Primary Elective Caesarean Section Research Articles

A Prospective Comparative Study of Removal of Urinary Catheter at 12 hours versus at or >24 Hours Following Elective Cesarean Section in Women

Background & Objective: To compare the outcomes of urinary catheter removal at 12 Hours versus at or >24 Hours post elective cesarean section. To assess and compare symptomatic UTI, time of ambulation, length of hospital stays and need for recatherization amongst these 2 groups.
 Methods: In all patients undergoing elective primary cesarean section, Preoperative urine routine and microscopy¯ were sent, UTI was ruled out, clinical examination was performed and were NPO at least 8 hours prior to surgery and given antibiotics. A foley catheter was inserted on the operating table immediately before starting cesarean section. Cesarean sections were performed in the usual manner under spinal anesthesia. After this, in Group 1 patients, catheter were removed 12hours post-operatively while in Group 2 it was removed 24 hours post-operatively. After catheter removal, women were encouraged to void and helped to ambulate.
 Results: 2 groups were compared and the overall rates of post caesarean section urinary complaints dysuria (8.69%), urinary frequeny(14.13%), urgency(10.86%), burning micturition(9.76%) were higher in 24 hours catheter removal group. The Mean duration of first Post-op voiding time (4 hours), ambulatory time(4 hours) and hospital stay(4 days) were shorter in 12 hours catheter removal group.
 Conclusion: Urinary catheter removal post Caesarean section at duration of 12 hours postoperatively is associated with decreased complications and morbidity in post Caesarean section women.

Factors Associated With Postoperative Opioid Prescribing After Primary Elective Cesarean Section.

Guidelines indicate the need to balance the risks of opioid prescribing with the need to adequately manage pain after cesarean section (CS). Although guidelines suggest the need for tailored opioid prescribing, it is unclear whether providers currently tailor opioid prescribing practices given patient-related factors. Thus, research is needed to first understand post-CS pain management and opioid prescribing. The objective of the present study was to identify factors related to CS discharge opioid prescriptions. This retrospective cohort study was approved by the Brooke Army Medical Center Institutional Review Board (San Antonio, Texas; #C.2020.094e) on June 23, 2020. Electronic health record data of healthy adult women undergoing primary elective CS, performed under regional neuraxial anesthesia at a single, academic, tertiary medical center from 2018 to 2019, were included. Multivariable regression examined patient and medical factors associated with post-CS opioid prescriptions. In the present sample (N = 169), 23% (n = 39) of patients did not use opioids postoperatively, while inpatient and almost all of those patients (n = 36) received a discharge prescription for opioids with a median amount of 225 morphine milligram equivalent doses. There was a lack of evidence indicating that patient and medical factors were associated with discharge opioid dose. Patient and medical factors were not associated with post-CS opioid prescribing. Larger studies are needed to better elucidate optimal post-CS pain management in the days and months that follow CS. Such findings are needed to better tailor opioid prescribing, consistent with clinical practice guidelines.

156 Trends in cesarean delivery on maternal request in the United States from 1999 to 2015

The rate of cesarean delivery has increased in the United States over the last several decades. The rate of cesarean delivery on maternal request (CDMR) however remains uncertain. The objectives of this study were to describe the prevalence and temporal trends of CDMR in the United States, and to characterize the population of patients who elect to undergo a CDMR. A retrospective cohort study was conducted using data from The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999 to 2015. An algorithm based on International Classification of Diseases, Ninth Revision (ICD-9) codes was created to identify patients who delivered by primary elective cesarean section in the absence of fetal or maternal indications. Maternal demographic characteristics between patients who delivered by CDMR and patients who did not were compared. Of the 13,698,836 deliveries included over the study period, 221,310 were identified as potential CDMR. CDMR rates peaked in 2009, and varied from 1% to 1.98% of all live births and 4.53% to 5.88% of all cesarean deliveries over the study period. Overall, the rate of CDMR among all live births increased over the study period, from 1% in 1999 to 1.56% in 2015 (p <0.0001). Patients who elected to deliver by CDMR were more likely to be over the age of 35, in the highest income quartile, and have private insurance, and were less likely to be African American (p <0.0001). Our findings indicate that CDMR accounts for a small proportion of all deliveries in the United States. Furthermore, rates of CDMR have increased only slightly since 1999. CDMR is more prevalent among patients with certain demographic characteristics. These results may indicate that the option of CDMR is more appealing or more frequently offered to a certain population of patients.

Effect of Primary Elective Cesarean Delivery on Placenta Accreta: A Case-Control Study.

Background:Cesarean section (CS) is an independent risk factor for placenta accreta. Some researchers think that the timing of primary cesarean delivery is associated with placenta accreta in subsequent pregnancies. The aim of this study was to investigate the risk of placenta accreta following primary CS without labor, also called primary elective CS, in a pregnancy complicated with placenta previa.Methods:A retrospective, single-center, case-control study was conducted at Peking University Third Hospital. Relevant clinical data of singleton pregnancies between January 2010 and September 2017 were recorded. The case group included women with placenta accreta who had placenta previa and one previous CS. Control group included women with one previous CS that was complicated with placenta previa. Maternal age, body mass index, gestational age, fetal birth weight, gravity, parity, induced abortion, the rate of women received assisted reproductive technology, other uterine surgery, and primary elective CS were analyzed between the two groups.Results:The rate of primary elective CS (90.1% vs. 69.9%, P < 0.001) was higher, and maternal age was younger (32.7 ± 4.7 years vs. 34.6 ± 4.0 years, P < 0.001) in case group, compared with control group. Case group also had higher gravity and induced abortions compared with the control group (both P < 0.05). Primary CS without labor was associated with significantly increased risk of placenta accreta in a subsequent pregnancy complicated with placenta previa (odds ratio: 3.32; 95% confidential interval: 1.68–6.58).Conclusion:Women with a primary elective CS without labor have a higher chance of developing an accreta in a subsequent pregnancy that is complicated with placenta previa.

Effect of Planned Mode of Delivery in Women with Advanced Maternal Age.

The purpose of this study was to determine the prognostic value of planned primary elective cesarean section versus planned vaginal delivery in women with advanced maternal age. We conducted a population-based, retrospective cohort study using the United States' Health Care Cost and Utilization Project's Nationwide Inpatient Sample to evaluate maternal outcomes in women with advanced maternal age delivering from 2003 to 2012. Healthy women who underwent primary elective cesarean section constituted a surrogate for low-risk planned cesarean delivery. Logistic regression was used to compare outcomes between women with planned cesarean and planned vaginal delivery. Among seven million births, we identified 442,067 deliveries in healthy women with advanced maternal age. The planned cesarean group comprised 7.96% of women in the cohort. When compared to healthy women in the planned vaginal group, women in the planned cesarean group had a significantly higher mortality ratio (2.56/10,000 vs. 0.44/10,000, p<0.01). The planned cesarean group was also at higher odds of numerous complications, including peripartum hysterectomy OR 1.81 (1.36-2.40), p<0.01, cardiac arrest OR 5.39 (4.54-6.38), p<0.01, acute renal failure OR 3.39 (1.78-6.46), p<0.01 and sepsis OR 2.27 (1.25-4.14), p<0.01. Planned cesarean section is a key factor significantly influencing maternal morbidity and mortality in healthy women with advanced maternal age. When possible, planned cesarean deliveries should be avoided in this population.

A study on obstetric profile of mothers undergoing primary caesarean section and their neonatal outcome in a tertiary care centre, South Kerala

Objectives : 1.) To studies the obstetric profile of mothers undergoing primary caesarean section in a tertiary care centre. 2) To study the associated maternal diseases in mothers undergoing primary caesarean section. 3) To study the outcome of the neonates delivered by primary caesarean section Materials and Methods : Cross sectional study was done on 150 women who underwent caesarean section for the first time during the period July2012 to July2013. Inclusion criteria : Women who underwent caesarean section for the first time either primi gravida or multi gravida are included. Exclusion criteria : Women who underwent previous caesarean sections are excluded. Study tool: Data collection method : All necessary details were personally collected from the records after obtaining permission from MRD incharge and maintaining confidentiality of the data Results : Compared to multipara, the nullipara has undergone more number of primary caesarean section. Induction patients have undergone more number of primary caesarean section when compared to spontaneous onset of labour. More number of mothers with GDM and PIH has undergone primary caesarean section when compared to other maternal diseases. The rate of emergency primary caesarean section is 88.7% which is very high when compared to elective primary caesarean section which is 11.3%. The leading indication for primary caesarean section is fetal distress followed by failure to progress. Only 27% of neonates needed NICU admission in mothers who underwent primary caesarean section.

Incidence of Early Postpartum Voiding Dysfunction in Primiparae: Comparison Between Vaginal Delivery and Cesarean Section.

To compare the incidence of early postpartum voiding dysfunction (PPVD) in primiparae women delivered vaginally (VD) to those delivered by elective Caesarean section (CS). A prospective study of primiparae in early postpartum period, were grouped into: VD group and CS group. Following the first 24 h from delivery, patients had uroflowmetry and post-void residual urine (PVR) volume measurement. Two hundred and fifty six primiparae women recruited; 204 (81%) had VD and 48 (19%) had primary elective CS. Forty-two women in the VD group (20.2%) diagnosed with PPVD compared to only four (8.3%) in the CS group (P = 0.05). Within VD group, women who had vaginal tear (86.4% vs. 44%, P < 0.001) or epidural analgesia (33.3% vs. 18.1%, P < 0.05) experienced higher incidence of PPVD. Women who had normal VD are at higher risk of transient PPVD than those delivered by CS during their early postpartum period.

Neonatal Transfer Rate and Mode of Delivery from 37th Week of Gestation in a German Perinatal Center Level 1.

Introduction: Rates for caesarean section are on the rise and the reasons for this are being discussed worldwide. As the data is unclear, the identification of additional predictive factors for caesarean section is important as caesarean sections are closely linked to maternal and neonatal morbidity. The aim of the study was to identify predictive factors for the transfer of the neonate to a neonatal intensive care unit (NICU) depending on the mode of delivery. The study investigated the neonatal transfer rates for singleton and twin pregnancies delivered at ≥ 36 + 0 weeks of gestation. Material and Methods: The data of all singleton (n = 4181) and twin pregnancies (n = 305 neonates), delivered between 1 January 2009 and 31 March 2012 in the OB/Gyn Department of the University Hospital Frankfurt/M, Germany, (perinatal center level 1) were evaluated. The indications for transfer to the NICU and possible predictive factors were evaluated. Results: Our study found a two times lower neonatal transfer rate for vaginal deliveries of pregnant women without risk factors compared to women with risk factors. The following neonatal transfer rates to the NICU were noted for singleton pregnancies: 4.7 % without risk factors, 8.3 % high-risk pregnancy, 6.2 % vaginal breech delivery, 9.3 % forceps delivery, 10 % elective primary caesarean section and 14 % secondary caesarean section. There was a statistically signific.

Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis

Is there an association between a Caesarean section and subsequent fertility? Most studies report that fertility is reduced after Caesarean section compared with vaginal delivery. However, studies with a more robust design show smaller effects and it is uncertain whether the association is causal. A previous systematic review published in 1996 summarizing six studies including 85 728 women suggested that Caesarean section reduces subsequent fertility. The included studies suffer from severe methodological limitations. Systematic review and meta-analysis of cohort studies comparing subsequent reproductive outcomes of women who had a Caesarean section with those who delivered vaginally. Searches of Cochrane Library, Medline, Embase, CINAHL Plus and Maternity and Infant Care databases were conducted in December 2011 to identify randomized and non-randomized studies that compared the subsequent fertility outcomes after a Caesarean section and after a vaginal delivery. Eighteen cohort studies including 591 850 women matched the inclusion criteria. Risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Data extraction was done independently by two reviewers. The meta-analysis was based on a random-effects model. Subgroup analyses were performed to assess whether the estimated effect was influenced by parity, risk adjustment, maternal choice, cohort period, and study quality and size. The impact of Caesarean section on subsequent pregnancies could be analysed in 10 studies and on subsequent births in 16 studies. A meta-analysis suggests that patients who had undergone a Caesarean section had a 9% lower subsequent pregnancy rate [risk ratio (RR) 0.91, 95% confidence interval (CI) (0.87, 0.95)] and 11% lower birth rate [RR 0.89, 95% CI (0.87, 0.92)], compared with patients who had delivered vaginally. Studies that controlled for maternal age or specifically analysed primary elective Caesarean section for breech delivery, and those that were least prone to bias according to the NOS reported smaller effects. There is significant variation in the design and methods of included studies. Residual bias in the adjusted results is likely as no study was able to control for a number of important maternal characteristics, such as a history of infertility or maternal obesity. Further research is needed to reduce the impact of selection bias by indication through creating more comparable patient groups and applying risk adjustment.

The risk of placenta accreta following primary elective caesarean delivery: a case–control study

To evaluate the risk of placenta praevia accreta following primary (first) elective or primary emergency caesarean section in a pregnancy complicated by placenta praevia. Retrospective matched case-control study, employing variable matching. Tertiary referral centre between 1993 and 2008. Sixty-five cases and 102 controls were used for the analysis from a total of 82667 births during the study period. Relevant data were abstracted from clinical records. Matching of cases with controls was based on co-existing placenta praevia, number of previous caesarean sections, and age, with one or two controls per case. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). Placenta accreta in a pregnancy complicated by placenta praevia following a primary elective or emergency caesarean section, and morbidity associated with pregnancies complicated by placenta accreta. Significantly more cases than controls had an elective caesarean section for their primary caesarean delivery (46.2 versus 18.6%; P<0.001). There were no differences between groups for previous pregnancy loss, uterine surgery, and vaginal delivery, before or after the primary caesarean section. Compared with primary emergency caesarean section, primary elective caesarean section significantly increased the risk of placenta accreta in a subsequent pregnancy in the presence of placenta praevia (OR 3.00; 95% CI 1.47-6.12; P=0.025). Our results suggest that women with a primary elective caesarean section without labour are more likely, compared with those undergoing primary emergency caesarean section with labour, to develop an accreta in a subsequent pregnancy with placenta praevia.

Early lactation failure and formula adoption after elective caesarean delivery: cohort study

ObjectiveTo investigate the effects of elective primary and elective repeat caesarean deliveries on lactation at hospital discharge.DesignCohort study.SettingFour Italian teaching hospitals – Padua, Brescia, L'Aquila and Udine.InterventionsDeliveries were classified as...

83: Neonatal outcome following primary elective caesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry

Cesarean Section at term but before 39 weeks is associated with increased perinatal morbidity.1 We wanted to evaluate the number and timing of elective caesarean sections at term in the Netherlands and to assess perinatal morbidity and mortality associated with this timing.

Secular Trends in Excess Fetal and Infant Mortality Using Perinatal Periods of Risk Analysis

Perinatal periods of risk (PPOR) provide an alternative analytical approach to studying infant mortality. Results can be used to focus community activities to improve infant and maternal health. This article demonstrates the use of PPOR to monitor trends in excess fetal and infant mortality related to disparities associated with race and ethnicity in Kansas City, MO (KC). Based on a comparison of PPOR analyses for 1996-2000 and 2001-2005, there was a 30% reduction in excess fetal and infant mortality in Kansas City and reductions for both non-Hispanic blacks (17%) and non-Hispanic whites (66.7%). However, the disparity ratio for excess mortality rates between non-Hispanic blacks and non-Hispanic whites nearly doubled. Prematurity, the most frequent cause of infant mortality in Kansas City during 2001-2005 accounted for 42.5% of the infant deaths. Being a teenage mother; having less than a high-school education; being unmarried; having an unintended pregnancy; being obese preconceptually; being diabetic; using substances such as tobacco or drugs during pregnancy; receiving late, inadequate or intermediate amounts of prenatal care; having a multifetal pregnancy; having a primary elective cesarean section; delivering a preterm infant or having a male infant; and being enrolled in Medicaid all increased the risk of infant death.

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.

A Systematic Review of the Efficacy of Cesarean Section in the Preservation of Anal Continence

Elective primary cesarean section is performed largely to avoid maternal pelvic trauma that may result in anal incontinence, although its efficacy in this regard has not been thoroughly assessed. We perform a systematic review of published reports that compare anal incontinence risk by mode of delivery. PubMed was searched from 1966 through August 2005. Authors were contacted for missing data or analyses. Both randomized and nonrandomized reports were included. Eligible studies included females having vaginal delivery or cesarean section, fecal and/or flatal incontinence was reported as an outcome, and risk was calculable from the reported data. Crude data were extracted from the reports, as well as reported odds ratios and confidence intervals. In the nonrandomized studies, adjusted odds ratios also were extracted and additional data obtained from authors to adjust risks for age and parity if not originally done. Sensitivity analyses were performed using quality indicators: age and parity adjustment, time to continence assessment, and mode of previous delivery. Fifteen studies were found eligible, encompassing 3,010 cesarean sections and 11,440 vaginal deliveries. The summary relative risk for fecal incontinence was 0.91 (95 percent confidence interval, 0.74-1.14). For flatus the relative risk was 0.98 (range, 0.86-1.13). The number needed to treat by cesarean section was 167 to prevent a single case of fecal incontinence. Five studies were judged to be of high quality. In these studies, the summary relative risk was 0.94 (range, 0.72-1.22) and number needed to treat was 198. The best evidence to assess the efficacy of cesarean section in the prevention of anal incontinence would be in randomized trials of average-risk pregnancies with few crossovers. In the absence of such trials and based on this review, cesarean section does not prevent anal incontinence. This implies that incontinence associated with delivery may be more likely incontinence caused by pregnancy.

B006 A Systematic Review of the Efficacy of Cesarean Section in the Preservation of Anal Continence

Objective Elective primary Cesarean section is performed largely to avoid maternal pelvic trauma that may result in anal incontinence. Its efficacy in this regard has not been thoroughly assessed.Methods The search was from 1966 through August, 2005, including both randomized and nonrandomized reports. Eligible studies included women having either vaginal delivery or Cesarean (C) section. Faecal and/or flatal incontinence was reported as an outcome and risk was calculable from the reported data. In the nonrandomized studies adjusted odds ratios were also extracted and additional data obtained from authors to adjust risks for age and parity. Sensitivity analyses were done using quality indicators – age and parity adjustment, time to continence assessment and mode of prior delivery.Results A total of 15 studies were found eligible, encompassing 3010 C sections and 11 440 vaginal deliveries. The summary relative risk for faecal incontinence was 0.91, 95% CI = 0.74–1.14, for flatus; 0.98, (0.86–1.13). The number needed to treat by C. section was 167 to prevent a single case of faecal incontinence. In five studies judged to be of high quality, the summary relative risk was 0.94 (0.72–1.22) and number needed to treat 198.Conclusion Caesarian section does not prevent anal incontinence. The incontinence associated with delivery may in fact be incontinence caused by pregnancy.

Advantages of Vaginal Delivery

Despite an impressive amount of effort and extensive research, our knowledge of parturition remains limited. Scientists have exhaustively investigated ‘‘the timing of birth’’; yet, we still have a limited understanding of the biologic mechanisms that control the events initiating delivery, and consequently, we lack tools to prevent these mechanisms from acting inappropriately. A multitude of factors and structures are involved; the uterus, the cervix, the placenta, and the fetus must all act in concert to ensure a successful delivery. We know that achievement of ‘‘perfect’’ myometrial contractile force to produce cervical dilatation is not the sole factor. Successful delivery also depends on pelvic shape and size as well as fetal size. Birth is perhaps the most exciting and risky journey taken over a lifetime. For many years, labor was simplistically regarded as the physiological process of expelling the fetus from the ‘‘womb’’ at or near term. Today, terms such as ‘‘labor’’ and ‘‘successful vaginal delivery’’ have a different meaning for many who have concentrated their attention onmaternal and fetal shortor long-term outcomes of a successful or unsuccessful vaginal birth, but also for the ones who have witnessed the evolution of obstetric ‘‘fashion.’’ Rational arguments have imposed a clear distinction between ‘‘facts’’ and ‘‘convenience.’’ Practice changes as knowledge progresses. One of the changes witnessed in the last decades is a steadily increasing focus on the fetus. Thus, it is not surprising to see that the overall rate of labor induction has doubled as part of our efforts to ‘‘save life.’’ Although there is compelling evidence to suggest elective induction of labor significantly increases the risk of cesarean delivery (CD), the concept of elective primary cesarean section is not anymore a ‘‘myth.’’ Powerful debate is taking place in obstetrics regarding the benefit of cesarean over vaginal delivery. Several lessons can be learned from this controversy, and skepticism must be countered only by solid lines of evidence. The purpose of this review is to provide the reader with a summary of our current understanding of the advantages of vaginal delivery.

Repeat cesarean section and primary elective cesarean section: Recently trained obstetrician-gynecologist practice patterns and opinions

This study was undertaken to determine opinions of obstetrician-gynecologists regarding vaginal birth after cesarean (VBAC) section and elective cesarean section. A questionnaire was administered to obstetrician-gynecologists attending 2 review courses. Of 500 obstetrician-gynecologists, 304 completed the survey for a response rate of 61%. Most (92%) counseled VBAC candidates differently, and 84% quoted differential VBAC completion rates on the basis of the indication for prior cesarean section. Uterine rupture was virtually always discussed (99%). Pelvic floor risks were infrequently discussed with urinary incontinence, pelvic organ prolapse, and fecal incontinence discussed by less than one third of obstetricians (30%, 28%, and 25%, respectively). Fifty-nine percent of physicians would perform a primary elective cesarean section, and 67% would perform a primary elective cesarean section specifically to prevent pelvic floor disorders. Two thirds of recent graduates are willing to perform an elective cesarean section to prevent pelvic floor injury. Most offer VBAC; however, less than a third include risk of pelvic floor injury in their informed consent discussions.

The influence of prior route of delivery: Postpartum maternal and neonatal outcomes

14 15 THE INFLUENCE OF PRIOR ROUTE OF DELIVERY: POSTPARTUM MATERNAL AND NEONATAL OUTCOMES ANNA MCKEOWN, DAVID LAGREW, MELISSA BUSH, JAMES KURTZMAN, University of California, Irvine, OB/Gyn Maternal Fetal Medicine, Orange, California, Saddleback Memorial Medical Center, Maternal Fetal Medicine, Laguna Hills, California OBJECTIVE: Accurate risk/benefit information is needed to counsel an increasing number of women requesting elective cesarean section. The purpose of this study was to assess maternal and neonatal postpartum outcomes associated with previous method of delivery. STUDY DESIGN: We analyzed prospectively collected singleton maternal and neonatal data from 7/2002-12/2003 in four MemorialCare hospitals. Birth data were collected into a dedicated perinatal database and combined with coded data from a MedAI database of postpartum maternal and neonatal procedures and outcomes. Patients were subdivided in four groups: (1) Nulliparous; (2) Prior vaginal; (3) Prior Cesarean (CS) without trial of labor (TOL); and (4) Prior Cesarean with TOL. Results were compared by chi square analysis with significance at P ! .05. RESULTS: During the study period there were 17,406 births fitting the above criteria. Compared to prior vaginal delivery, patients with prior CS had significantly increased risks of morbidity. The subgroup of prior CS patients without a TOL were more likely to require blood transfusion (P ! .001, OR 3.1), ICU admission (P ! .001, OR 4.5), and readmission within 30 days (P ! .025, OR 1.7) than patients with prior vaginal deliveries. Prior CS with TOL patients did not have these increased risks but were more likely to receive aminoglycosides for postpartum infection (P ! .01, OR 1.81). Term neonates born to mothers with previous CS were more likely to have prolonged hospitalization (>7 days) in both groups: no TOL (P ! .001, OR 6.69) and TOL (P ! .05, OR 2.51). There were no significant differences based on prior delivery route for neonatal mortality within the first 28 days of life, neonatal seizures or encephalopathy. CONCLUSION: Prior cesarean delivery is a significant risk factor for important postpartum morbidities of the mother and neonate. These risks and benefits should be carefully discussed with women considering elective primary cesarean section. SMFM Abstracts S7

The influence of prior route of delivery: Intrapartum procedures and outcomes

OUTCOMES DAVID LAGREW, MELISSA BUSH, ANNA MCKEOWN, JAMES T. KURTZMAN, Saddleback Memorial Medical Center, Maternal Fetal Medicine, Laguna Hills, California, University of California, Irvine, OB/Gyn Maternal Fetal Medicine, Orange, California OBJECTIVE: Despite intensive debate over cesarean section rates there is a paucity of information regarding the long term effects of a uterine scar. The purpose of this study was to evaluate the risk/benefit of prior route of delivery on intrapartum procedures and outcomes. STUDY DESIGN: We analyzed prospectively collected singleton maternal and neonatal data from 1/1/1998 to 12/31/2003 in four MemorialCare hospitals into a dedicated perinatal database at delivery. The patients were then divided into groups by presence of prior delivery, prior delivery method (vaginal or cesarean) and current trial of labor (TOL). Results were compared by chi square analysis with significance at P ! .05. RESULTS: During the study period there were 60,606 births fitting the above criteria. There were 28,638(47.3%) prior vaginal and 8,920 (14.7%) prior cesarean (CS) deliveries. Compared to patients with prior vaginal deliveries, patients with prior cesarean delivery had an increased risks of cesarean for abruptio placenta (P ! .01, RR 1.7); previa (P ! .001, RR 1.8), suspected uterine rupture (P ! .001, RR 25.7), intrapartum fetal non-reassuring fetal status (P!0.001, RR 1.6), breech (P ! .001, RR 1.8) and abnormal antepartum testing (P ! .001, RR 3.1); in addition, hysterectomy (P ! .001, RR 5.4) and infant intubations (P ! .001, RR 1.6). The increased risks of suspected rupture (P! .001, RR 17.1) and hysterectomy (P! .001, RR 6.7) persisted by removing patients with TOL. Prior cesarean patients had reduced risk of thick meconium (P ! .001, RR 0.7) and shoulder dystocia (P ! .001, RR 0.2). There was no difference in the risk of emergent cesarean, 5 minute Apgar ! 7 or stillbirth. Prior cesarean patients who avoided TOL had fewer dilatation and curettages (P ! .001, RR 0.2). CONCLUSION: These data strongly confirm that the lowest risk multiparous parturient is the woman with a prior vaginal delivery. These risks and benefits should be carefully considered when counseling a patient for elective primary cesarean section who is planning future pregnancies. 329 THE PREVALENCE OF HELICOBACTER PYLORI IN THE HISPANIC POPULATION AFFECTED BY HYPEREMESIS GRAVIDARUM RICHARD LEE, VIVIEN PAN, DEBORAH WING, University of Southern California, Keck School of Medicine, Department of Obstetrics and Gynecology, Los Angeles, California, University of California, Irvine, Department of Obstetrics and Gynecology, Orange, California OBJECTIVE: To determine the prevalence of Helicobacter pylori (H pylori) seropositivity in pregnant Hispanics affected by hyperemesis gravidarum. STUDY DESIGN: This is a prospective cross-sectional study conducted over a 22 month period. Serum from pregnant Hispanics affected by hyperemesis gravidarum and unaffected Hispanics matched for age and ethnicity were tested for H pylori IgG. Hyperemesis gravaridum was defined by the presence of all of the following criteria: (1) intractable nausea and vomiting for greater than 24 hours prior to admission occuring at least three times per day; (2) three-plus ketonuria on urine dipstick; (3) weight loss of at least five pounds within three weeks of diagnosis. IgG levels specific for H pylori were determined by ELISA. Assuming the background prevalence of H pylori serum positivity in the Hispanic population is approximately 60%, 38 patients in each group were needed to detect a 30% difference in affected patients versus controls with a power of 80% and a = .05. Statistical analysis was performed using c. RESULTS: A total of 82 patients between the ages of 18 to 39 years were enrolled. Of 40 patients diagnosed with hyperemesis gravidarum, 26 (65%) were seropositive for H pylori compared to 28 of 42 (67%) unaffected controls (P = .94). There were no statistical differences in maternal age or countries of origin between the two groups. CONCLUSION: The overall prevalence of H pylori seropositivity in this patient population is 66%. In pregnant Hispanics affected by hyperemesis gravidarum, H pylori seropositivity is not increased compared to unaffected controls.