Incidence Of Cesarean Delivery Research Articles

The vertical dimension of obesity: adverse pregnancy outcomes in the short obese versus tall obese parturient

The objective of this study was to examine the effect of maternal height on adverse perinatal outcomes in obese parturients. This retrospective study was conducted from January 2015 to December 2015. Patients with BMI ≥ 35.0 kg/m2 before delivery were included and divided into 2 groups based on height. Patients ≤63 inches were in the short stature group and those > 63 inches were in the tall stature group. One hundred and twenty-five patients were in the short stature cohort and 124 in the tall stature cohort. Patients in short cohort had a significantly higher risk of preterm delivery <37 weeks (RR = 4.21 [1.24, 12.88]), spontaneous rupture of membranes (RR 1.47 [1.01–2.16]), and second stage caesarean delivery (CD) (RR 2.64 [1.1–6.39]). After multiple regression analysis, Hispanic race and short stature were independent predictors of preterm birth for obese patients. IMPACT STATEMENT What is already known on this subject? Compared to normal weight individuals, those who are obese have at a higher risk of adverse obstetric and perinatal outcomes including gestational diabetes, hypertension, pre-eclampsia, thromboembolism, macrosomia, higher incidence of caesarean deliveries and perinatal mortality. What do the results of this study add? Our findings show that short stature is an independent predictor for adverse perinatal outcomes in obese women. Specifically, short obese patients had significantly higher risk of preterm delivery before 37 weeks and second stage CD. What are the implications of the findings for clinical practice and/or further research? Our findings highlight the need for formulating a tailored plan for preconception health including pregnancy weight goals in short obese women. Additionally, maternal fat distribution and its effect on pro-inflammatory cytokine profiles is a potential area for future research, as maternal body composition may be a better predictor of perinatal outcome than BMI.

Maternal and neonatal outcomes of pregnancies complicated by late fetal growth restriction undergoing induction of labor with dinoprostone compared with cervical balloon: A retrospective, international study.

The aim of this study was to compare vaginal dinoprostone and mechanical methods for induction of labor (IOL) in pregnancies complicated by late fetal growth restriction. Multicenter, retrospective, cohort study involving six referral centers in Italy and Spain. Inclusion criteria were pregnancies complicated by late fetal growth restriction as defined by Delphi consensus criteria. The primary outcome was the occurrence of uterine tachysystole; secondary outcomes were either cesarean delivery or operative vaginal delivery for non-reassuring fetal status, a composite score of adverse neonatal outcome and admission to neonatal intensive care unit (NICU). Univariate and multivariate logistic regression analysis was used to analyze the data. A total of 571 pregnancies complicated by late fetal growth restriction undergoing IOL (391 with dinoprostone and 180 with mechanical methods) were included in the analysis. The incidence of uterine tachysystole (19.2% vs. 5.6%; p=0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. Similarly, the incidence of cesarean delivery or operative delivery for non-reassuring fetal status (25.6% vs. 17.2%; p=0.027), composite adverse neonatal outcome (26.1% vs. 16.7%; p=0.013) and NICU admission (16.9% vs. 5.6%; p<0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. At logistic regression analysis, IOL with mechanical methods was associated with a significantly lower risk of uterine tachysystole (odds ratio 0.26, 95% confidence interval 0.13-0.54; p<0.001). In pregnancies complicated by late fetal growth restriction, IOL with mechanical methods is associated with a lower risk of uterine tachysystole, cesarean delivery or operative delivery for non-reassuring fetal status, and adverse neonatal outcome compared with pharmacological methods.

Evaluation of toxoplasmosis risk on anxiety and perception of cat owner pregnant women

Cats are the main host of Toxoplasma gondii and pregnant women who own cats at home may be at risk. This condition may cause anxiety and stress in pregnant women. The aim of this study is to evaluate toxoplasmosis risk on anxiety and perception of cat owner pregnant women. The study group consisted of 59 pregnant women feeding cats in the home and 369 pregnant women not feeding cats. A Health Anxiety Inventory (HAI-18) was used to measure the anxiety of all participants. Age and anxiety variables were analyzed using a two-sample independent t-test. Gravida, education, and job status were analyzed using chi-square tests, and live to abort ratio &amp; pregnancy number were analyzed using Fisher exact test. Measurement of the anxiety level between the two groups showed that anxiety is significantly higher among the pregnant women who feed cats in their house with an average of 32.03±8.72. The average anxiety level among the pregnant women who don't have cats in their house was 25.94±8.99. The difference between the Health Anxiety Inventory of the two groups was significant (p= 0.0001) It was shown in the literature that pets can reduce anxiety but not studied in pregnant women, yet. Our results showed that pregnant women who own cats at home had more environmental anxiety than women who don’t feed cats at home which is possibly associated with fear of Toxoplasma gondii transmission. This anxiety may also cause unfavorable pregnancy outcomes like eclampsia, preterm birth, low birth weight and high incidence of cesarean delivery.

Comparison of video based learning and lecture based learning in last year medical faculty students

Cats are the main host of Toxoplasma gondii and pregnant women who own cats at home may be at risk. This condition may cause anxiety and stress in pregnant women. The aim of this study is to evaluate toxoplasmosis risk on anxiety and perception of cat owner pregnant women. The study group consisted of 59 pregnant women feeding cats in the home and 369 pregnant women not feeding cats. A Health Anxiety Inventory (HAI-18) was used to measure the anxiety of all participants. Age and anxiety variables were analyzed using a two-sample independent t-test. Gravida, education, and job status were analyzed using chi-square tests, and live to abort ratio &amp; pregnancy number were analyzed using Fisher exact test. Measurement of the anxiety level between the two groups showed that anxiety is significantly higher among the pregnant women who feed cats in their house with an average of 32.03±8.72. The average anxiety level among the pregnant women who don't have cats in their house was 25.94±8.99. The difference between the Health Anxiety Inventory of the two groups was significant (p= 0.0001) It was shown in the literature that pets can reduce anxiety but not studied in pregnant women, yet. Our results showed that pregnant women who own cats at home had more environmental anxiety than women who don’t feed cats at home which is possibly associated with fear of Toxoplasma gondii transmission. This anxiety may also cause unfavorable pregnancy outcomes like eclampsia, preterm birth, low birth weight and high incidence of cesarean delivery.

Intrapartum sonographic assessment of the fetal head flexion in protracted active phase of labor and association with labor outcome: a multicenter, prospective study

To date, no research has focused on the sonographic quantification of the degree of flexion of the fetal head in relation to the labor outcome in women with protracted active phase of labor. This study aimed to assess the relationship between the transabdominal sonographic indices of fetal head flexion and the mode of delivery in women with protracted active phase of labor. Prospective evaluation of women with protracted active phase of labor recruited across 3 tertiary maternity units. Eligible cases were submitted to transabdominal ultrasound for the evaluation of the fetal head position and flexion, which was measured by means of the occiput-spine angle in fetuses in nonocciput posterior position and by means of the chin-to-chest angle in fetuses in occiput posterior position. The occiput-spine angle and the chin-to-chest angle were compared between women who had vaginal delivery and those who had cesarean delivery. Cases where obstetrical intervention was performed solely based on suspected fetal distress were excluded. A total of 129 women were included, of whom 43 (33.3%) had occiput posterior position. Spontaneous vaginal delivery, instrumental delivery, and cesarean delivery were recorded in 66 (51.2%), 17 (13.1%), and 46 (35.7%) cases, respectively. A wider occiput-spine angle was measured in women who had vaginal delivery compared with those submitted to cesarean delivery owing to labor dystocia (126±14 vs 115±24; P<.01). At the receiver operating characteristic curve, the area under the curve was 0.675 (95% confidence interval, 0.538-0.812; P<.01), and the optimal occiput-spine angle cutoff value discriminating between cases of vaginal delivery and those delivered by cesarean delivery was 109°. A narrower chin-to-chest angle was measured in cases who had vaginal delivery compared with those undergoing cesarean delivery (27±33 vs 56±28 degrees; P<.01). The area under the curve of the chin-to-chest angle in relation to the mode of delivery was 0.758 (95% confidence interval, 0.612-0.904; P<.01), and the optimal cutoff value discriminating between vaginal delivery and cesarean delivery was 33.0°. In women with protracted active phase of labor, the sonographic demonstration of fetal head deflexion in occiput posterior and in nonocciput posterior fetuses is associated with an increased incidence of cesarean delivery owing to labor dystocia. Such findings suggest that intrapartum ultrasound may contribute in the categorization of the etiology of labor dystocia.

A185 THE IMPACT OF PRIOR SURGERY ON ADVERSE PREGNANCY OUTCOMES IN PREGNANT PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background During the course of inflammatory bowel disease (IBD), approximately 20% of patients with ulcerative colitis (UC) and 80% of Crohn’s disease (CD) patients will require surgery. The most common operation is total proctocolectomy and ileoanal pouch anastomosis (IPAA) for UC patients and ileocecal (IC) resection for CD. In pregnant IBD patients, guidelines name the presence of IPAA as a relative indication for Cesarean section (C-section). The effect of prior IBD-related surgery on mode of delivery and pregnancy-related outcomes remains unknown. Aims To describe pregnancy-related outcomes in pregnant women with IBD who have undergone prior IBD-related surgery. Methods We performed a retrospective cohort study of pregnant women with IBD including those with prior IBD-related surgeries including IPAA, IC resection, total or partial colectomy and ileostomy formation who delivered an infant at our medical center from 2016 to 2020. We assessed the mode of delivery, delivery characteristics (emergency vs. planned C-section) and maternal and neonatal outcomes Results Fifty-six UC patients and 64 CD patients were included in the analysis, of which 10 and 24 had undergone prior IBD-related surgery, respectively. The mean age at conception was 34.10 years in the surgical UC group and 30.30 years in the surgical CD group. Mode of delivery: C-section rates were higher in post-surgical compared to non-surgical UC patients (70% vs. 30.4%, p = 0.02). Similar numbers of C-sections were performed emergently in the surgical compared to non-surgical UC group (10% vs. 18%, p = 0.53). Comparatively, there was no significant difference in C-section rates in post -surgical compared to non-surgical CD mothers (50% vs. 40%, p = 0.44), with 13% performed emergently in both groups. Maternal outcomes: Gestational diabetes developed in 10% of surgical UC and 4.5% of surgical CD patients. Premature rupture of membranes developed in 10% of surgical UC and 9.1% of surgical CD patients. There was no difference in pre-eclampsia rates in the surgical and non-surgical CD groups (9.1% vs 13.2%, p = 0.64). Neonatal outcomes: There was no significant difference in pre-term birth rates in post-surgical compared to non-surgical UC mothers (10% vs. 15.2%, p = 0.67) or in surgical compared to non-surgical CD mothers (13.6% vs. 5.1%, p = 0.29). Neonatal Intensive Care Unit (NICU) requirements were higher in infants born to post-surgical CD compared to non-surgical CD mothers (18.2% vs. 2.7%, p = 0.04). More low birth weight (LBW) infants were born to post-surgical CD vs non-surgical CD mothers (13.6% vs. 0%, p = 0.02). Conclusions Women with IBD who have had prior IBD-related surgery may be at increased risk of developing adverse gestational and neonatal outcomes. Women with surgical UC have an increased incidence of Cesarean delivery. Funding Agencies None

CESAREAN SCAR PREGNANCY - A RARE ENTITY BECOMING MORE COMMON - CASE SERIES.

Cesarean scar pregnancy is a rare and life threatening complication. As there is an increase in incidence of cesarean deliveries,there is also an increase in incidence of cesarean scar pregnancy. The complications of cesarean scar pregnancy are uterine rupture, massive haemorrhage, need for hysterectomy and risk of severe maternal morbidity and mortality. Here we present 7 cases of cesarean scar pregnancy illustrating the different diagnostic and therapeutic modalities..High suspicion of scar pregnancy in rst trimester bleeding with previous caesarean delivery,timely diagnosis and prompt management can prevent catastrophic complications

Perinatal outcome and possible vertical transmission of coronavirus disease 2019: experience from North India.

BackgroundThe consequences of severe acute respiratory syndrome corona virus 2 on mother and fetus remain unknown due to a lack of robust evidence from prospective studies.PurposeThis study evaluated the effect of coronavirus disease 2019 (COVID-19) on neonatal outcomes and the scope of vertical transmission.MethodsThis ambispective observational study enrolled pregnant women with COVID-19 in North India from April 1 to August 31, 2020 to evaluate neonatal outcomes and the risk of vertical transmission.ResultsA total of 44 neonates born to 41 COVID-19–positive mothers were evaluated. Among them, 28 patients (68.3%) (2 sets of twins) were delivered within 7 days of testing positive for COVID-19, 23 patients (56%) (2 sets of twins) were delivered by cesarean section; 13 newborns (29.5%) had low birth weight; 7 (15.9%) were preterm; and 6 (13.6%) required neonatal intensive care unit admission, reflecting an increased incidence of cesarean delivery and low birth weight but zero neonatal mortality. Samples of cord blood, placental membrane, vaginal fluid, amniotic fluid, peritoneal fluid (in case of cesarean section), and breast milk for COVID-19 reverse transcription-polymerase chain reaction tested negative in 22 prospective delivery cases. Nasopharyngeal swabs of 2 newborns tested positive for COVID-19: one at 24 hours and the other on day 4 of life. In the former case, biological samples were not collected as the mother was asymptomatic and her COVID-19 report was available postdelivery; hence, the source of infection remained inconclusive. In the latter case, all samples tested negative, ruling out the possibility of vertical transmission. All neonates remained asymptomatic on follow-up. ConclusionCOVID-19 does not have direct adverse effects on the fetus per se. The possibility of vertical transmission is almost negligible, although results from larger trials are required to confirm our findings.

Safety and efficacy of titrated oral misoprostol solution versus vaginal dinoprostone for induction of labor: A single-center randomized control trial.

ObjectiveTo compare the efficacy and safety of the hourly administration of titrated oral misoprostol solution (OMS) and vaginal dinoprostone for induction of labor.MethodsTitrated OMS was administrated hourly for induction of labor, starting with a dose of 20 µg and terminating at a dose of 50 µg. The safety and efficacy of OMS were compared with that of vaginal dinoprostone for induction of labor.ResultsFrom June 2016 to October 2019, 2280 (78.3%) and 2115 (72.9%) women who received titrated OMS and vaginal dinoprostone, respectively, had a vaginal delivery (P = 0.005). Cesarean delivery was performed in 632 (21.7%) and 783 (27.0%) women who received titrated OMS and vaginal dinoprostone, respectively (P = 0.008). Tachysystole with changes in fetal heart rate (FHR) was seen in 104 (3.6%) and 249 (8.6%) women in the OMS and dinoprostone groups, respectively (P = 0.007). The frequency of non‐reassuring FHR was lower in the OMS group compared to the dinoprostone group (P = 0.006).ConclusionThe titrated OMS has an efficacy comparable to vaginal dinoprostone. Moreover, it causes a lower incidence of cesarean delivery, lower frequency of tachysystole with changes in FHR, and non‐reassuring FHR.

695 Cesarean delivery incidence by maternal BMI and diabetes status in multiparous women without prior cesarean

To examine the association between body mass index (BMI) and cesarean delivery (CD) in multiparous women without prior CD by diabetes status. This is a retrospective cohort study of multiparous women without prior CD, with singleton, non-anomalous, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of CD in diabetic and non-diabetic women categorized by BMI class. Pre-pregnancy BMI was categorized into underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity (30-39.9 kg/m2), and morbid obesity (≥40 kg/m2). Diabetes was classified by pre-existing diabetes, gestational diabetes, and no diabetes. Multivariable logistic regression was used to examine the association of BMI with CD by diabetes classification, controlling for maternal race/ethnicity, age, education, and insurance status. The cohort of 893,965 multiparous women without prior CD consisted of 188,913 (21.1%) obese and morbidly obese pregnant women. A significant association was demonstrated between BMI category and CD for women with pre-existing diabetes, gestational diabetes, and without diabetes (Figure 1). For example, in those with pre-existing diabetes, the risk of CD rose from 14.6% in normal-weight women to 37.9% in those with morbid obesity (p<0.001). After controlling for potential confounders, a higher BMI class was found to be associated with increased odds of CD, independent of diabetes status (Table 1). Further, when compared to women without diabetes, those with gestational and pre-existing diabetes have significantly increased odds of CD (aOR 1.55, 95% CI 1.52-1.59; aOR 2.55 95% CI 2.40-2.71, respectively). Diabetes status and higher BMI category were both found to be individually associated with increased risk of CD in multiparous women without prior CD. This study also demonstrated the compounding effect of diabetes status and obesity on the incidence of CD. Obstetrical education for women in these categories should emphasize the increased potential of this birth outcome.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

601 Is calculator validated to predict cesarean among induced women accurate in a strictly nulliparous population?

A validated calculator has been shown to predict likelihood of cesarean delivery (CD) among both nulliparous and parous patients undergoing induction with unfavorable cervices. This calculator has also been shown to decrease CD rates and maternal morbidity. We aimed to determine if the calculator maintains accuracy in a strictly nulliparous population. This retrospective cohort study included nulliparous women with non-anomalous, singleton, vertex, term pregnancies undergoing labor induction with intact membranes and unfavorable cervices at an academic hospital from January 2015 to April 2017. Each woman was entered into the calculator to determine pre-induction risk of CD. Women were then stratified into four groups based on predicted risk of CD: <20%, 20-39%, 40-59%, and ≥60%. Primary outcomes were accuracy of predicted CD risk, overall and in each predicted risk group. Secondary outcomes included induction duration, composite maternal morbidity, and composite neonatal morbidity. The data were analyzed using chi-squared, binomial probability, and Kruskal-Wallis tests. Among 846 women, 31% (n=262) underwent CD (vs expected 40%, p<0.001). Overall, the predicted probability of CD had no association with actual incidence of CD (AUC 0.53, 95% CI 0.49-0.57). Similarly, there was no association between predicted CD risk and actual CD rate. However, significant differences in induction duration were identified within the CD risk categories (median 24.3, 29.5, 30.8, and 32.4 hours for CD risks <20%, 20-39%, 40-59%, and ≥60% respectively; p=0.002). There was no association between predicted CD risk and composite maternal or neonatal morbidity. The labor induction calculator does not reliably predict CD incidence in this nulliparous population but is associated with differences in induction duration. This inconsistency may be due to differences in patient characteristics or practice patterns. These findings should encourage providers to assess the validity of the calculator in their population prior to implementing it as a strategy to impact CD rates or maternal morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

494 Pregnancy outcomes among 184 women with turner syndrome

Turner syndrome is one of the most common sex chromosomal disorders. A small number of women with this disorder might be able to conceive. However, their pregnancy outcomes remain unclear. The purpose of this study was to evaluate the association between Turner syndrome and pregnancy, delivery, and neonatal outcomes. We conducted a retrospective study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (HCUP-NIS) from the United States. We included pregnant women with Turner Syndrome (ICD-9 code 758.6) who delivered between 2004 and 2014, and compared them to those without Turner Syndrome. We evaluated their pregnancy complications, delivery, and neonatal outcomes. Logistic regression was used to compare maternal and neonatal outcomes between the two groups while controlling for maternal baseline confounding variables. Of 9,096,604 pregnant women, 184 had a diagnosis of Turner Syndrome with a prevalence of 2 per 100,000 pregnancies. Women with Turner Syndrome were more likely to require an IVF treatment to be pregnant, White, and have a Private insurance. They had higher proportions of multiple pregnancy, thyroid disease, and preeclampsia. Pregnancy in women with Turner syndrome were associated with PPROM (OR 3.04, CI 1.33 – 6.95), preterm delivery (OR 1.76, CI 1.08 – 2.87), had a higher incidence of cesarean delivery (OR 1.61, CI 1.16 – 2.23), and a higher rate of maternal infection (OR 2.48, CI 1.22 – 5.06). Neonates of mothers with Turner Syndrome were found to be at increased risk for adverse neonatal outcomes, SGA (OR 2.99, CI 1.62 – 5.51), IUFD (OR 23.76, CI 13.66 – 41.32), and congenital anomaly (OR 12.31, CI 6.45 – 23.49). Pregnancy in women with Turner syndrome is associated with increased maternal morbidity, as well as neonatal morbidity. Pregnancy is often associated with increased risk of preeclampsia, prematurity, SGA, IUFD and congenital anomalies. Women with Turner syndrome is better treated in tertiary obstetrics centers.

Obstetrics outcome in pulmonary tuberculosis

BackgroundTo evaluate the maternal and perinatal outcome in pulmonary tuberculosis cases as compared to low risk pregnancies in a tertiary referral hospital. MethodsA total of 15 cases of pulmonary tuberculosis over a period of two years who delivered in our unit was studied in the retrospective study. The maternal and perinatal outcome in them was compared with 191 low risk pregnancies who delivered at the same time in the hospital after taking into account inclusion and exclusion criteria. ResultsThe mean age and mean parity was 25.73 ± 2.85 and 28.75 ± 3.11, 2.1 and 1.9 in the 2 groups. Symptoms of pulmonary tuberculosis were cough (100%), chest pain (80%), expectoration (100%), hemoptysis (33.3%), fever (93.33%), anorexia (86.66%) and loss of weight (80%). Symptoms in study patients were significantly more common in study patients. The presence of associated medical problems was similar in the 2 groups. The prevalence of oligoamnios, gestational diabetes mellitus, antepartum hemorrhage and intrahepatic cholestasis was similar in the 2 groups. Prevalence of preterm labor was 53.33% in study group which was significantly higher than in controls (8.9%). Risk of premature rupture of membrane was also significantly higher in the study groups (53.33%) as compared to control groups (8.9%). Mean gestational age was also significantly lower (36.2 weeks) in study group as compared to 38.6 weeks in control group. The incidence of cesarean delivery was similar in the 2 groups (26.66% vs 28.79%). The mean birth weights was 2308.6 gm in the study group as compared to 2707.56 gm in control group. Fetal growth restrictions and Respiratory distress syndrome in babies was significantly higher in study group than in control group. Low APGAR score (<8) was also higher (33.3%) in study group as compared to control group (2.61%). ConclusionPulmonary tuberculosis during pregnancy is associated with increased perinatal morbidity, low birth weight, poor APGAR and increased respiratory distress rates.

CONTINUATION VERSUS DISCONTINUATION OF OXYTOCIN INFUSION THROUGHOUT THE ACTIVE PHASE OF LABOR AND ITS EFFECT ON THE COURSE OF INDUCED LABOR

Background: Oxytocin is an effective commonly used drug for induction of labor, However it is associated with several maternal and neonatal adverse effect. So, controlled dosage is recommended. Objective: To determine the effect of continuation or discontinuation of the infusion of oxytocin on the duration of the active phase of labor and maternal and neonatal complications. Patients and Methods: This was a randomized controlled trial study conducted in the Obstetrics and Gynecology Department of Dikirnis General Hospital from (August 2018 to September 2019). The women participated in this study was divided in 2 groups, each group consists of 100 women [40 of them were nulliparous and 60 were multiparous]: Group (A) received continuous oxytocin infusions throughout labor until the end of labor. Group (B) received oxytocin infusion which was discontinued once the active phase of labor was established (cervix ≥ 6 cm, uterine contraction at a rate of 3-5 per 10 minutes). Results: The active phase of labor was longer by 53 minutes in the discontinued group (primigravida) versus the continued group (primigravida) and was longer by 75 minutes in the discontinued group B (multigravida) versus the continued group A (multigravida). The incidence of intrapartum fetal distress and uterine hyperstimulation were non-significantly greater in the continued than the discontinued group. The mode of delivery, incidence of cesarean deliveries, postpartum hemorrhage, cervical tear and NICU admission were higher in the continued group versus the discontinued group. Conclusion: The duration of active phase of labor prolonged after discontinuing oxytocin infusion. The new protocol may improve labor outcomes and significantly decrease the rate of uterine hyperstimulation, intrapartum fetal distress and decrease cesarean delivery.

CONTINUATION VERSUS DISCONTINUATION OF OXYTOCIN INFUSION THROUGHOUT THE ACTIVE PHASE OF LABOR AND ITS EFFECT ON THE COURSE OF INDUCED LABOR

Background: Oxytocin is an effective commonly used drug for induction of labor, However it is associated with several maternal and neonatal adverse effect. So, controlled dosage is recommended. Objective: To determine the effect of continuation or discontinuation of the infusion of oxytocin on the duration of the active phase of labor and maternal and neonatal complications. Patients and Methods: This was a randomized controlled trial study conducted in the Obstetrics and Gynecology Department of Dikirnis General Hospital from (August 2018 to September 2019). The women participated in this study was divided in 2 groups, each group consists of 100 women [40 of them were nulliparous and 60 were multiparous]: Group (A) received continuous oxytocin infusions throughout labor until the end of labor. Group (B) received oxytocin infusion which was discontinued once the active phase of labor was established (cervix ≥ 6 cm, uterine contraction at a rate of 3-5 per 10 minutes). Results: The active phase of labor was longer by 53 minutes in the discontinued group (primigravida) versus the continued group (primigravida) and was longer by 75 minutes in the discontinued group B (multigravida) versus the continued group A (multigravida). The incidence of intrapartum fetal distress and uterine hyperstimulation were non-significantly greater in the continued than the discontinued group. The mode of delivery, incidence of cesarean deliveries, postpartum hemorrhage, cervical tear and NICU admission were higher in the continued group versus the discontinued group. Conclusion: The duration of active phase of labor prolonged after discontinuing oxytocin infusion. The new protocol may improve labor outcomes and significantly decrease the rate of uterine hyperstimulation, intrapartum fetal distress and decrease cesarean delivery.

The 'Quiet Revolution' and the Cesarean Section in the United States

This paper estimates how changes in family structure and women’s labor market attachment during the last fifty years have affected the incidence of cesarean delivery in the United States. Both sets of factors are strongly related to cesarean utilization, and have generally changed so as to increase the rate of cesarean delivery over time. Altogether, changes in these factors, complemented by demographic changes, raised the U.S. cesarean section rate by 8-12 percentage points since 1978, one-half to two-thirds of the increase over that period. Today’s elevated cesarean section rate is, to a substantial degree, a social phenomenon.

Pregestational obesity, maternal morbidity and risk of caesarean delivery in a country in an advanced stage of obstetric transition

ObjectiveTo evaluate whether pregestational obesity is associated with the risk of caesarean section in pregnant women living in a country in an advanced stage of the obstetric transition. MethodsRetrospective cohort study. Data were collected from prenatal and hospital records. Pregestational obesity was defined as: body mass index, [weight(k)/height (m2)] ≥30, and caesarean sections were categorized as elective, emergency, or non-emergency/medically necessary. Biodemographic and sociodemographic characteristics, obstetric and perinatal pathologies, and maternal anthropometric variables were assessed. Chi-square and t-tests were used to compare qualitative and quantitative variables, respectively. Simple and adjusted generalized linear models were used to evaluate the association between pregestational obesity and caesarean delivery. Finally, population attributable risk was calculated. Data analysis was performed using STATA.v.14.0. Participants2309 pregnant women with a singleton pregnancy who gave birth at a public hospital in the Metropolitan Region of Santiago, Chile in 2015. ResultsThe prevalence of pregestational obesity was 21.4%, and the incidence of caesarean deliveries was 34.8% (33% of which corresponded to elective, 46% to emergency, and 21% to non-emergency/medically necessary caesarean deliveries). Pregestational obesity increased the risk of caesarean delivery (aRR = 1.46; 95%CI. [1.19–1.79] as well as the risk of elective (aRR = 1.74; 95%CI. [1.23–2.45]) and emergency caesarean delivery (aRR = 1.44; 95%CI. [1.03–2.00]). The population attributable risk of pregestational obesity for caesarean section was 32%. ConclusionGiven the significant association between pregestational obesity and caesarean delivery, it is necessary to develop strategies to decrease obesity among women of childbearing age in order to decrease obstetric intervention.

Antenatal cardiotocography with and without computer analysis in high-risk pregnancy: a randomized clinical trial

Cardiotocography or nonstress test is a technical means of recording the fetal heartbeat and uterine contractions for antenatal monitoring. This study aimed to evaluate whether antepartum cardiotocography with computer analysis (computerized cardiotocography) increases the incidence of cesarean delivery in women with high-risk pregnancies but without intrauterine growth restriction. This was a parallel group nonblinded randomized clinical trial of singletons with high-risk pregnancies admitted for inpatient monitoring between 24 0/7 and 37 6/7 weeks' gestation. Eligible participants were randomly allocated in a 1:1 ratio to antenatal monitoring with either standard cardiotocography or computerized cardiotocography. Women randomized to the computerized cardiotocography arm received cardiotocographic monitoring with computerized analysis in a central monitoring station. The primary outcome was the incidence of cesarean delivery. Overall, 28 women were enrolled in this trial. In addition, 14 women were randomized to the computerized cardiotocography group and 14 women to the control group. No woman was excluded after randomization or lost to follow-up. Cesarean delivery occurred in 9 women (64.3%) in the computerized cardiotocography group and 9 women (64.3%) in the control group (relative risk, 1.00; 95% confidence interval, 0.21-4.69).There was no significant between-group difference in preterm birth, gestational age at delivery, Apgar score, and birthweight. Among women with high-risk pregnancies, use of computerized cardiotocography for antenatal monitoring did not result in a significant increase in cesarean delivery compared with standard cardiotocography. The results of this single-center randomized trial require confirmation in multicenter studies.

Internal fetal and uterine monitoring in obese patients and maternal obstetrical outcomes

The maternal habitus in the setting of obesity makes external monitoring of the fetal heart rate and contractions suboptimal, and internal monitors may be utilized more often in this population. Obesity is a risk factor for obstetrical infectious complications, but it is unknown whether the use of internal monitors in this population is associated with additional risks. This study aimed to investigate the association between the use of an intrauterine pressure catheter and a fetal scalp electrode and maternal infectious morbidity among women with obesity. This secondary analysis of a prospective cohort study included women with singleton gestations admitted for labor at ≥37 weeks' gestation at a tertiary care institution from 2010 to 2014. Obesity was defined as a body mass index of ≥30 kg/m2. The primary outcome was a composite maternal infectious morbidity, which included peripartum maternal fever, chorioamnionitis, and endomyometritis. Secondary outcomes were cesarean delivery and individual components of the maternal infectious composite. Multivariable logistic regression was used to compare the rates of infectious maternal morbidity, cesarean delivery, or operative vaginal delivery between patients with and without internal monitors, while adjusting for the confounders. An interaction term was included in the logistic regression models to test whether the relationship between the internal monitors and cesarean delivery or infectious morbidity was modified by the presence or absence of obesity. Of the 8482 women who met the inclusion criteria for the study, 4727 (55.7%) had obesity and 3755 (44.3%) did not have obesity. The women with obesity were more likely to have internal monitors placed during labor than those without obesity (65.4% vs 50.5%; P<.001). The use of internal monitors was associated with an increased risk for the composite maternal infectious morbidity (9.9% vs 4.1%; P<.01 and adjusted odds ratio, 2.08; 95% confidence interval, 1.70-2.55). Women with obesity had a weaker association between the use of internal monitors and maternal infectious morbidity than women without obesity (P value for interaction of .02). The incidence of cesarean delivery was also significantly higher among women who had internal monitors placed during their labor course (adjusted odds ratio, 2.84; 95% confidence interval, 2.46-3.28), and this interaction was not modified by obesity. Although a higher proportion of women with obesity have internal monitors placed during their labor course, they are not more susceptible to maternal infectious morbidity as a result of internal monitor use. Providers should not limit the necessary internal monitor use in women with obesity on the basis of concerns for maternal infectious morbidity.

Turn, Baby, Turn: Anesthesia for Extracephalic Version.

Extracephalic versions are recommended by the American College of Obstetricians and Gynecologists for breech presentation to reduce the incidence of cesarean delivery. While that recommendation is clear, there is less consensus regarding anesthetic management, specifically whether or not an anesthetic should be performed to facilitate the procedure, and if so, of which type. In this infographic, we review a recent network meta-analysis that identifies high-quality studies performed to evaluate the impact of anesthetic choice on clinical outcomes for extracephalic versions.