Number Of Cesarean Deliveries Research Articles

Планування пологів – сучасний підхід в акушерстві у разі тазового передлежання плода

The world data on stable perinatal losses in breech presentation and a significant increase in the number of cesarean deliveries (70–80%) have led to a search for fundamentally new approaches to breech deliveries. The objective: the aim of the research is to evaluate the effectiveness and the validity of individual delivery planning for breech presentations. Materials and methods. Pregnant patients were divided into two groups: 1) the main group (MG) (n=36) which included women with planned conservative deliveries for breech presentations; 2) the control group (CG) (n=33) which included women with planned cesarean deliveries for breech presentations. Results. Pregnancy completion in the majority of patients from both groups occurred in the planned way: MG – 27 (75%), CG – 29 (87.8%). The MG patients gave birth in the all-fours position – 11 (40.7%) and with the help of the Tsoyanov method – 16 (53.9%). There were 9 (25%) cases of cesarean deliveries in the CG which were mainly classified as the 1st urgency category – 5 (55.5%). The need for urgent cesarean section in the CG occurred in half as many cases – 4 (12.2%) and most cases – 3 (75%) – had the 3rd urgency category. Perinatal complications were more common among the children from the CG who had received manual help at birth: birth trauma – 8 (22.2%), asphyxia – 3 (8.3%), aspiration – 2 (5.55%), hypoxic-ischemic brain damage – 3 (8.3%). Conclusion. The presented data indicate the lack of highly professional skills which require thorough execution and improvement of obstetrical manipulations by obstetricians and gynecologists. Key words: breech position, conservative delivery, cesarean section, perinatal outcomes.

A Study on the Fetomaternal Outcome in Cases of Previous Three Caesarean Section

Introduction: Caesarean section is the most common obstetrical surgery performed worldwide. Its incidence continuously rising. The rate of caesarean section is 24.4% in urban educated India. In our college LSCS rate of previous 5 years is 25.4%, amongst which 0.2% were previous three LSCS. Methodology: A retrospective observational stu dy of 200 cases of caesarean deliveries from January 2010 to December 2017 in a tertiary care centre. Cases were divided in four groups such as first LSCS, second LSCS, third LSCS and fourth LSCS, each group contained 50 cases. Results: Patients were group ed as per number of caesarean deliveries. There is an increase in maternal morbidity with increase in the number of previous caesarean deliveries. There is increased morbidity in the form of adherent placenta, blood loss, bladder, ureter injury, intra - oper ative adhesions, scar dehiscence, need for ICU admission. Conclusion: Cases of previous 2 and previous 3 LSCS are bound to increase in near future, such cases need proper referral to tertiary care centre for proper management based on the risk of varied co mplications.

Long-term Follow-up After Endometrial Ablation in Finland: Cancer Risks and Later Hysterectomies.

To study the risk of endometrial cancer and breast cancer and the hysterectomy rate after endometrial ablation. In this retrospective cohort study, records of all women with endometrial ablation at ages 30-49 years in Finland (1997-2014) were extracted from the Hospital Discharge Register and linked to the Cancer Registry and Finnish Central Population Register. The primary outcome was cancer incidences in the endometrial ablation cohort compared with those in the background population of the same age. Secondarily, the postablation hysterectomy rate was compared with that of a control cohort of similar-aged women extracted from the Finnish Central Population Register. Multivariate regression models with adjustment for age, parity, number of cesarean deliveries, history of sterilization, and the duration of follow-up were evaluated as risk factors for postablation hysterectomy. In total, 154 cancers (standardized incidence ratio [observed-to-expected ratio] 0.96, 95% CI 0.82-1.13) were diagnosed among 5,484 women treated with endometrial ablation during the follow-up of 39,892 women-years. The standardized incidence ratio for endometrial cancer was 0.56 (95% CI 0.12-1.64) and for breast cancer 0.86 (95% CI 0.67-1.09). A total of 1,086 (19.8%) women had postablation hysterectomy. Risk of hysterectomy was almost fourfold in the endometrial ablation cohort compared with 26,938 women in a control group (adjusted hazard ratio [HR] 3.63, 95% CI 3.32-3.96). Factors predisposing to postablation hysterectomy were leiomyomas (adjusted HR 1.78, 95% CI 1.03-3.10), age younger than 35 years (adjusted HR 1.44, 95% CI 1.15-1.81), at least two prior cesarean deliveries (adjusted HR 1.27, 95% CI 1.04-1.55), and history of sterilization (adjusted HR 1.15, 95% CI 1.01-1.32). Endometrial ablation was not associated with an elevated endometrial cancer or breast cancer risk in Finland. Leiomyomas, young age, and history of prior cesarean deliveries or sterilization were associated with an increased risk of postablation hysterectomy.

Gynecological and Obstetrical Outcomes After Laparoscopic Repair of a Cesarean Scar Defect in a Series of 38 Women

(Abstracted from Fertil Steril 2017;107:289–296) As the number of cesarean deliveries has continued to rise worldwide in recent decades, cesarean scar defects have been increasingly described.

The association of impaired gestational glucose tolerance with maternal and fetal outcomes

The aim of the present study was to examine the associations of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) with maternal and fetal outcomes.A total of 200 pregnant women were included in this cross-sectional study. A 50-gram oral glucose challenge test (GCT) was performed between 24 and 28 weeks of gestation, followed by glucose tolerance test (OGTT) with 100 grams of oral glucose in those with an abnormal one-hour test result. The following were not significantly different between groups. Preterm labour (PL), pregnancy induced hypertension(PIH), pre-eclampsia, polyhydramnios, and macrosomia. However, a significant increase was noted in the fetal birth weight as well as in number of cesarean deliveries among GDM subjects. Neonatal outcomes were also similar between the two groups. In conclusion, the present results suggest that single high glucose readings in OGTT may be as important as a diagnosis of GDM in terms of fetomaternal complication risk.

Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity?

Objective: The aim of the present study is to evaluate the effects of the increased number of caesarean deliveries (CDs) in cases of multiple repeat caesarean deliveries (MRCDs) on maternal and neonatal morbidity.Methods: MRCDs admitted to our hospital between January 2013 and September 2014 were analysed retrospectively. A total number of 1133 women were included in the study and were divided into 4 groups. Group 1: second CDs (n = 329); Group 2: third CDs (n = 225); Group 3: fourth CDs (n = 447); Group 4: fifth CDs (n = 132). The clinical, demographic, intraoperative and postoperative data of the patients were registered upon the review of patient files.Results: The differences among the groups were found to be statistically significant in terms of mean maternal age, gravida, APGAR (Activity, Pulse, Grimace, Appearance, Respiration) scores, hospital stay and operation time. In addition, the difference was also statistically significant for severe adhesion, bladder injury and premature birth. No statistically significant difference was observed among the groups with respect to placenta previa, placenta accreta, caesarean hysterectomy, uterine scar rupture.Conclusions: According to our findings, MRCDs seem to increasing the maternal and neonatal morbidity even though they are not life-threatening.

Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality

Importance Based on older analyses, the World Health Organization (WHO) recommends that cesarean delivery rates should not exceed 10 to 15 per 100 live births to optimize maternal and neonatal outcomes. Objectives To estimate the contemporary relationship between national levels of cesarean delivery and maternal and neonatal mortality. Design, Setting, and Participants Cross-sectional, ecological study estimating annual cesarean delivery rates from data collected during 2005 to 2012 for all 194 WHO member states. The year of analysis was 2012. Cesarean delivery rates were available for 54 countries for 2012. For the 118 countries for which 2012 data were not available, the 2012 cesarean delivery rate was imputed from other years. For the 22 countries for which no cesarean rate data were available, the rate was imputed from total health expenditure per capita, fertility rate, life expectancy, percent of urban population, and geographic region. Exposures Cesarean delivery rate. Main Outcomes and Measures The relationship between population-level cesarean delivery rate and maternal mortality ratios (maternal death from pregnancy related causes during pregnancy or up to 42 days postpartum per 100 000 live births) or neonatal mortality rates (neonatal mortality before age 28 days per 1000 live births). Results The estimated number of cesarean deliveries in 2012 was 22.9 million (95% CI, 22.5 million to 23.2 million). At a country-level, cesarean delivery rate estimates up to 19.1 per 100 live births (95% CI, 16.3 to 21.9) and 19.4 per 100 live births (95% CI, 18.6 to 20.3) were inversely correlated with maternal mortality ratio (adjusted slope coefficient, −10.1; 95% CI, −16.8 to −3.4; P = .003) and neonatal mortality rate (adjusted slope coefficient, −0.8; 95% CI, −1.1 to −0.5; P P P = .004). Conclusions and Relevance National cesarean delivery rates of up to approximately 19 per 100 live births were associated with lower maternal or neonatal mortality among WHO member states. Previously recommended national target rates for cesarean deliveries may be too low.

Conservative Management of Placenta Accreta by Systemic Metho-trexate: Report of Two Cases and Review of the Literature

Objective: Owing to the growing number of cesarean deliveries, the abnormally invasive placenta-tion so called placenta accreta rate is increasing. Placenta accreta is difficult to manage and traditionally resolved by cesarean hysterectomy after the birth due to the following massive hemorrhage. In recent years different conservative treatments leaving partially or totally the placenta in the uterine cavity have been reported in patients willing to preserve their fertility. Methods: We reviewed literature data about conservative management of placenta accreta in the PubMed, Researchgate and Medline from 2007 to date. We included in the review the studies about the use of methotrexate (MTX) for conservative treatment of placenta accreta. Results: We reported 2 literature reviews and 4 studies about the use of MTX in the management of placenta accreta and 2 unpublished cases treated in our Department. MTX is administered when it is not possible to remove totally or partly the placenta accreta in order to promote the cytolysis of the residual trophoblast. The schedule and outcome of the methotrexate use have not been established yet due to the paucity of literature data. Conclusions: The role of MTX to improve both, the feasibility and success rate of conservative management and placental resorption needs further studies. Hemodynamic stability of patients and informed consent are prerequisites before starting MTX treatment. Vaginal bleeding and infections may complicate the conservative treatment and close surveillance is recommended by imaging techniques and laboratory parameters.

COMPARATIVE CHARACTERISTIC OF THE PREGNANCY AND DELIVERY AT THE PATIENTS AFTER PREVIOUS SURGERIES ON A UTERUS

The complex analysis of indications to cesarean delivery in the Ryazan Regional Clinical Perinatal Center during 2011-2013 is carried out. Frequency of cesarean delivery was 32.8%. Earlier undergone surgeries on a uterus made 26,4% in structure of all indications to cesarean delivery. Results of research showed that conservative conducting childbirth at pregnant women after the undergone surgeries on a uterus is an essential reserve of decrease in number of cesarean delivery. The main conditions of conservative conducting childbirth: anatomic and functional quality of a uterus; clinical compliance of the sizes of a fetus and woman's pelvis; absence of absolute contraindications to childbirth from mother and fetus.

Effect of intravenous hyoscine-N-butyl bromide on active phase of labor progress: a randomized double blind placebo controlled trial

Introduction: Appropriate cervical dilatation and effacement are essential for the progression of labor. With the active management of labor, number of cesarean deliveries reduces and the duration of labor shortens. Cervical dilatation can be facilitated by mechanical, pharmacological and non-pharmacologic methods. Cervix is richly supplied by autonomic nerves, which may play a role in the dilatation of cervix. Hyoscine-N-butylbromide (HBB) is a muscarinic antagonist and acts as a cervical spasmolytic agent. After intravenous administration it is rapidly distributed into the tissues. We aimed to study the effects and safety of a single dose 20 mg HBB injection during the active phase of labor in both primi- and multigravid women.Materials and method: A randomized, double-blinded, controlled trial, with healthy primigravid and multigravid women in spontaneous labor at term was considered in this study. Once the active phase of labor was achieved, either a single dose of 20 mg (1 mL) of HBB or placebo (1 mL saline) was given intravenously.Results: The mean duration of the first stage of labor was 191.1 ± 43.06 min in the primigravid patients of the HBB group, while it was 248.2 ± 66.1 min in the placebo group, a statistically significant difference of 57 min (p < 0.001). The mean duration of the first stage of labor was 170.1 ± 50.8 min in the multigravid patients of the HBB group, while it was 224.06 ± 53.7 min in the placebo group (difference of 54 min, p < 0.001). The mean duration of the first stage of labor was significantly different both for multigravida and primigravid patients. There was no significant change in the times for the second and third stages of labor. There were no significant differences in terms of APGAR scores noted at 1 and 5 min, prepartum and postpartum hemoglobin levels and birth weight. No adverse maternal and fetal effects were observed in both HBB and placebo groups.Conclusion: A single dose of 20 mg intravenous HBB is effective and safe in shortening the duration of the first stage of labor without any adverse effects on fetus and mother.

Likelihood of continued childbearing after cesarean delivery in the United States.

To estimate the likelihood of continued childbearing as a function of mode of delivery and number of cesarean deliveries and to explore whether it varies by sociodemographic characteristics. Cross-sectional data from the 2006-2010 National Survey of Family Growth were used to conduct an analysis of U.S. childbearing women. The birth trajectory for respondents who identified a live, singleton, first birth was assessed through four births. Population-weighted analyses were performed to test the association between route of delivery and sociodemographic characteristics with the likelihood of subsequent birth. Among 6,526 respondents, cesarean delivery, regardless of birth order, was associated with a lower likelihood of future birth, which decreased in a dose-response fashion as the number of cesarean deliveries increased. Among women with three births, those with two or three cesarean deliveries were 37% and 59% less likely (P<.05), respectively, to have a fourth birth when compared with women with three vaginal deliveries, adjusting for confounders. When interaction terms were added to the model, lower income women were significantly more likely to have a fourth birth after undergoing two or three cesarean deliveries than women with higher incomes (adjusted incidence rate ratio 2.50, 95% confidence interval [CI] 1.23-5.05 and adjusted incidence rate ratio 2.39, 95% CI 1.01-5.65, respectively). U.S. women who have cesarean deliveries are less likely to continue childbearing, especially because they undergo higher numbers of cesarean deliveries; however, this relationship is attenuated among low-income women. Given the risks associated with multiple cesarean deliveries, these findings underscore the need to further examine this relationship and what factors may be driving the income-based difference in childbearing after cesarean deliveries. II.

Assessing the incidence of gestational diabetes and neonatal outcomes using the IADPSG guidelines in comparison with the Carpenter and Coustan criteria in a Belgian general hospital

We have conducted a systematic universal screening for gestational diabetes mellitus (GDM) since 2008, following the criteria outlined by the International Association of Diabetes and Pregnancy Study Group (IADPSG) since 2011. However, we recently replaced the IADPSG standards with those established by the Belgian French Language Gynecologists and Obstetricians Group (GGOLFB). These new criteria indicate GDM when fasting plasma glucose (FPG) is ⩾0·92 g/l at the beginning of pregnancy or when an orally provoked hyperglycaemia test (75 g of glucose) between the twenty-fourth and twenty-eighth week results in an FPG of ⩾0·92 g/l and/or ⩾1·80 g/l after 1 hour and/or ⩾1·53 g/l after 2 hours. The goal of this retrospective study was to evaluate the incidence of GDM, neonatal outcomes, and the use of insulin therapy 21 months post-implementation of the IADPSG criteria within our centre. A total of 393 patients were diagnosed with GDM from January 2009 to December 2012. After applying the new criteria, the incidence of GDM rose significantly from 8 to 23% (P<0·0001). However, there were no significant changes in the proportion of GDM patients requiring insulin therapy (34·2% versus 34·7%) or the rate of foetal large for gestational age (11·2% versus 8·8%). In addition, the ⩾90% percentile decreased non-significantly from 96·3±0·6% to 94·3±0·70% (P = 0·057), whereas the lower quartiles and the proportion of cesarean deliveries (27·0% versus 25·6%) did not change significantly. Therefore, non-targeted screening significantly increased the incidence of GDM in our centre without significantly decreasing large for gestational age or the number of cesarean deliveries.

English

OBJECTIVE: The purpose of this study was to compare the feto-maternal outcome after induction of labor in oligohydramnios and borderline liquorat term. STUDY DESIGN: This retrospective study was conducted in a medical college and general hospital with women of 37-42 weeks' gestation. The amniotic fluid index (AFI) was determined in all cases using the four-quadrant technique. The cases were divided into two groups based on their AFI. Oligohydramnios group (n=102) with AFI ≤ 5 cm and borderline liquor group (n=99) with AFI of 5.1 to 8 cm. Induction of labor was done by misoprostol in all cases. Different maternal outcomes like mode of delivery, indication for operative or instrumental delivery, meconium stained liquor and perinatal outcomes were compared in between the two groups.RESULTS: The two groups were similar with regard to maternal age, parity, and gestational age. Meconium staining of the amniotic fluid was significantly higher in the group with AFI < 5 cm (p = 0.05). The number of cesarean deliveries and incidence non-reassuring fetal heart (fetal distress) were similar in both the groups. There was no significant difference between the two groups with regard to Apgar scores or admission to neonatal intensive care unit (NICU). CONCLUSION: Induction of labor at term in women with oligohydramnios is associated with an increased incidence of meconium staining of the amniotic fluid but the risk of cesarean delivery or fetal distress it is not increased as compared with borderline liquor.

Effectiveness of a novel device in the reduction of cesarean deliveries.

Objective. To test the hypothesis that the use of the HEM-AVERT Perianal Stabilizer will result in a reduction of cesarean births and shorter duration of second-stage labor. Study Design. In a prospective controlled trial, 102 women scheduled for vaginal delivery were randomized to either the HEM-AVERT investigational device or control group. Ninety eight (98) patients completed the study. A chi-square test was used to evaluate the difference in the number of cesarean deliveries between the investigational and control groups. Duration of second-stage labor was assessed as a secondary outcome. Results. Six (6) of the 50 patients in the investigational group (12%) failed to deliver vaginally and required cesarean delivery. Comparatively, 19 of the 48 control patients (39.6%) required cesarean delivery. Duration of second-stage labor was shorter in the investigational group, but the difference was not statistically significant. Results from 4 patients were excluded due to protocol violations. Conclusion. The HEM-AVERT device effectively reduced the incidence rate of cesarean deliveries in the investigational group when compared to women who delivered without use of the device. This trial is registered with ClinicalTrials.gov NCT01739543.

Robotic Repair of Uterine Dehiscence

During the past few decades, there has been a significant increase in the number of cesarean deliveries, and thus an increase in the number of complications. A common complication of multiple cesarean deliveries is symptomatic uterine scar dehiscence, for which there are no treatment guidelines available. We report a case of uterine scar dehiscence-the repair of it by robotic surgery-and review the literature on this defect. The patient was a 39-year-old woman, gravida 4 para 2022, complaining of persistent vaginal spotting for the prior 5 months with a history of a cesarean delivery 3 months before the onset of the symptoms. We report a case of a successful robotic repair of a symptomatic cesarean scar defect. We propose further studies that include more patients so this technique may become the standard for cesarean scar defect.

Delayed postpartum hemorrhage: the implications of making a diagnostic mistake

A 25-year-old woman, P1001 with unremarkable clinical history was admitted to her local referral hospital for severe vaginal bleeding (SVB), significant anemia (Hb 7 g/dl) and abdominal pain occurred 6 weeks after caesarean section. Ultrasound revealed a minimal flap in the Douglas and a 25-mm vascularized area on the uterine wall at the site of caesarean scar, which was confirmed by CT scan, hence a vascular malformation (AVM) was suspected. Angiography showed the presence of AVM at left corner of the uterus. Left ipogastric arteriography showed the early opacification of the dilated para-uterine venous plexus, associated with multiple microflow of active spreading of contrast from a branch of the uterine artery. Hemoglobin blood value rose to 10.1 g/dl after the first arterial embolization and red blood cell transfusion, but after the second hemorrhage it dropped to 8.0 g/dl. Then, a second selective embolization of the left uterine artery was performed with complete vessel occlusion. Nevertheless, the SVB persisted and a further embolization was performed on anterior branch of the left internal iliac artery. After few days SVB reappeared and the patient was admitted to our hospital (101 days after caesarean section). Ultrasonography and color Doppler evaluation showed a 15 9 8 9 5 mm left parametrial vascularized formation and intraperitoneal free fluid. Hysteroscopy was not performed because of the SVB. Because the angiography had been already detected location, size and relation of AVM to the uterine vasculature, an operative laparoscopy with multiple ligations of the uterine plexus was performed. This approach was preferred to laparotomic surgery because of its minimal invasion and complications, few hospitalization and recovery days. An ultrasound control showed a reduction of the left parametrial formation and the patient was asymptomatic. Elapsed 4 days, the patient presented the same symptoms and she was prepared for emergency hysteroscopy; a dehiscence of previous hysterotomy at the left uterine corner extended to isthmus–cervical tract was detected. Dehiscence was sutured after a laparotomy on previous scar. Common causes of delayed postpartum hemorrhage are retention of gestational products and endometritis. In this case, both were excluded. The management of vaginal bleeding provides hysteroscopy, which has not been possible to perform at first, because of the severe bleeding. Operative laparoscopy was carried out, but the lesion was not visible outside the uterus. A new episode of vaginal bleeding required an emergency diagnostic hysteroscopy, which showed the underlying cause of bleeding: a uterine scar dehiscence. This is a rare but potentially dangerous cause of delayed postpartum hemorrhage, which should be considered because of the increasing number of cesarean deliveries. Uterine scar dehiscence is estimated to occur between 0.3 and 1.9 % of cases and only a minority of these shows vaginal bleeding or abdominal pain [1]. Many patients may be asymptomatic, consequently incidence rate may be underestimated. The risk of scar deficiency is increased in retroflexed uterus and after multiple cesarean sections [2]. The etiopathogenesis is unclear. Generally, the uterine incision is performed transversely in the lower uterine segment, whose reduced thickness and vascularization decrease the risk of dehiscence [3]. Dehiscence could depend on the suture material used, the suturing technique itself, or both [4]. High uterine incisions, ischemic technique and the slowest resorbable suture should be considered. In our case, the D. Surico (&) C. Codeca A. Vigone N. Surico University of Eastern Piedmont, Novara, Italy e-mail: daniela.surico@med.unipmn.it

Ratio of Cesarean Deliveries to Total Operations and Surgeon Nationality Are Potential Proxies for Surgical Capacity in Central Haiti

The World Health Organization has a standardized tool to assess surgical capacity in low- and middle-income countries (LMICs), but it is often resource- and time-intensive. There currently exists no simple, evidence-based measure of surgical capacity in these settings. The proportion of cesarean deliveries in regard to the total operations (C/O ratio) has been suggested as a way to assess quickly the capacity for emergency and essential surgery in LMICs. This ratio has been estimated to be between 23.3 and 41.5 % in LMICs, but the tool's utility has not been replicated. We reviewed operative logbooks for the Partners In Health/Zanmi Lasante hospital in Cange, Haiti. We recorded data on all consecutive surgical patients from July 2008 to 2010 and calculated the C/O ratio by dividing the number of cesarean deliveries by the total number of operations performed. We also analyzed surgical data by surgeon nationality to provide additional information about local surgical capacity. A total of 3,641 operations were performed between 2008 and 2010. The C/O ratio decreased significantly between 2008-2009 and 2009-2010 (13.4 vs. 10.7 %, p = 0.001) as the surgical volume and resources increased. Nationality analysis demonstrated that Haitian surgeons were able to provide a spectrum of general and specialist surgical care. In its inherent relation to essential surgical procedures and to the overall rate of cesarean deliveries in the region, the C/O ratio can provide an accessible assessment of regional surgical resources. In Haiti, the change in the C/O ratio demonstrated a relative increase in surgical capacity from 2008 to 2010. An additional analysis of surgeon nationality ensured that C/O ratio estimates more accurately reflect local practitioner activity, but deficiencies in the regional capacity to address the local burden of surgical disease may still exist.

Effects of parity and mode of delivery on urinary incontinence among postmenopausal women in Taiwan

ObjectiveTo investigate the association between the prevalence of urinary incontinence and parity or mode of delivery among Taiwanese women aged 60years or older. MethodsBetween July 1999 and December 2000, a nationwide epidemiologic study was conducted in Taiwan among 2410 women selected by a multistage random sampling method. Face-to-face interviews with 1517 women were conducted. The relationship between the prevalence of urinary incontinence and the number of vaginal deliveries or number of cesarean deliveries was assessed by frequency and Pearson χ2 test using a significance level of less than 0.05. Logistic regression was used to investigate the significance of dichotomous dependent variables. ResultsDecades ago, most Taiwanese women (1435 of 1511 respondents, 94.97%,) gave birth via vaginal delivery and the rate of cesarean delivery was low (20 of 1513 respondents, 1.32%). Parity (odds ratio [OR], 2.42; 95% confidence interval [CI], 0.87–6.71; P=0.091), vaginal delivery (OR, 0.76; 95% CI, 0.39–1.47; P=0.408), and cesarean delivery (OR, 1.47; 95% CI, 0.59–3.70; P=0.409) did not increase the risk of urinary incontinence. ConclusionThere was no association between urinary incontinence and parity or mode of delivery among Taiwanese postmenopausal women decades after their first delivery.

317: Neonatal and infant morbidity and mortality among women with a failed trial of labor after cesarean

women with a failed trial of labor after cesarean Han-Yang Chen, Suneet Chauhan, William Grobman, Anthony Vintzileos, Cande Ananth, Alfred Abuhamad University of Wisconsin Madison, School of Medicine and Public Health, Center for Urban Population Health, Milwaukee, WI, Eastern Virginia Medical School, Department of Obstetrics and Gynecology, Norfolk, VA, Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL, Stony Brook-Winthrop University Hospitals, Obstetrics and Gynecology, Long Island, NY, Columbia University, Department of Obstetrics and Gynecology, New York, NY OBJECTIVE: Despite the increased maternal risks associated with failed trial of labor after cesarean (TOLAC), it remains unknown whether failed TOLAC is also associated with increased morbidity and mortality in infants. The purpose of this study was to determine rates of early (EMR), late (LMR), post-neonatal (PMR) and infant (IMR) mortality in those with failed TOLAC as compared to those with successful TOLAC, specifically among women at 34-41 weeks who had induction or stimulation of labor. Secondary measures of neonatal morbidity (5-min Apgar score 4 and neonatal seizures) were also compared. STUDY DESIGN: Linked birth and infant death cohort data, between 2000 and 2004, from the US were used to identify women with a prior cesarean who were between 34-41 weeks, delivered non-anomalous singletons, and underwent either labor induction or stimulation. Multivariable log-binomial regression models were fitted to estimate the risk ratio (RR) for infant morbidity and mortality in relation to TOLAC following adjustments for several confounders. RESULTS: During the study period, the rate of successful TOLAC among the 164,113 women who met the inclusion criteria declined from 62% in 2000 to 52% in 2004 (P 0.001). The rates of EMR, LMR, PNMR, and IMR for the overall cohort were 0.3, 0.3, 1.6 and 2.2/1,000 live births, respectively. A failed TOLAC was significantly associated with a higher risk of neonatal and infant mortality, as well as immediate neonatal morbidity (Table). CONCLUSION: Among women undergoing labor induction or stimulation, failed TOLAC is associated with a significantly higher rate of neonatal morbidity, as well as neonatal and infant mortality. 318 The association between induction of labor and primary cesarean delivery in the Northeastern U.S. between 1996 and 2004 Yvonne W. Cheng, Hung Key Nguyen, Sanae Nakagawa, Jonathan Snowden, Aaron Caughey University of California, San Francisco, Obstetrics & Gynecology, San Francisco, CA, Albert Einstein School of Medicine, School of Medicine, Bronx, NY, University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, Oregon Health and Sciences University, Obstetrics and Gynecology, Portland, OR, Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR OBJECTIVE: The annual incidence rates of labor induction and cesarean delivery have increased dramatically over the past decade. We aim to examine the association between induction of labor and cesarean delivery among low risk nulliparous women in the northeastern U.S. over time. STUDY DESIGN: This was a retrospective cohort study of non-anomalous, singleton, term, vertex live births by nulliparous women in the northeastern U.S. states between 1996 and 2004 using the U.S. Natality birth data. We excluded medical and obstetric conditions, yielding a low-risk population. The association between labor induction and cesarean delivery was examined by time trend in 2-year intervals using chi-square test and multivariable logistic regression. Populationbased expected and observed numbers of cesareans over time were estimated using baseline cesarean risk and adjusted odds ratio based on induction of labor. RESULTS: There were 1,300,393 live births meeting study criteria; of these, 21.4% had cesarean delivery. Compared to women without induction of labor, those induced had about 1.5 times the adjusted odds of cesarean: 1.58 for 1996 and 1998, 1.55 for 2000, 1.54 for 2002, and 1.55 for 2004. Of note, these odds ratios remained stable over the study period. However, the difference between observed and expected numbers of cesarean sections increased over time (Figure). CONCLUSION: While nulliparous women who had induction of labor had higher odds of cesarean, this effect estimates were stable over time. However, the actual number of cesarean deliveries increasingly deviated from the expected amounts, suggesting that increase in labor induction only provides partial explanation for the current cesarean epidemic.

Evaluation of demographic, clinical characteristics, and genetic polymorphism as risk factors for pelvic organ prolapse in brazilian women

Verify the association between genital prolapse, other risk factors and a polymorphism in exon 31 of the collagen III-a1 gene (COL3A1). The etiology of genital prolapse is multifactorial, and genetic defects have been proposed. Also, there is evidence that changes in collagen may be responsible for defects in pelvic floor support. The exon 31 polymorphism results in structural changes in the triple helical of the collagen and appears to lead to abnormal synthesis of type III collagen. Basic science study. The studied group consisted of 107 patients with stage III and IV genital prolapse (POP-Q). The control group included 209 women with stage 0 and I prolapse. After extracting genomic DNA from the peripheral blood, the exon 31 COL3A1 polymorphism was typed by restriction fragment length polymorphism analysis. Association between genital prolapse and exon 31 COL3A1 polymorphism. No statistically significant differences in genotype and allele frequencies were found between cases and controls (P = 0.75 and 0.66, respectively). Multiple logistic regression analyses identified age (OR = 1.05; 95%CI = 1.01-1.10), BMI (OR = 1.09; 95%CI = 1.01-1.17), presence of at least one vaginal delivery (OR = 7.22; 95%CI = 1.84-28.27), positive family history of POP (OR = 2.27; 95%CI = 1.05-4.93) and a macrosomic foetus (OR = 2.91; 95%CI = 1.24-6.79) as independent risk factors for genital prolapse. In contrast, the number of caesarean deliveries was found to be an independent protective factor (OR = 0.43; 95%CI = 0.24-0.78). The type III collagen exon 31 polymorphism is not a risk factor for pelvic genital prolapse in this sample.