Rate Of Elective Cesarean Delivery Research Articles

Neonatal Outcomes of Infants Diagnosed with Fetal Growth Restriction during Late Pregnancy versus after Birth.

Objective: The aim of this study was to investigate the potential differences in the outcomes of neonates in whom FGR was diagnosed late in pregnancy as compared to those in whom growth restriction was diagnosed after birth. Methods: A retrospective study was conducted in a tertiary medical center between 2017 and 2019. The study included women carrying a single infant with an estimated fetal weight below the tenth percentile in whom FGR was diagnosed during late pregnancy, after 32 gestational weeks (known late-onset FGR; study group) or only after birth (unknown FGR; control group). Data were collected by review of the electronic health records. The primary outcome measure was the rate of composite adverse neonatal outcome. Results: A total of 328 women were included, 77 (23.47%) in the known-FGR group and 251 (75.53%) in the unknown-FGR group. In the known-FGR group, an etiology for the FGR was identified in 28.57% cases, most commonly placental insufficiency (21.74%). Compared to the unknown-FGR group, the known-FGR group was characterized by significantly higher rates of elective cesarean delivery (15.58% vs. 9.96%, p < 0.001), preterm birth (18.18% vs. 3.98%, p < 0.01), and labor induction (67.53% vs. 21.51%, p < 0.01). A significantly higher proportion of neonates in the known-FGR group had a positive composite adverse outcome (38.96% vs. 15.53%, p < 0.01). For multivariate regression analysis adjusted for maternal age, gestational age at delivery, and mode of delivery, there was no difference between groups in the primary outcome (aOR 1.73, CI 0.89-3.35, p = 0.1). Every additional gestational week at delivery was a protective factor (aOR = 0.7, 95% CI 0.56-0.86, p < 0.01). Conclusions: A prenatal diagnosis of late-onset FGR is associated with higher intervention and preterm birth rates as compared to a diagnosis made after birth. Fetuses diagnosed with late-onset FGR during pregnancy should undergo specific and personalized assessment to determine the cause and severity of the growth delay and the best management strategy. This study highlights the importance of careful decision-making regarding the induction of labor in late-onset FGR.

Twin pregnancy following a short interpregnancy interval: Maternal and neonatal outcomes

ObjectiveTo evaluate maternal and neonatal outcomes of women with twin pregnancies following a short interpregnancy interval (IPI < 6 months).Study design.A retrospective computerized database study in a single tertiary medical center between 2005 and 2021. Women who had an index singleton delivery and a subsequent twin gestation in their next pregnancy at the Shaare Zedek Medical Center (SZMC) were included. Maternal and neonatal outcomes of twin pregnancies following a short IPI (<6 months) were compared to those with an optimal IPI (18–48 months). Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) were calculated. ResultsDuring the study period, 2,079 women had an index singleton delivery followed by a twin gestation in their next pregnancy recorded at our medical center; 116 (5.9 %) had a history of short IPI, and 1,057 (50.8 %) had a history of optimal IPI. Women with a history of short IPI had higher rates of preterm labor < 37 weeks and < 34 weeks, NICU admissions and prolonged hospital stay of the first and second fetuses, mechanical ventilation of the first fetus, 1 and 5 Minute Apgar score lower than 7 of the second fetus and lower rates of elective cesarean delivery. An adjusted multivariate analysis showed that a history of short IPI was not an independent risk factor for preterm birth either < 34 weeks or < 37 weeks or for composite adverse neonatal outcome of the first and second twin. ConclusionTwin pregnancy following a short IPI was not associated with neither preterm labor nor composite adverse neonatal outcome.

Association between elective cesarean delivery and duration of breastfeeding in Ma'anshan City from 2013 to 2014

Objective: To analyze the correlation between elective cesarean delivery and duration of breastfeeding in Ma'anshan city from 2013 to 2014. Methods: From May 2013 to September 2014, a total of 3 474 pregnant women with the first prenatal checkup were recruited from Ma'anshan maternal and child health care hospital. Finally, 3 109 pregnant women were included after exclusion of those with terminated pregnancies, adverse birth outcomes, twin or multiple pregnancies, breech traction, breech midwifery and loss of delivery information. Demographic data of pregnant women, mode of delivery and breast feeding of children were collected through questionnaires and hospital records. Logistic regression model was used to analyze the relationship between elective cesarean delivery and duration of breastfeeding in children, with the mode of delivery as independent variable and the duration of breastfeeding as dependent variable. Results: The age of 3 109 subjects was (26.6±3.6) years old, the rate of vaginal delivery was 51.1% (1 589), and the rate of elective cesarean delivery was 46.4% (1 443), among which the rate of non-indicative elective cesarean delivery was 26.4% (820), the rate of indicative elective cesarean delivery was 20.0% (623), and the rate of emergency cesarean delivery was 2.5% (77). The proportion of breastfeeding lasting until 4, 12 and 18 months was 45.0% (1 348/2 998), 23.7% (702/2 962) and 5.2% (154/2 944), respectively. After adjusting the confounding factors, compared with vaginal delivery, the OR (95%CI) values of breastfeeding for 4 months in indicative elective cesarean delivery and non-indicative elective cesarean delivery women were 0.870(0.714-1.059), 0.795(0.665-0.949), and the OR (95%CI) values of breastfeeding for 12 months were 0.772(0.611-0.975), 0.755(0.610-0.934), respectively. Conclusion: Elective cesarean delivery may result in shorter duration of breastfeeding in children.

The effect of the systematic birth preparation program on fear of vaginal delivery and quality of life.

The aim of this study was to assess the impact of systematic birth preparation program on fear of vaginal delivery and quality of life (QoL) in pregnant women who request elective cesarean delivery without any obstetric indication. This study was conducted prospectively. A total of 100 women who requested elective cesarean delivery due to psychosocial reasons were included into the study. Women were divided into two groups according to their desire to participate in the systematic birth preparation program. Group A: case group (n = 50) consisted of women who participated in the systematic birth preparation program. Group B: control group (n = 50) received usual antenatal care. All patients were interviewed with questionnaires including the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF) and Edinburgh Postnatal Depression Scale (EPDS) at postpartum 6th week. Type of delivery, maternal request for cesarean section, scores for QoL, and postpartum depression were compared between the two groups. Vaginal delivery rate was significantly higher in among the patients who received the systematic birth preparation program (group A: 78%, group B: 56%). Maternal request for elective cesarean section significantly decreased after the systematic birth preparation program (group A: 8%, group B: 28%). In group A, the WHOQOL-BREF-TR mean scores (SD) for physical domain, psychological domain, and environmental domain were significantly higher than the values exhibited in group B. In scores of the postpartum depression scale, there were no significant differences between the two groups (p = 0.075). The current study indicates that systematic birth preparation program may decrease the rate of elective cesarean delivery by reducing fear of vaginal delivery and improve the quality of life at postpartum period.

58: Association between twin vaginal delivery promotion and twin vaginal birth

Association between twin vaginal delivery promotion and twin vaginal birth. Using randomized trial data and society guidelines promoting twin vaginal birth as evidence, we implemented a program promoting twin vaginal delivery at an academic tertiary care center in 2013. The program included a provider needs assessment, provider didactics on and simulation of vaginal twin delivery, a hospital protocol for twin delivery, online patient education material, and the creation of a dedicated twin clinic for the highest risk twin pregnancies. The objective of the study is to investigate the impact of the program on vaginal delivery rates for twins. Out of 1,574 twins delivering between 2010 and 2015, 897 were eligible for inclusion. Rates of obstetric characteristics with the exception of intrauterine growth restriction were similar across the study. The rate of vaginal delivery nearly doubled by the last year of the study compared to the first year of the study (50.5% v. 27.8%, p<0.01 across years) with a lower number of patients electing cesarean delivery (59.8% v. 36.0%, p<0.01 across years) (Figure). After adjusting for fetal presentation, maternal age, and parity the adjusted odds of vaginal delivery increased across the study period with a stable decline in the adjusted odds of elective cesarean delivery (Table). The adjusted odds of vaginal delivery doubled comparing the time period before and after the intervention (aOR 2.12, 95% CI 1.54-2.91) and the adjusted odds of maternal and neonatal morbidity remained stable. Comparing the rates of twin vaginal birth before and after the intervention, 7.7 patients would need to be seen in a clinical environment promoting twin vaginal birth to prevent one cesarean delivery for twins. The promotion and support of attempted twin vaginal delivery is associated with an increase in rates of twin vaginal birth primarily due to decreased rates of elective cesarean delivery. Hospital-based implementation of similar programs may be a way to decrease rates of primary cesarean delivery for twins.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Twin Birth Study: 2-Year Neurodevelopmental Follow-up of the Randomized Trial of Planned Cesarean or Planned Vaginal Delivery for Twin Pregnancy

(Am J Obstet Gynecol. 2016;214:371.e1–371.e19) Twin pregnancies occur more often and present with complications in 2% to 3% of all deliveries. Earlier studies reporting reduced risk of adverse perinatal outcomes for one or both twins when delivered by elective cesarean delivery has led to increased rates of elective cesarean delivery. The Twin Birth Study, a randomized controlled trial, enrolled women with twin pregnancies to planned cesarean or planned vaginal deliveries. Primary analysis revealed that cesarean delivery did not alter the risk of fetal or neonatal death as compared to vaginal delivery. The secondary outcome was a combination of death or neurodevelopmental delay of the children at 2 years of age. This study presented the 2-year outcomes of the children in the Twin Birth Study.

Effect of health education on knowledge, attitudes, and practice of pregnant women in reducing elective cesarean delivery rate

Effect of health education on knowledge, attitudes, and practice of pregnant women in reducing elective cesarean delivery rate

Anhedonia, anxiety, and depression components of Edinburgh postnatal depression scale in cesarean delivery

Introduction Previous studies have indicated that cesarean delivery might pose risk factors for post-partum depression (PPD). However, results are conflicting and have failed to clearly distinguish between elective (ElCD) and emergency (EmCD) cesarean delivery. Objective The rate of elective cesarean delivery is rapidly increasing all over the world and it is important to identify whether the mode of delivery has an influence on PPD. The Edinburgh Postnatal Depression Scale (EPDS) is a widely used instrument for PPD screening, also capable to detect in subscales anhedonia, anxiety, and depression factors. Methods A cohort of 959 Italian mothers delivering a healthy baby at Policlinico Abano Terme, Italy, completed the EPDS 2 days after delivery. Results EPDS scores were significantly higher in mothers with a cesarean delivery compared to mothers with a vaginal delivery (7.0±4.8 vs 6.1±4.2, P P Conclusions The results of our study indicate that women who had an ElCD have an increased risk of developing early symptoms of post-partum depression, anxiety, and anhedonia. In particular, this study shows that the use of EPDS subscales in the immediate post-partum is a good tool to better understanding the spectrum of maternal post-partum psychological problems related to delivery mode.

Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age.

To delineate adverse obstetric and neonatal outcomes as well as indications for cesarean delivery by maternal age in a contemporaneous large national cohort. This was a retrospective analysis of electronic medical records from 12 centers and 203,517 (30,673 women aged 35 years or older) women with singleton gestations stratified by maternal age. Logistic regression was performed to investigate maternal and neonatal outcomes for each maternal age strata (referent group, age 25.0-29.9 years), adjusting for race, parity, body mass index, insurance, pre-existing medical conditions, substance and tobacco use, and site. Documented indications for cesarean delivery were analyzed. Neonates born to women aged 25.0-29.9 years had the lowest risk of birth weight less than 2,500 g (7.2%; P<.001), admission to neonatal intensive care unit (11.5%; P<.001), and perinatal mortality (0.7%; P<.001). Hypertensive disorders of pregnancy were higher in women aged 35 years or older (cumulative rate 8.5% compared with 7.8%; 25.0-29.9 years; P<.001). Previous uterine scar was the leading indication for cesarean delivery in women aged 25.0 years or older (36.9%; P<.001). For younger women, failure to progress or cephalopelvic disproportion (37.0% for those younger than age 20.0 years and 31.1% for those aged 20.0-24.9-years; P<.001) and nonreassuring fetal heart tracing (28.7% for those younger than 20.0 years and 21.2% for those aged 20.0-24.9-years; P<.001) predominated as indications. Truly elective cesarean delivery rate was 20.2% for women aged 45.0 years or older (adjusted odds ratio 1.85 [99% confidence interval 1.03-3.32] compared with the referent age group of 25.0-29.9 years). Maternal and obstetric complications differed by maternal age, as did rates of elective cesarean delivery. Women aged 25.0-29.9 years had the lowest rate of serious neonatal morbidity. : II.

Bonding and breastfeeding after a cesarean delivery

Breastfeeding is associated with benefits to lifelong health, yet the rate of exclusive breastfeeding remains low in many industrialized countries. In the United States, less than one half of mothers breastfeed for 6 months, and only 15% do so exclusively [1]. Similarly, while more than 80% of mothers who reside in Italy initiate breastfeeding [2], only 55% of mothers who exclusively or predominantly breastfeed during the postpartum hospital stay still breastfeed 6 months after delivery, and fewer than 40% practice full breastfeeding within the first 6 months [3]. Mode of delivery, in particular cesarean delivery (CD), is widely believed to affect breastfeeding adversely. Some studies reported no association and others an inverse relation [4]. CD (prelabor or in-labor) has increased rapidly worldwide. It accounts for 31.8% of all births [5], and it is even more widespread in China and parts of South America, where rates are reported to be between 40% and 50% [6,7], figures far in excess of the WHO recommended rate of 15% [8]. The rise in elective prelabor CD is thus particularly concerning. In the United States, the number of elective CDs increased by 53% between 1996 and 2007 [9], whereas in England there was a 250% increase between 1980 and 2010, and currently 40% of all CDs are prelabor [10]. The contribution of maternal choice to the increasing elective CD rate is important. In the United Kingdom, 6–8% of pregnant women express a preference for CD [11], whereas in Australia, an increase in elective CD has not been accompanied by increases in potentially explanatory health related factors [12]. This finding should be interpreted with caution as maternal choice is not the only reason for elective CD, and there are a wide range of medical reasons that obstetricians recommend a prelabor CD [13]. Instead, in-labor cesarean delivery is often associated with the cumulative impact of different intrapartum interventions, which may affect a woman’s decision and ability to initiate breastfeeding. Therefore, better understanding of caesarean section rates, their consequences and their benefits will consent to professionals to monitor the quality of their practice to ensure that women can make the right feeding choice. Breastfeeding is considered the ideal way to provide nutrition to infants, and can significantly reduce infant morbidity. The World Health Organization (WHO) has developed the “Ten Steps to Successful Breastfeeding”, a strategy to support and improve breastfeeding [14], suggesting the use of standard definitions for breastfeeding outcomes. However, the duration of any and

Increased Rate of Elective Cesarean Delivery and Neonatal Respiratory Disorders in Twin Pregnancies

We examined whether the incidence of neonatal respiratory disorders has increased with the increased rate of elective cesarean delivery in twin pregnancies. We reviewed the obstetric records of 292 twin deliveries with vertex presentation of the first twin after 37 weeks' gestation at our hospital from 2000 through 2008. The study period was divided into 3 parts as follows: period 1: 2000 through 2002 (n=76); period 2: 2003 through 2005 (n=104); and period 3: 2006 through 2008 (n=112). We compared the rate of elective cesarean delivery due to maternal request and the incidence of transient tachypnea of the newborn (TTN). There has been a significant increase in rate of elective cesarean delivery (period 1: 18%; period 2: 25%; period 3: 48%) over the past several years. This increase was observed to be due to an increase in maternal requests for elective cesarean delivery. However, there were no significant differences in the incidence of TTN in the 3 periods [period 1: 7.2%; period 2: 6.7%; period 3: 8.0%]. The recent increase in the rate of cesarean delivery did not cause the increase in the incidence of neonatal respiratory disorders in twin pregnancies.

Cesarean delivery outcomes from the WHO global survey on maternal and perinatal health in Africa

Objective To assess the association between cesarean delivery rates and pregnancy outcomes in African health facilities. Methods Data were obtained from all births over 2–3 months in 131 facilities. Outcomes included maternal deaths, severe maternal morbidity, fresh stillbirths, and neonatal deaths and morbidity. Results Median cesarean delivery rate was 8.8% among 83 439 births. Cesarean deliveries were performed in only 95 (73%) facilities. Facility-specific cesarean delivery rates were influenced by previous cesarean, pre-eclampsia, induced labor, referral status, and higher health facility classification scores. Pre-eclampsia increased the risks of maternal death, fresh stillbirths, and severe neonatal morbidity. Adjusted emergency cesarean delivery rate was associated with more fresh stillbirths, neonatal deaths, and severe neonatal morbidity—probably related to prolonged labor, asphyxia, and sepsis. Adjusted elective cesarean delivery rate was associated with fewer perinatal deaths. Conclusion Use of cesarean delivery is limited in the African health facilities surveyed. Emergency cesareans, when performed, are often too late to reduce perinatal deaths.

Information médicale et choix des patientes. Influences sur la pratique de l'accouchement du siège à terme par voie basse

Objective The mode of delivery of term singleton breech presentation has been argued for decades. Many elements are responsible for the current increase in the rate of elective cesarean delivery. Among these elements, the influence of medical information and patients' choices are unknown. Patients and methods We studied retrospectively, between January 1996 and December 2005, the mode of term breech delivery in a French maternity. Results Medical information relates primarily to the complications of vaginal birth. Patient's request for an elective Cesarean has been in constant increase since 1996. Discussion and conclusion Medical information and patients' choices strongly influence the practice of breech delivery.

For Baby’s Better Breathing After Elective Cesarean Delivery, Each Week In Utero Counts

Rates of elective cesarean delivery without clear medical indication have increased dramatically worldwide; however, this practice can increase the risk for neonatal respiratory morbidity. In a prospective cohort study of 34,458 live singleton deliveries from 1998 through 2006 in a Danish hospital, the respiratory status of 2687 infants born by elective cesarean delivery was compared with that of …

Children Born to HIV-1-Infected Women in Sweden in 1982-2003

To describe the HIV-1 epidemic among childbearing women and their children in Sweden, a population-based analysis of data on all known mother-child pairs in Sweden with perinatal exposure to HIV-1 1982-2003 was conducted. The mother-to-child transmission (MTCT) rate in children prospectively followed from birth decreased from 24.7% in 1985-1993 to 5.7% in 1994-1998 and 0.6% in 1999-2003. The use of antiretroviral treatment of the mother during pregnancy and/or prophylactic antiretroviral intervention increased from 2.3% to 91.6% during the same period, and the elective cesarean delivery rate increased from 8.0% to 80.3%. No MTCT of HIV-1 occurred in Sweden after 1999.Fifty-one vertically HIV-1-infected children aged 2.7 to 17.6 years were living in Sweden by 31 December 2003, 71% being treated with antiretroviral agents. No HIV-1-related child death has been reported in Sweden after 1996. The conclusion is that MTCT of HIV-1 can be almost eliminated when appropriate resources are available. A national pregnancy screening program for HIV-1 running since 1987 with a high acceptance rate and the implementation of measures to prevent MTCT since 1994 have resulted in a significant decrease in the number of infected children. Inasmuch as knowledge of the infection status of the mother is crucial for reduction in MTCT of HIV-1, continued antenatal screening is important even in a low-prevalence country such as Sweden.

Neonatal Respiratory Morbidity Risk and Mode of Delivery at Term: Influence of Timing of Elective Cesarean Delivery

In view of the increasing rates of elective cesarean delivery in Western countries, occasioned chiefly by previous cesarean delivery or breech presentation, this study was designed to compare rates of respiratory distresssyndrome (RDS) and transient tachypnea of the newborn (TTN) in infants delivered electively at term during each week of gestation between 37 + 0 and 41 + 6 weeks gestation. Control women who delivered vaginally were matched with the study group for week of gestation. Elective cesarean deliveries at or after 37 + 0 weeks gestation totalled 1284, representing 13% of live births during the years 1998 to 2000. Previous section delivery accounted for approximately half the elective cesarean deliveries at term and breech presentation for approximately one fourth. The incidence of RDS after elective cesarean delivery at term and after vaginal delivery were, respectively, 22 and 4 per 1000; the incidence of TTN after elective cesarean delivery at term and after vaginal delivery were respectively 9 and 8.5 per 1000 deliveries. Compared with vaginal births, infants delivered by elective section had a significant and progressive reduction in neonatal RDS, but there were no significant differences in TTN related to mode of delivery. The odds ratio (OR) for total neonatal respiratory morbidity in the elective cesarean group, compared with the vaginal delivery group, was 2.6. The OR for TTN in the cesarean group was only 1.19, but the risk of RDS increased significantly (OR, 5.85) and peaked in weeks 37 + 0 to 38 + 6 (OR, 12.9). There was no significant difference in RDS risk beyond 39 + 0 weeks. There were no neonatal deaths in this study. In this population lacking prenatally identified risk factors, elective cesarean delivery at term was associated with more neonatal respiratory morbidity than was vaginal delivery. Less morbidity may be expected by waiting until week 39 + 0 before performing elective cesarean deliveries.

Pregnancy outcome in spontaneous twins versus twins who were conceived through in vitro fertilization

OBJECTIVE: The purpose of this study was to compare maternal and neonatal complications in spontaneous versus in vitro fertilization twins. STUDY DESIGN: Twin gestations that were delivered from 1995 to 2000 were reviewed. Cases consisted of 56 in vitro fertilization twins, each of which was matched to two control mothers by age and parity. They were compared regarding various maternal and neonatal complications. RESULTS: In vitro fertilization twins were more likely to have preterm labor compared with control twins, with no difference in the incidences of pregnancy-induced hypertension, gestational diabetes mellitus, placenta previa, or preterm premature rupture of membranes between the two groups. The cesarean delivery rate was significantly higher in cases of twins who were conceived by in vitro fertilization (76.8% vs 58.0%, P = .026), despite a similar rate of elective cesarean delivery and the incidence of nonvertex twin A in both groups. The preterm delivery rate was significantly higher (67.9% vs 41.1%, P = .002) and the gestational age was significantly lower (35±3 weeks vs 36±3 weeks, P = .043) in cases compared with control subjects. Both twins were, on the average, 230 g lighter in the in vitro fertilization group compared with the control group. However, intrauterine growth restriction was more frequent in the control group (36.6% vs 25%, P = .044). There was a significantly higher incidence of admission to the neonatal intensive care unit, respiratory distress syndrome, a need for mechanical ventilation, and pneumothorax in cases compared with control subjects. CONCLUSION: When compared with spontaneous twins, in vitro fertilization twins are more likely to be delivered by cesarean delivery and to have a higher incidence of preterm birth and prematurity-related respiratory complications with a longer nursery stay.

Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis.

Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission. To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995. Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children. Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2 periods-1985 through 1995 (January 1, 1985, through December 31, 1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995. The transmission rate was 15.5% in the 1985-1995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined. Prophylactic interventions, and in particular ART, reduced perinatal HIV-1 transmission at a population level in Italy.