Mode Of Previous Delivery Research Articles

PP.13 Previous Caesarean Delivery and the Risk of Unexplained Stillbirth: Analysis of 128,585 Second Pregnancies in Scotland, 1999–2008

BackgroundA previous study (Lancet 2003; 362:1779–84) reported an increased risk of unexplained stillbirth in women with previous caesarean delivery among women having second births in Scotland, 1992–1998. Subsequent studies have...

Unusual case of spontaneous uterine rupture in a single gestational primipara

Spontaneous rupture of the primiparous uterus is a rare but catastrophic obstetrical emergency. It is usually associated with prior uterine surgery, trauma, or placental abnormality. To remind physicians to include this condition in their differential diagnosis of acute abdominal pain in pregnant patients, we describe an interesting case of spontaneous uterine rupture that clinically mimicked bowel perforation. A 27-year-old single primiparous pregnant woman presented with sudden onset of severe abdominal pain and peritoneal signs, with absence of vaginal bleeding at 26 weeks’ gestation. The usual risk factors for uterine rupture, such as advanced maternal age, scarred uterus due to mode of previous delivery, or unusual pregnancy, were not present in our patient. Based on clinical examination, abdominal sonography and magnetic resonance imaging, uterine rupture was suspected and eventually confirmed at exploratory laparotomy. No uterine pathological abnormality was noted on the microscopic examination The preterm newborn expired after surgery. Since surgical intervention is the only definitive treatment, emergency physicians should be aware of this rare complication. Emergency physicians should be aware of spontaneous uterine rupture in pregnant patients, even in the absence of risk factors.

Comparison of Cervical Parameters by Three-Dimensional Ultrasound according to Parity and Previous Delivery Mode

We would like to find out that whether the patient's parity, previous delivery mode and previous labor could influence cervical parameters. Cervical length, volume and width were measured using two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound on normal pregnant women. This study was conducted between January 2009 and December 2010 in singleton pregnant women who were admitted for routine antenatal care at hospitals in affiliation with the Catholic University, Seoul, Korea. The study group was classified by parity (nullipara and multipara) and previous delivery mode (cesarean section group and vaginal delivery group). The previous cesarean section group was divided by elective group who did not undergo labor and labor group who underwent labor. Cervical parameters such as cervical length, volume and width were measured using 2D and 3D ultrasound examinations in the first and second trimesters and the results were analyzed between those groups mentioned above. One hundred and twenty-one pregnant women in their 1st trimester and 233 pregnant women in their 2nd trimester (a total of 354) were enrolled in this study. Cervical parameters were not statistically significant from parity, nor previous delivery mode and previous labor in 1st trimester. Cervical volumes were not statistically significant from nullipara and elective cesarean section groups (35.96±9.81 vs. 34.73±9.75 cm3), but the nullipara groups were significantly lowered in the vaginal group (35.96±9.81 vs. 43.10±11.87 cm3) in 2nd trimester. For the nullipara group, cervical widths were not statistically significant in the elective cesarean section group but these were significantly lower than labor and previous vaginal group in the 2nd trimester. The cervical volume and width have an influence on parity, previous delivery mode and labor in the 2nd trimester.

Factors influencing the choice between cold knife conization and loop electrosurgical excisional procedure for the treatment of cervical intraepithelial neoplasia

To determine whether cold knife conization (CKC) or loop electrosurgical excisional procedure (LEEP) is the better option for the treatment of cervical intraepithelial neoplasia (CIN) under specific circumstances. We retrospectively reviewed the medical records of patients who underwent CKC or LEEP for the treatment of CIN. The proportion of non-negative surgical margins between the two treatment groups was calculated based on their age, parity, previous mode of delivery, and grade of CIN. The Student's t-test and multivariate logistic regression analysis were used to find the better option for the treatment of CIN under the specific circumstances. A total of 118 patients were enrolled in the study. Between the two treatment groups, there was no significant difference in the overall proportion of non-negative surgical margins (P > 0.05). The grade of CIN, the previous mode of delivery, and parity did not affect the surgical margin status. The CKC treatment group had a significantly lower incidence of non-negative surgical margins than the LEEP treatment group (14.3% vs. 52.6%, respectively; P < 0.05) in the patients >45 years of age. Based on multivariate analyses, LEEP was identified as a significant risk factor for non-negative surgical margins in the patients >45 years of age. Of the 11 patients with non-negative surgical margins who underwent a secondary procedure within 6 months of the initial CKC or LEEP, five patients (45.5%) had residual CIN II and III. In patients >45 years of age, CKC is the preferred treatment for CIN.

Examining Local Government Service Delivery Arrangements Over Time

While scholars of local service delivery arrangements are fully aware the process is dynamic, research has tended to take the form of cross-sectional studies that are inherently static in nature. In this article, the authors model the determinants of production mode accounting for past delivery decisions. They find, not surprisingly, that there are strong inertial effects; previous delivery mode is a strong predictor of the current service delivery arrangement. More interestingly, the impact of the transaction cost nature of services on production choice is conditioned on past decisions, such as the extent of contracting and the type of vendors used. There is also evidence that contract management capacity and the competitiveness of the contracting environment are influential.

Reduced Fertility After Cesarean Delivery

To explore the association between mode of delivery and subsequent fertility. Deliveries registered in the Medical Birth Registry of Norway were linked to mothers through national identification numbers. The study population was 596,341 women who had their first delivery during 1967-1996, and who were followed up through 2003. We compared rates of continuation to a subsequent birth according to mode of previous delivery (cesarean compared with vaginal). If the first child survived the first year of life, cesarean delivery was associated with a significantly reduced probability of a second birth (relative risk [RR] 0.82, 95% confidence interval [CI] 0.81-0.83 during 1967-1981, and RR 0.88, 95% CI 0.88-0.89 during 1982-1996). Following a stillbirth or an infant loss, the association was less strong during 1967-1981 (RR 0.93, 95% CI 0.89-0.97) and no longer significant during 1982-1996 (RR 1.00, 95% CI 0.97-1.03). A similar pattern was observed from the second to the third birth and in subgroup analyses of women with preeclampsia or breech presentation and in an obstetric low-risk group. Cesarean delivery was more strongly associated with reduced fertility if the infant survived than if it was stillborn or died. This suggests that the reduced fertility was to a large degree voluntary and not related to the indication, nor to any physical consequence, of the cesarean delivery. II.

Women’s Views on Elective Primary Caesarean Section

ObjectiveElective primary Caesarean section (EPCS), Caesarean section performed at a woman’s request in the absence of a recognized obstetrical indication, is becoming increasingly common. Recent articles and opinions in both the medical and lay press have polarized this issue. The purpose of this study was to determine the opinions and choices of nulliparous and multiparous women with respect to mode of delivery. MethodsAll women attending antenatal clinics at Kingston General Hospital from May to August 2005 were invited to participate in a confidential survey. Basic demographic data including maternal age, level of education, parity, and previous mode of delivery were collected. Respondents who had had a previous Caesarean section were excluded from data analysis. The questionnaire provided a written statement of potential benefits and risks of an EPCS compared with vaginal delivery; no other counselling was provided. Respondents were asked if EPCS should be offered to all women and whether they would choose EPCS if given the choice. Respondents were also asked to indicate the most and least influential factors in their decision. ResultsResponses were received from 107 nulliparous women and 103 multiparous women. Thirteen percent of nulliparas (14/107) stated that they would choose EpCs if given the option, compared with 5% of multiparas (5/103). Fifty-one percent of nulliparas (55/107) and 28% of multiparas (29/103) believed that EPCS should be offered to all women receiving antenatal care. The most and least important reasons, chosen from a list, for requesting or declining EPCS varied between nulliparas and multiparas. The convenience of scheduling permitted by Caesarean section was not important for either multiparas or nulliparas. The perceived risks of vaginal delivery were commonly cited by both nulliparas and multiparas as reasons for requesting EPCS, whereas the risks of Caesarean section for the baby or for future pregnancies were the most commonly cited reasons to decline EPCS in both groups. Regardless of the decision to request or decline EPCS, cost to the health care system was not an important factor for either nulliparas or multiparas. ConclusionThe majority of pregnant women surveyed would not request an EPCS. However, a significant number of pregnant women, both nulliparous and multiparous, felt that women should be given the option of undergoing EPCS.