Trends In Mode Of Delivery Research Articles

National trends in mode of delivery among patients with HIV, 2000-2018

Management of HIV in pregnancy has changed considerably in the past 20 years. Since 2000, ACOG has recommended scheduled cesarean delivery (CD) for women with HIV with viral load >1000 copies/ml. We sought to describe trends in cesarean and operative vaginal delivery (OVD) among women with HIV in the United States.

224: Trends in mode of delivery of infants with congenital heart disease

Prenatal diagnosis of critical congenital heart disease (CCHD) has been increasing over the last two decades. While this allows care teams to plan deliveries of infants with CCHD, efforts may result in increasing rates of Cesarean-section delivery. We sought to identify trends in mode of delivery in infants with CCHD over an 18-year period in Texas and compare this to the general population in the state of Texas over the same time period. We identified live born infants with a diagnosis of CCHD from January 1999 through December 2016 using the Texas Public Use Data File, a population-based administrative database that captures nearly 100% of hospitalizations in the state of Texas. CCHD was defined as congenital heart disease likely to require intervention within the first year of life. Infants with a discharge diagnosis of a multiple gestation birth, significant birth defect or a known genetic abnormality were excluded. We evaluated the proportion of births annually that were delivered via Cesarean over the course of the time period studied. We compared this to the proportion of live births that were delivered via Cesarean in the state of Texas, using data from the Texas Department of State Health Services Vital Statistics Data over the same time period. Cesarean delivery over time in CCHD was evaluated using generalized estimating equations accounting for hospital clustering. The rates of Cesarean delivery were compared between CCHD and Texas data overall using Chi square test and Chi square test for trend. There was a total of 5,961 births fulfilling inclusion criteria. The mean percentage of cesareans performed for infants with CCHD during the study period was 46.1% compared to 32.6% in the overall infant population in Texas (p<0.001). For both groups, there appeared to be a significant yearly increase in the number of cesareans performed for both groups until 2008 (CCHD group mean annual change +1.45%, p=0.024, and Texas +1.13%, p=0.003); after this time the number of cesarean sections plateaued in CCHD and has had a mild decline overall (CCHD group mean annual change -0.06%; p=0.854, and Texas -0.13%, p=0.031). Cesarean delivery occurred more frequently in infants with CCHD than the general population in the state of Texas from 1999-2016. For both groups, the rates of Cesarean delivery increased and then appear to have plateaued. Further study to identify the reason for the higher percentage of cesarean delivery in CCHD is warranted.

Trends in mode of delivery for breech presentation in Japan: ‘Transverse figure 8 breech delivery’

Trends in mode of delivery for breech presentation in Japan: ‘Transverse figure 8 breech delivery’

Trends in Mode of Delivery of Twin Pregnancies in Victoria, 1983 ‐ 2015

Trends in Mode of Delivery of Twin Pregnancies in Victoria, 1983 ‐ 2015

Mode of delivery among HIV-positive pregnant women in areas with high prevalence of HIV in China, 2007-2013

To describe the changing demographic profile over time of pregnant women diagnosed with HIV infection, and trends in mode of delivery and pregnancy outcome. An observational investigation was conducted based on a population of 1 128 HIV-positive pregnant women at eight sites in China in provinces with high prevalence of HIV among pregnant women and children between 2007 and 2013. The study area included Shangcai and Weishi counties in Henan province; Ruili and Longchuan counties and Linxiang prefecture in Yunnan province; Yining County in Xinjiang; and Lingshan county and Babu district in Guangxi province. Main outcome measures were maternal characteristics, mode of delivery, and related trends over time by Cochram-Mantel-Haenszel(CMH) χ(2)-test. A total hospital delivery rate of 96.4% was reported. For each year during the period 2007-2013, hospital delivery rates were 95.1% (253/266), 94.8% (188/198), 93.7% (164/175), 98.8% (159/161), 98.6% (141/143), 97.4% (114/117), and 100.0% (68/68), respectively (χ(2)CMH=7.68, P=0.006). The neonatal survival rate increased by 0.7% incrementally from 2007 to 2013, with 98.5% (262/266), 99.0% (196/198), 99.4% (174/175), 99.4% (160/161), 100.0% (143/143), 100.0% (117/117), and 100.0% (68/68), respectively (χ(2)CMH=4.58, P=0.030). The proportions of vaginal deliveries in those years were 62.2% (166/266), 54.8% (109/198), 59.9% (105/175), 61.7% (100/161), 66.7% (96/143), 58.8% (69/117), and 66.7% (46/68), respectively (χ(2)CMH=1.19, P= 0.276). The average rate for midwives skilled in procedures such as artificial rupture of membranes and episiotomy was 37.8% (261/691), with proportions decreasing during the study period at 39.2% (65/166), 47.4% (52/109), 35.9% (38/105), 46.0% (46/100), 25.5% (25/96), 31.2% (22/69), and 28.3% (13/46), respectively (χ(2CMH)=6.76, P=0.009). The annual rate of reported hospital delivery increased between 2007 and 2013, with a declining rate of skilled midwifery over the same period. Survival of neonates born to HIV-infected mothers in China has increased to nearly equivalent levels as those of developed countries.

Low Rates of Mother-to-child Transmission of HIV-1 and Risk Factors for Infection in Spain

The objective of the study was to describe temporal patterns in the management of HIV-1 infected women and their newborns and the changes over time in the mother-to-child transmission (MTCT) rates and risk factors. A multicenter prospective observational study was performed in Madrid, Spain, from 2000 to 2007. Cohort period 1 (CP1) included births in 2000-2003 and cohort period 2 (CP2) included births in 2004-2007. Of the 803 HIV-infected women and their infants, 427 were in the CP1 and 376 in CP2. Almost all CP2 women received highly active antiretroviral therapy. More women in CP2 received antiretroviral treatment for ≥16 weeks during pregnancy (72.0% in CP1 vs. 84.8% in CP2; P < 0.001). Overall, no differences in trends in mode of delivery were observed. The proportion of women with vaginal deliveries who had undetectable viral loads increased from 31.1% in CP1 to 42.7% in CP2 (P = 0.02). Thirteen children (1.6%, 95% confidence interval: 0.68-2.55) were HIV-1 infected by MTCT. No changes in the rates of infection were observed over time. All the cases of MTCT occurred when antiretroviral treatment was not given or was given for <16 weeks during pregnancy. Low MTCT rates were observed over time. Lack of timely provision of antiretroviral drugs was the main limitation to develop all preventive interventions available nowadays. Nonsustained control of viral load could be associated with residual transmission.

Is there a place for selective vaginal breech delivery in Malaysian hospitals: experiences from the Ipoh hospital

Background. The ‘Term Breech Trial’ (TBT) results of 2001 have impacted on the mode of delivery of breech with a low threshold for caesarean delivery (CD) worldwide.Aims. The trends in mode of delivery in developing countries have also changed. The aims of this retrospective analysis of all breech presentation was to see if similar trends are seen in Ipoh Hospital in Malaysia and if perinatal outcome is affected by mode of delivery.Methods. All breech pregnancies presenting in the labour at the Ipoh Hospital, Malaysia, irrespective of gestation or booking status were analysed with respect to mode of delivery, fetal outcome and maternal mortality.Results. Out of 4886 breech presentation between 1992 and 2004, 3725 cases were evaluable. The prevalence of breech at birth was 3%. Vaginal breech deliveries decreased from 70.4% in 1994 to 13.1% in 2004. Consequently, CDs rose to 86.9% in CDs. There were 107 perinatal deaths (1994–2004) in the series and the crude perinatal mortality rate (PNMR) was four times higher than the hospital PNMR (11.4/1000 in 2004).Conclusion. Although the CD rates rose exponentially with the release of the ‘TBT’, the mode of delivery did not impact on better PNMR in breech cases in this hospital. The need for selective vaginal births for breech, increased use of external cephalic version and the long implications of a uterine scar in future pregnancies in the ‘shared antenatal care in the local context in a developing country is discussed.

Trends in mode of delivery of breech presentation over a 5-year period

Trends in mode of delivery of breech presentation over a 5-year period

Trends in mode of delivery during 1984–2003: can they be explained by pregnancy and delivery complications?

To describe trends in mode of delivery, to identify significant factors which affected mode of delivery, and to describe how these factors and their impact have changed over time. Total population birth cohort. Western Australia 1984-2003. The analysis was restricted to all singleton infants delivered at 37-42 weeks of gestation with a cephalic presentation (n = 432,327). Logistic regression analyses were undertaken to estimate significant independent risk factors separately for elective and emergency caesarean sections compared with vaginal delivery (spontaneous and instrumental), adjusting for potential confounding variables. Trends in mode of delivery, demographic factors, and pregnancy and delivery complications. Estimated likelihood of elective caesarean section compared with vaginal delivery and emergency caesarean section compared with vaginal delivery. Between 1984-88 and 1999-2003, the likelihood of women having an elective caesarean section increased by a factor of 2.35 times (95% CI 2.28-2.42) and the likelihood of an emergency caesarean section increased 1.89 times (95% CI 1.83-1.96). These caesarean section rate increases remained even after adjustment for their strong associations with many sociodemographic factors, obstetric risk factors, and obstetric complications. Rates of caesarean section were higher in older mothers, especially those older than 40 years of age (elective caesarean section, OR 5.42 [95% CI 4.88-6.01]; emergency caesarean section, OR 2.67 [95% CI 2.39-2.97]), and in nulliparous women (elective caesarean section, OR 1.54 [95% CI 1.47-1.61]; emergency caesarean section, OR 3.61 [95% CI 3.47-3.76]). Our data show significant changes in mode of delivery in Western Australia from 1984-2003, with an increasing trend in both elective and emergency caesarean section rates that do not appear to be explained by increased risk or indication.

Trends in mode of delivery at a community teaching hospital by service from 1987 to 2005

Trends in mode of delivery at a community teaching hospital by service from 1987 to 2005

Trends in mode of delivery of twin gestations in the united states

LISA RICE, ROBERT BONEBRAKE, MICHAEL BARSOOM, Creighton University, Obstetrics and Gynecology, Omaha, Nebraska OBJECTIVE: To evaluate the trends in delivery mode of twin gestations in the United States from 1990 and 2000 and neonatal outcomes. STUDY DESIGN: This is a population-based retrospective cohort study evaluating all twin deliveries in the US, occurring in 1990 and 2000, identified using the CDC/NCHS natality database. Exclusion criteria were EGA ! 24 weeks, !500 g, placenta previa and major fetal anomalies. Variables evaluated were maternal demographics, obstetric history, intrapartum and neonatal outcomes. Primary outcome was mode of delivery. Secondary outcomes included 5 minute Apgar !5, respiratory distress(RDS), need for ventilatory support, and birth injury. Descriptive statistics using two-tailed Chi-squared and Fisher’s exact tests were used with significance at p !0.05. RESULTS: 44,400 and 56,788 twin gestations from 1990 and 2000, respectively, were included. There were significantly more primary CS in 2000 regardless of fetal presentation. In 1990, there were significantly more infants with 5 minute Apgars ! 5. In 2000, there were significantly more cases of RDS, need for ventilatory support, and birth injury. Analyzing the data from 2000 by mode of delivery, CS was associated with a significant reduction in birth injuries and 5 minute Apgars !5 compared to vaginal delivery. This persisted when controlled for EGA. There was significantly more RDS and need for ventilatory support in the CS group, which persisted when controlled for presentation. CONCLUSION: This demonstrates the dramatic shift in the mode of delivery for twin gestations from 1990 to 2000, specifically in VTX/VTX twins. More twin gestations were delivered by CS in 2000, regardless of presentation. There was a significant rise in the number of CS performed for VTX/VTX presentation. CS was associated with a significant decrease in birth injuries and 5 minute Apgars ! than 5 compared to vaginal twins. There was noted to be an increase in RDS and ventilatory support in the CS group. Based on this data, CS in VTX/VTX twin gestations appear to be associated with fewer birth injuries and 5 minute Apgars !5.

Trends in Mode of Delivery of Twins From 1999 to 2004

Trends in Mode of Delivery of Twins From 1999 to 2004

Trends in Mode of Delivery for Gastroschisis Infants

Cesarean delivery for infants with gastroschisis has not been clearly demonstrated to produce superior outcomes compared with vaginal delivery; however, it not clear whether this has been translated into common clinical practice. Therefore, we analyzed the shifts in type of delivery during the last three decades at our institution. The medical records of all infants with gastroschisis treated at our hospital during the last 33 years were reviewed. Two groups, based on mode of delivery, were compared with regard to demographics, treatment, and outcome. A statistical analysis of changes in type of delivery was performed, and compared with the neonatal population as a whole. A total of 222 patients with gastroschisis were analyzed: 103 delivered via cesarean section and 119 delivered via vaginal birth. Logistic regression demonstrated a significant trend toward cesarean delivery over time (p=0.0001). The odds ratio indicated a 16% per year increase in the chance of cesarean delivery. There has been a significant trend toward cesarean delivery in patients with gastroschisis treated at our institution.