented to improve the quality of care provided to obstetrical patients. Although many factors contribute to delivery decisions, a reduced workload has addressed how provider issues such as fatigue or behaviors surrounding impending shift changes may influence the delivery mode and outcomes. The objective was to assess whether intrapartum obstetrical interventions and adverse outcomes differ based on the temporal proximity of the delivery to the attending's shift change. This was a secondary analysis from a multicenter obstetrical cohort in which all patients with cephalic, singleton gestations who attempted vaginal birth were eligible for inclusion. The primary exposure used to quantify the relationship between the proximity of the provider to their shift change and a delivery intervention was the ratio of time from the most recent attending shift change to vaginal delivery or decision for cesarean delivery to the total length of the shift. Ratios were used to represent the proportion of time completed in the shift by normalizing for varying shift lengths. A sensitivity analysis restricted to patients who were delivered by physicians working 12-hour shifts was performed. Outcomes chosen included cesarean delivery, episiotomy, third- or fourth-degree perineal laceration, 5-minute Apgar score of <4, and neonatal intensive care unit admission. Chi-squared tests were used to evaluate outcomes based on the proportion of the attending's shift completed. Adjusted and unadjusted logistic models fitting a cubic spline (when indicated) were used to determine whether the frequency of outcomes throughout the shift occurred in a statistically significant, nonlinear pattern RESULTS: Of the 82,851 patients eligible for inclusion, 47,262 (57%) had ratio data available and constituted the analyzable sample. Deliveries were evenly distributed throughout shifts, with 50.6% taking place in the first half of shifts. There were no statistically significant differences in the frequency of cesarean delivery, episiotomy, third- or fourth-degree perineal lacerations, or 5-minute Apgar scores of <4 based on the proportion of the shift completed. The findings were unchanged when evaluated with a cubic spline in unadjusted and adjusted logistic models. Sensitivity analyses performed on the 22.2% of patients who were delivered by a physician completing a 12-hour shift showed similar findings. There was a small increase in the frequency of neonatal intensive care unit admissions with a greater proportion of the shift completed (adjusted P=.009), but the findings did not persist in the sensitivity analysis. Clinically significant differences in obstetrical interventions and outcomes do not seem to exist based on the temporal proximity to the attending physician's shift change. Future work should attempt to directly study unit culture and provider fatigue to further investigate opportunities to improve obstetrical quality of care, and additional studies are needed to corroborate these findings in community settings.

Assessing the Factors Affecting Cesarean Section Selection in Iranian Women Using Multilevel Count Models with Excess Zeros.

Background:Iran has ranked second in the frequency of cesarean delivery (CD) and this rate in 2014 has increased by 56 percent. The CD has multiple complications for the woman and newborn, and due to the women’s readmission after surgery impose additional costs to the countries. Although CD has many complications and is not recommended by obstetrician and midwives; some factors affect the choice of this method of delivery.Methods:We used data from the Iranian Institute for Health Sciences Research (IIHSR) in 2015. We studied the effects of factors such as socioeconomic and demographic factors and supplemental insurance status in the choice of CD. We used multilevel Zero-Inflated models for the modeling of data.Results:The employed women resident in urban areas with the high-income and age greater than 34-yr old and supplemental insurance more likely chose CD. On the other hand, women with high education level, women who use at least one media (e.g. Radio, television, etc.) and women that use contraceptive methods have chosen the less CD.Conclusion:Our findings highlighted the importance of supplemental insurance and socio-economic status in choosing a CD by women. However, in some cases especially in the rich class of society, the high cost of this type of delivery does not affect the choice decrease of it, and governments should adopt rigorous policies in using this method.

Changes in the Frequency of Cesarean Delivery in Nulliparous Women in Labor in a Canadian Population, 1992-2018.

To examine the relative contribution of changes in patient demographics and physician management to changes in the cesarean delivery rate in labor among nulliparous women. We conducted a retrospective cohort study of 485,451 births to nulliparous women who experienced labor at or beyond 35 weeks of gestation in Alberta, Canada, from 1992 to 2018. The data were from a province-wide perinatal database. The primary outcome was cesarean delivery. Multivariate logistic regression and calculation of population attributable risk for identified risk factors were performed. The cesarean delivery rate increased from 12.5% in 1992 to 24% in 2018. The prevalence of maternal risk factors for cesarean delivery such as obesity, maternal age 35 years or older at delivery, and comorbidities increased over the study period. However, this did not account for the increase in cesarean delivery, because the frequency of cesarean delivery increased irrespective of risk status. Additionally, the population-attributable risk for each risk factor was stable across the study period. For example, for maternal age 35 years or older at delivery, the number of cesarean deliveries attributable to this factor (the population-attributable risk) was 0.9 per 100 deliveries in 1992-1998 and 1 per 100 in 2014-2018. The proportion of cesarean deliveries in which nonreassuring fetal status was the indication increased from 30.1% in 1992 to 51.1% in 2018. The absolute rate of cesarean delivery in the second stage of labor increased from 3.1% in 1992 to 5.9% in 2018. This was due to a significant increase, among those who entered the second stage, in cesarean delivery without a trial of forceps, from 2.5% in 1992 to 7.0% in 2018. The observed doubling of the rate of cesarean delivery in labor in first-time mothers was not driven by patient risk factors. Increases in the rate of cesarean delivery for nonreassuring fetal status and decreased operative vaginal deliveries were important factors.