Primary Cesarean Delivery Research Articles

Pre-Pregnancy Physical Fitness, Body Mass Index and Gestational Weight Gain as Risk Factors for Cesarean Delivery: A Study of Active Duty Women.

The World Health Organization considers the optimal rate of delivery by Cesarean among healthy nulliparous women to be <15%. In 2020, the rate of primary Cesarean delivery (CD) in the US among nulliparous women with singleton, vertex pregnancies was 26%. An enhanced understanding of factors associated with women undergoing CD may assist in reducing this rate. One potential factor is the level of physical fitness in women before pregnancy. Active duty (AD) soldiers provide a cohort of women who begin pregnancy while actively pursuing physical fitness. The research team sought to assess the effects of pre-pregnancy physical fitness of AD soldiers as measured by the Army Physical Fitness Test (APFT) on the incidence of CD in AD women, in addition to examining known demographic and pregnancy risk factors in this cohort. We conducted a retrospective study of healthy AD nulliparous women who delivered their singleton pregnancy of >32 weeks at a tertiary medical center between 2011 and 2016. Soldiers undergoing non-labored CD were excluded. Demographics, pre-pregnancy APFT results, antepartum and labor and delivery data were collected from the Digital Training Management System, the outpatient, and inpatient medical records respectively. Weight gain in pregnancy was assessed using the Institute of Medicine Guidelines for pregnancy. Fisher's exact tests and chi-squared tests assessed associations between categorical outcomes, and unpaired t-tests assessed differences in APFT scores between women who underwent CD vs. vaginal delivery. Multivariable logistic regression analysis was used to assess for independent risk factors among all collected variables. The protocol was approved by the Regional Health Command-Pacific Institutional Review Board. Five-hundred-and-twenty-three women delivering singleton pregnancies between 2011 and 2016 were reviewed for this study. Three-hundred ninety women met inclusion criteria: 316 in the vaginal delivery cohort, and 74 in the CD cohort, with a CD rate of 19%. Twenty non-labored CDs were excluded. Neither total APFT performance nor performance on the individual push-up, sit-up or run events in the 15 months prior to pregnancy was associated with mode of delivery. Excessive gestational weight gain (EWG) and neonatal birth weight were the only two factors independently associated with an increased rate of cesarean delivery. Women who had excessive gestational weight gain, were twice as likely to undergo CD as those who had adequate or insufficient weight gain (24% vs. 12%, p = 0.004). Soldiers delivering a neonate ≥4,000 g were 2.8 times as likely to undergo CD as those delivering a neonate <4,000 g (47% vs. 17%, p < 0.001). Age, race, and rank, a surrogate marker for socioeconomic status, were not associated with mode of delivery. Pre-pregnancy fitness levels as measured by the APFT among healthy physically active nulliparous AD women showed no association with the incidence of labored CD. EWG is one modifiable factor which potentially increases the risk for CD in this cohort and has been documented as a risk factor in a recent metanalysis (RR-1.3). Counseling on appropriate weight gain in pregnancy may be the most effective way to reduce the rate of CD among this population of healthy and physically active women.

A Nonimmune Hydrops Case.

A Nonimmune Hydrops Case.

Is HbA1c in the first trimester associated with adverse outcomes among pregnant Asian Indian women without gestational diabetes?

AimsThe aim of this study is to determine the association of elevated HbA1c in the first trimester (HbA1c-FT) with adverse events among pregnant Asian Indian women without gestational diabetes (GDM). MethodsThis retrospective cohort study included 1618 pregnant women who delivered at a single urban tertiary care center and had HbA1c-FT estimation between January 2011 and September 2017. Those with GDM according to a 75-g OGTT after 24 gestational weeks were excluded. Multivariable logistic regression models assessed the association between elevated HbA1c-FT and adverse events. ResultsAt a cutoff of ≥37 mmol/mol (5.5%), HbA1c-FT was associated with preterm birth at <37 gestational weeks (adjusted odds ratio (OR) 2.10, 95% CI 1.11–3.98). There was a continuum of risk for primary caesarean delivery with higher HbA1c-FT levels (adjusted OR per 5-mmol/mol (0.5%) increase in HbA1c-FT for primary caesarean delivery: 1.27, 95% CI 1.06–1.52). In the crude analysis, gestational hypertension was associated with HbA1c-FT, but not after adjustment for confounding factors. HbA1c-FT was not associated with other adverse events (macrosomia, large for gestational age babies, or other neonatal complications). ConclusionsEven without GDM, the results suggest an association of HbA1c-FT with preterm birth and primary caesarian delivery among Asian Indian women.

Experience of a tertiary pandemic centre on the labour and delivery of 337 pregnant women with COVID-19: a prospective cohort study from Turkey

The aim of the present study is to share the experience of a tertiary reference pandemic centre on the labour and delivery of pregnant women with coronavirus disease 2019 (COVID-19). This prospective cohort study was conducted on pregnant women with COVID-19 (n = 337). Patients were divided into two groups based on their severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) positivity (n = 103 positive and n = 234 negative) during the delivery. Thereafter, clinical characteristics and perinatal outcomes were compared between the groups. Moreover, delivery characteristics and clinical features were compared between primary caesarean section (n = 117) and normal spontaneous vaginal delivery cases (n = 100). Labour induction was performed in 16% of cases with a failure rate of 35%. Caesarean rate was 70% and the most common indication was worsening in maternal condition. Significant, positive and moderate correlations were observed between COVID-19 severity at admission (r = 0.422, p<.001), radiologic findings consistent with COVID-19 (r = 0.400, p<.001), the necessity for oxygen support during the delivery (r = 0.406, p<.001) and postpartum worsening in maternal condition. A significant, positive weak correlation was found between caesarean delivery and postpartum worsening in maternal condition (r = 0.176, p<.001). COVID-19 seems to be associated with increased rates of obstetric complications and caesarean delivery. Impact Statement What is already known on this subject? Increased rates of foetal distress and caesarean section were reported in pregnant women with COVID-19. Appropriate management of labour and delivery in infected pregnant women is crucial to obtain favourable perinatal outcomes. What do the results of this study add? COVID-19 seems to be associated with increased rates of obstetric complications and caesarean delivery. PCR positive group had significantly higher primary and prelabor caesarean delivery rates. Severe/critic COVID-19 infection rate was significantly higher in the primary caesarean group. Significant, positive and moderate correlations were observed between COVID-19 severity at admission, radiologic findings consistent with COVID-19, the necessity for oxygen support during the delivery and postpartum worsening in maternal condition. A significant, positive weak correlation was found between caesarean delivery and postpartum worsening in maternal condition. What are the implications of these findings for clinical practice and/or further research? Management and delivery of pregnant women with COVID-19 should be individualised. The findings of the present study may lead to the establishment of future obstetric protocols in this special population.

Adherence to Definitions of Labor Arrest Influence on Primary Cesarean Delivery Rate.

The cesarean delivery rate in the United States is 31.9%. One of the leading indications for primary cesarean delivery is labor arrest. A modern understanding of the labor curve supports more time prior to the diagnosis of labor arrest. We conducted this study to examine the impact of adherence to the modern criteria for labor arrest and failed induction on rates of primary cesarean delivery and to identify predictors of meeting these criteria. We analyzed rates of primary cesarean deliveries overall and primary cesarean deliveries occurring due to arrest of dilation, arrest of descent, and failed induction among the 17,877 live births at a large academic center from 2010 through 2013. Multiple logistic regression modeling identified predictors of meeting the new criteria for these indications based on guidelines published by the 2012 National Institute of Child Health and Human Development. The primary cesarean delivery rate decreased from 23.5 to 21.1% (p = 0.026) from 2010 to 2013. Primary cesarean delivery rate for labor arrest and failed induction decreased from 8.5 to 6.7% (p = 0.005). The percentage of primary cesarean deliveries meeting the 2012 criteria for labor arrest increased from 18.8 to 34.9% (p = 0.002), and the rate of primary cesarean deliveries due to arrest of dilation decreased from 5.1 to 3.4% (p < 0.0005). The percentage of cases meeting the 2012 criteria for arrest of descent increased from 57.8 to 71.0% (p < 0.007), while primary cesarean delivery rate due to arrest of descent remained relatively unchanged, 3.1 to 2.6% (p = 0.330). A decrease in the primary cesarean rate was attributable to a decrease in cesarean for arrest of dilation in the setting of a significant increase in meeting the 2012 criteria for arrest of dilation. At the end of the study period, 65.2% of cesareans still did not meet the criteria for arrest of dilation. Greater rates of adherence to these guidelines may yield further reductions in the cesarean rate. · Primary cesarean delivery for labor arrest was decreased.. · Meeting criteria for labor arrest increased.. · A hospitalist provider increased odds of meeting criteria..

Seeking the Truth About Primary Elective Cesarean Delivery and Pelvic Floor Disorders: A Systematic Review and Meta-Analysis.

A better understanding of the effect of elective cesarean delivery (CD) on the development of pelvic floor disorders can help obstetricians counsel pregnant women. This study aimed to perform a systematic review and meta-analysis evaluating whether primary elective CD is protective against pelvic floor disorders. Using the MOOSE criteria, electronic databases were searched for studies that compared the prevalence of pelvic floor disorders among primiparous women. Outcomes of interest were urinary incontinence (UI), fecal incontinence (FI), anal incontinence (AI), and pelvic organ prolapse (POP). Comparisons were made between CD before the onset of labor ("Elective CD"), CD after trial of labor ("Labor CD"), and vaginal delivery (VD). Risk ratios (RRs) were computed using STATA. Between-study heterogeneity was assessed via Cochrane's homogeneity test and review of the I2 statistic. Nineteen studies were included. The overall prevalence of UI for Elective CD was estimated at 7% (95% confidence interval [CI], 3%-13%), Labor CD at 14% (95% CI, 8%-21%), and VD at 26% (95% CI, 20%-32%). Meta-analysis demonstrated a decreased risk of UI after Elective CD compared with Labor CD (RR, 0.75; P = 0.011) or VD (RR, 0.43; P < 0.001). There was a decreased risk of FI or AI after Elective CD compared with VD, but not when compared with Labor CD. Only 2 studies examined POP, precluding meta-analysis. Among primiparous women, Elective CD may be protective against UI when compared with Labor CD. There was not a protective effect of Elective CD against FI and AI when compared with Labor CD. More data on the effect of elective CD on POP are needed.

Comparison of Prophylactic Norepinephrine and Phenylephrine Infusions During Spinal Anaesthesia for Primary Caesarean Delivery in Twin Pregnancies: A Randomized Double-Blinded Clinical Study.

BackgroundNorepinephrine has been associated with improved heart rate (HR) and cardiac output (CO) compared to phenylephrine as a treatment for post-spinal hypotension during caesarean delivery (CD) in singleton pregnancies. Our current study compared the effects of norepinephrine and phenylephrine in maintaining maternal hemodynamics after spinal anaesthesia in twin pregnancies during elective CD.MethodsThis was a double-blinded, randomized, controlled study. From December 2017 to December 2018, 62 women with healthy twin term pregnancies undergoing elective CD under spinal anaesthesia were studied. Following spinal induction, either norepinephrine (6 μg/mL) or phenylepinephrine (75 μg/mL) was infused at 60 mL/h to maintain systolic blood pressure (SBP) near baseline until delivery. HR, SBP, systemic vascular resistance (SVR), and CO were collected using anaesthesia monitors and continuous-pulse waveform analysis. The primary outcome was maternal CO. Other parameters of maternal hemodynamics, umbilical cord blood gases, and adverse events were also compared.ResultsHemodynamic variables (CO, SBP, HR, and SVR) between spinal anaesthesia induction to skin incision were similar between the two groups (P = 0.889, 0.057, 0.977, and 0.416, respectively). The incidence of bradycardia was significantly higher in the phenylephrine group (69%) than in the norepinephrine group (24.2%, P<0.001). Maternal nausea and vomiting, hypotension, reactive hypertension, and neonatal outcomes did not differ between the groups.ConclusionWhen administered as a prophylactic fixed-rate infusion, phenylephrine and norepinephrine are both capable of maintaining maternal blood pressure following spinal anaesthesia in twin pregnancies. There were no differences in the maternal hemodynamics or foetal outcomes between women receiving norepinephrine and phenylephrine.Previous PresentationsPresented at the 51st Society for Obstetric Anesthesia and Perinatology Annual Meeting, Phoenix, Arizona, May 1–5, 2019.Clinical Trial Number and RegistryNo. ChiCTR-IOR-17013358.

An informative video before planned cesarean delivery and maternal anxiety—a multicenter randomized controlled trial

Cesarean delivery is one of the most common procedures performed in obstetrics, and although cesarean delivery is a blissful occasion, it is commonly associated with fear and anxiety for the new mother. We aimed to study the impact of watching a detailed, informative video on maternal anxiety levels, childbirth experience, and patient satisfaction in patients undergoing a primary cesarean delivery. We performed a multicenter randomized control trial. Women scheduled to undergo a primary nonemergent cesarean delivery were recruited. All participants in the intervention group watched an informative video on recruitment. This 4-minute video described in detail the expected cesarean delivery process: preparations before entering the operation room, regional anesthesia administration, sterile covering, the surgical procedure itself, and recovery (including mobilization and lactation). Situation-specific anxiety was measured at recruitment, before exposure to the video (S1), at the day of the operation (S2), and at postpartum day 1 (S3) using the State-Trait Anxiety Inventory score. In addition, participants answered a 10-item Childbirth Experience Questionnaire. A sample size of 63 per group was planned to achieve 80% power to detect a difference of 5 points in the primary outcome (State-Trait Anxiety Inventory score on the day of the operation). Overall, 154 participants from 4 medical centers were randomized, and 132 participants were analyzed after completing all questionnaires, 64 participants in the video group and 68 participants in the control group. The groups did not differ in demographics and delivery characteristics and had similar baseline anxiety levels (S1). On operation day (S2, the primary outcome), significantly lower anxiety levels were reported in the video group than in the control group (State-Trait Anxiety Inventory scores, 41.3±9.5 vs 49.3±10.3; P<.001). Moreover, anxiety levels in postpartum day 1 (S3) remained significantly lower in the video group (P<.001). No difference between the groups in childbirth experience score or patient satisfaction was demonstrated. A detailed informative video shown to patients before primary cesarean delivery decreased maternal anxiety levels before and after the procedure.

Postoperative Cesarean Pain Management and Opioid Use Disorder: Anticipate the Need for Higher Opioid Doses and Communicate Expectations With Patients and the Obstetric Team.

Peripartum care coordination for the obstetric patient on medications for opioid use disorder (OUD) can be challenging and is best accomplished by a multidisciplinary team. The benefits of buprenorphine, methadone, or naltrexone initiation or continuation in pregnancy are well established and beyond the scope of this commentary; instead, we narrow the focus on planning for sufficient pain management in labor and during recovery from cesarean delivery. Conversations about postoperative pain management should begin in the antepartum period, and likely do for the 15%-20% of individuals with a history of cesarean delivery who schedule a repeat cesarean. Nevertheless, 18%-20% of pregnant individuals deliver via primary cesarean delivery, underscoring the need for universal antepartum counseling on the possibility of undergoing and recovering from an unanticipated major abdominal surgery. The optimal intrapartum and postpartum pain regimen for individuals with OUD remains incompletely characterized as research on this topic is limited. Enhanced understanding of the unique needs of postpartum individuals with OUD will aid in closing knowledge gaps and elevate the standard of care in this population.

A COMPARATIVE STUDY OF PRIMIGRAVIDA WITH UNENGAGED V/S ENENGAGED HEAD AT ONSET OF LABOUR AT TERM IN THE DEPARTMENT OF OBSTETRICS &amp; GYNAECOLOGY, SMS MEDICAL COLLEGE, JAIPUR

Objective: The study was conducted to compare the outcome of labour between the unengaged and engaged head at the onset of labour at term in primigravidas. The aim was to determine the course of labour in between unengaged and engaged head in primigravida at term at the onset of labour and to study the maternal and neonatal outcome.&#x0D; Design: A prospective hospital-based comparative study.&#x0D; Methods: In this prospective comparative study, primigravida women at onset of labour at term who were admitted in labour room and satisfying inclusion and exclusion criteria were included. Group (I) study group included 110 primigravida at term with unengaged (at 37-41weeks) head at onset of labour and in Group (II) Control Group 110 primigravida at term with engaged (at 37-41weeks). Detailed clinical history, physical examination and investigation are reported. The duration of stages of labour and total duration of labour and its partographic analysis, need for Induction and augmentation of labour or surgical intervention, mode of delivery and fetomaternal outcome was recorded.&#x0D; Results: In Group I, 83.64% cases went into spontaneous labour while 90 % cases in Group II. 16.36% cases in group I and 10% cases in group II needed induction of labour with PGE2 gel. In group I, 68.18% required augmentation of labour compared to 33.63% in group II. Duration of 1st ,2nd stage of labour and total duration was more in group I as compare to group-II. Incidence of normal vaginal delivery and LSCS were 52.73%,32.73%respectivaly in group I while 71.82%,17.27% respectively in group II, the difference was statistically significant with p-value 0.011. Fetomaternal morbidity which was higher in group-I as compare to group-II was documented which was not statistically significant.&#x0D; Conclusion: The unengaged head in primigravida at the onset of labour at term can have normal vaginal delivery with appropriate induction and augmentation of labour and constant vigilance throughout the labour by partograph monitoring. Which can reduce primary caesarean delivery rate, maternal morbidity and healthcare expenditure in unengaged primigravida. Proper trial of labour in primigravida with unengaged head at term in the absence of cephalopelvic disproportion, vaginal delivery is possible with watchful expectancy with appropriate means of intervention.&#x0D; Keywords: Primigravida, Engaged, Unengaged, Lower segment caesarean section.

Monofilament vs multifilament suture for uterine closure at the time of cesarean delivery: a randomized clinical trial

Different factors may influence the closure of the uterine wall, including suture material. Suture materials may indeed influence tissue healing and therefore the development of scar defects. To test whether uterine closure using synthetic absorbable monofilament sutures at the time of cesarean delivery would reduce the rate of cesarean scar defects compared with uterine closure using synthetic absorbable multifilament sutures. Parallel-group, nonblinded, randomized clinical trial of women with singleton pregnancies undergoing cesarean delivery at term in a single center in Italy. The inclusion criteria were singleton pregnancy, first or second cesarean delivery, scheduled and emergent or urgent cesarean deliveries, and gestational age between 37 0/7 and 42 0/7 weeks. Eligible participants were randomly allocated in a 1:1 ratio to either the monofilament group (polyglytone 6211 [Caprosyn]; Covidien, Dublin, Ireland) or the multifilament suture group (coated polyglactin 910 suture with Triclosan [Vicryl Plus]; Ethicon, Inc, Raritan, NJ). The primary outcome was the incidence of cesarean scar defect at ultrasound at the 6-month follow-up visit. The secondary outcomes were residual myometrial thickness and symptoms. Overall, 300 women were included in the trial. Of the randomized women, 151 were randomized to the monofilament group and 149 to the multifilament group. However, 27 women were lost to follow-up: 15 in the monofilament group and 12 in the multifilament group. Of note, 6 months after delivery, the incidence rates of cesarean scar defect were 18.4% (25 of 136 patients) in the monofilament group and 23.4% (32 of 137 patients) in the multifilament group (relative risk, 0.79; 95% confidence interval, 0.41-1.25; P=.31). The mean residual myometrial thicknesses were 7.6 mm in the monofilament group and 7.2 mm in the multifilament group (mean difference, +0.40 mm; 95% confidence interval, -0.23 to 1.03). There was no between-group substantial difference found in the incidence of symptoms, including pelvic pain, painful periods, and dyspareunia. In singleton pregnancies undergoing primary or second cesarean delivery, the use of synthetic absorbable monofilament sutures at the time of uterine wall closure was not associated with a reduction in the rate of cesarean scar defect 6 months after delivery compared with the use of synthetic absorbable multifilament sutures.

Reducing Implicit Bias in Maternity Care: A Framework for Action

Reducing Implicit Bias in Maternity Care: A Framework for Action

Trends in racial and ethnic disparity for the risk of primary cesarean delivery

The primary cesarean delivery rate has significantly increased over time leading to important impacts on maternal morbidity and mortality. Racial disparities in obstetric care have been well well-established, and may impact primary cesarean delivery rates. The aim of this study is to describe trends in rates and indications for primary cesarean delivery by race and ethnicity.

Do pregnancy outcomes differ by mode of insulin delivery for type 1 diabetes mellitus?

Type 1 diabetes mellitus (T1DM) in pregnancy increases maternal and neonatal complications. These complications are related to degree of hyperglycemia and can be reduced with insulin treatment, via multiple daily injections (MDI) or continuous subcutaneous insulin infusions (CSII). CSII appears superior to MDI in non-pregnant patients, but it is unclear whether CSII confers clinical benefits in pregnancy. This study investigated whether mode of insulin delivery affects risk of complications among pregnant individuals with T1DM, in a contemporary cohort accounting for disease severity. All T1DM singleton pregnancies delivered at UCSF from 01/2008 to 07/2020 were included. The primary predictor was mode of insulin delivery, the primary maternal outcome was primary cesarean delivery (PCD), and the primary neonatal outcome was NICU admit. Baseline characteristics were compared using Fisher’s exact and Kruskall-Wallis tests. Odds ratios (OR) were obtained using a generalized estimating equations model to account for individuals with > 1 pregnancy during the study period. Early A1c and time since T1DM diagnosis were included in adjusted analyses as markers of disease severity. 129 individuals with 153 pregnancies were included, with 40% using MDI and 60% using CSII. There was no difference in PCD between the groups (51% CSII vs 49% MDI). CSII was associated with a significant reduction in the odds of NICU admit (57% vs 87%, p < 0.01), even after adjusting for early A1c, time since diagnosis, preterm birth, and year of delivery (adjusted OR 0.33, 95% CI 0.12-0.90). When used for T1DM in pregnancy, CSII reduced the odds of NICU admit by 67%. Currently, shared decision-making is utilized to determine best mode of insulin delivery, as there is no compelling evidence to promote use of one mode over the other in pregnancy. These findings provide preliminary support for improved neonatal outcomes with CSII and, if replicated in larger, multicenter cohorts, may encourage use of CSII over MDI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prediction model for primary cesarean delivery in patients with gestational diabetes mellitus

To identify predictors of primary cesarean delivery (PCD) in patients with gestational diabetes mellitus (GDM) and to develop and validate a clinically relevant prediction model to assist in patient counseling.

Is age over forty a risk factor for morbidity in women undergoing primary cesarean delivery?

Cesarean delivery (CD) is associated with increased maternal morbidity including increased blood loss, need for transfusion, ICU admission and hysterectomy compared to vaginal delivery. Advanced maternal age (AMA) confers additional obstetric risks, including higher rates of CD. It is not yet well understood whether increased maternal morbidity from CD is more common among women of advanced maternal age. Our objective was to investigate the risk of complications related to primary CD among women of advanced maternal age, specifically > 40 years.

Exposure to an informative video before planned Cesarean-delivery and maternal anxiety-a multicenter randomized controlled trial

We aimed to study the impact of exposure to a detailed informative video on maternal anxiety levels, childbirth experience, and patient satisfaction – in patients undergoing a primary Cesarean delivery (CD).

Medical versus elective induction of labor resulted in comparably low cesarean rates in single center

Medical induction of labor (mIOL) is generally associated with high risk of Cesarean Delivery (CD) and performed under non ideal circumstances. We sought to compare the rate of primary CD in women requiring mIOL to women undergoing elective induction of labor (eIOL) at term in viable pregnancies.

Early Versus Routine Oral Glucose Tolerance Test in Women With Intermediate Hyperglycemia at First Prenatal Visit: A Retrospective Cohort Study in China.

Background and ObjectivesIntermediate hyperglycemia in the first half of pregnancy, defined as a fasting plasma glucose level between 5.1- 6.9 mM, increases the risk of gestational diabetes mellitus, but clinical evidence for further management is lacking. We aim to evaluate the effectiveness of an early oral glucose tolerance test (OGTT) followed by the identification of intermediate hyperglycemia on pregnancy outcomes in real world setting.Subjects and MethodsA retrospective cohort study was conducted at the Obstetrics and Gynecology Hospital, Shanghai, China, between 2013 and 2017. Women with intermediate hyperglycemia at the first prenatal visit were identified and underwent an immediate (within one week) or a routine OGTT (24-28 gw) according to their wishes and received nutrition and exercise advice. Women diagnosed of gestational diabetes (GDM) were managed by standard interventions. Primary outcome was larger for gestational age (LGA). Secondary outcomes were primary cesarean delivery, preterm birth, shoulder dystocia or forceps delivery, preeclampsia, neonatal hypoglycemia, hyperbilirubinemia, and low Apgar score. Logistic regressions with or without a further propensity score-matched analysis were performed.ResultsAmong 42406 women involved, 1104 (2.6%) with intermediate hyperglycemia at the first prenatal visit were identified, of whom 176 (15.9%) underwent an early OGTT and 741 (67.1%) received a routine OGTT. Logistic regression showed that an early OGTT was not significantly associated with an altered risk of LGA (adjusted OR 1.13, 95% CI 0.73-1.75) but was related to an increased odds for neonatal hyperbilirubinemia (adjusted OR 2.89; 95% CI 1.55-5.37). No significant associations were observed for other secondary outcomes. These trends remained consistent in propensity score-matched models.ConclusionsOur data from a real-world setting did not support that an early OGTT among women with intermediate hyperglycemia at the first prenatal visit improved pregnancy outcomes.

The association between primary cesarean delivery in primipara and subsequent mode of conception, a retrospective study

Objective To examine the association between primary cesarean delivery and the mode of conception in the subsequent delivery among women without a history of infertility. Methods A retrospective study. Women with the first two consecutive deliveries in our medical center were included. Excluded were women who conceived following fertility treatments or were older than 35 years at their first delivery Results Twenty-three thousand four hundred and twenty-seven women were included in the study. Of those, 2215 (9.5%) underwent cesarean delivery in their first delivery, while 21,212 (90.5%) delivered vaginally. Univariate analysis revealed that women with primary cesarean delivery compared to women how delivered vaginally had higher rates of fertility treatments at the subsequent delivery (2.5 vs. 0.8%; p < .01). Those who had fertility treatments were significantly older during both the first and second deliveries, had higher rates of diabetic disorders of pregnancy (pregestational and gestational) at both the first and second deliveries, obesity and morbid obesity at the second delivery, and higher incidence of repeat cesarean delivery. Multivariate analysis revealed that the only factor that correlated significantly with the use of fertility treatments at the second delivery was maternal age at second delivery [aOR 1.2 (1.1–1.3), p < .01]. Conclusion Among women without a history of infertility, cesarean delivery in the first delivery is not independently associated with fertility treatments in the subsequent delivery.