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Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes
... 13 It is generally believed that neonatal morbidity is lowest between 39 completed weeks to 41 weeks of gestation. 4,[14][15][16][17][18] Elective cesarean is usually performed at 37 completed weeks onwards as at this time fetus is considered to be fully mature. The risk of respiratory morbidity is increased in babies born by CS before labor. ...
... However, the risk of neonatal morbidities in newborns born via elective CS is decreased significantly in CS performed after 39 completed weeks. 4,[14][15][16][17][18] Several observational studies suggest a strong association between earlier gestational age at elective cesarean section and risk of breathing problems, feeding problems, respiratory distress, and transient tachypnea of newborn and neonatal admission in the NICU. British and American societies in obstetrics recommend elective cesarean section to be scheduled after 39 completed weeks of gestation. ...
... The common neonatal problems causing NICU admission in our study are similar to other studies where a higher proportion of admissions were from respiratory morbidity and others being hypoglycemia.56,58 Tita et al in their study among 24077 repeat cesarean deliveries demonstrated higher NICU admissions for births at 37 weeks of gestation (12.8%) compared to higher gestational ages 39 weeks (5.9%) or more.16 There is increased proportions of NICU admissions and a need for a higher level of respiratory support among neonates delivered at earlier gestations in our study but it was not statistically significant when compared between gestational ages. ...
Introduction: Cesarean section is done whenever delivery by vaginal route puts the mother or the baby at risk. It is the commonest obstetric operative procedure performed worldwide. Timing of elective cesarean delivery either in early-term gestation (before 39 completed weeks) or in late-term gestation (≥ 39 completed weeks) is a debatable topic worldwide. Various studies recommend scheduling elective cesarean section after 39 completed weeks of gestation.
Objective: To identify the appropriate time for elective cesarean delivery at term before 39 weeks or after 39 completed weeks of gestation based on neonatal outcome in low-risk pregnant women.
Methods: This is a hospital-based prospective observational study for a period of one year. Pregnant women with uncomplicated singleton pregnancy admitted to Kathmandu Medical College in Obstetrics and Gynecology department at term for elective scheduled cesarean delivery (n=146) and their newborns after delivery were taken for the study. The gestational age of mother (term before 39 weeks vs 39 completed weeks and after) and neonatal outcome in terms of Apgar score at one and five minutes at birth, birth weight, NICU admission, respiratory complications of newborns, and perinatal mortality were studied.
Results: A total of 146 cases, 73 in each group were studied. There was 6.8% of NICU admission in term before 39 weeks group neonates and 4.1% in 39 completed weeks and after group. The odds of NICU admission was 1.268 (95% CI: 0.722 – 2.227, P=0.719) for newborns delivered at term before 39 weeks. The mean one minute and five minutes Apgar scores were not statistically significantly different between the two groups (mean difference for 1 minute Apgar: 0.14, 95% CI: -0.058 to 0.085, P=0.704, and mean difference for 5 minutes Apgar: 0.14, 95% CI: -0.013 to 0.041, P=0.319). TTN was present in 4.10% (n=3) in the term before 39 weeks group and 2.73% (n=2) neonates in the 39 completed weeks group. Congenital pneumonia was present in the term before 39 weeks group only (n=2, 2.73%) and MAS only in those delivered after 39 completed weeks of gestation (n=1, 1.36%). None of the variables studied as an outcome of newborns were statistically significant among both groups.
Conclusion: This study found that elective cesarean section performed at term before 39 completed weeks versus after 39 completed weeks carries a similar risk of neonatal morbidity in terms of NICU admission and respiratory morbidity.
Key-words: Apgar scores, Respiratory morbidity, NICU admission, Perinatal mortality
... However, there is growing research evidence that babies born at early term (37 +0 -38 +6 , completed GW and additional days) are at increased risk for short-term adverse outcomes including admission to neonatal intensive care unit (NICU), respiratory morbidity, hypoglycemia, hyperbilirubinemia, longer hospital stay, and hospital readmission compared with babies born at full term (39 +0 -40 +6 GW). [1][2][3][4] Further, early-term babies are at higher risk of long-term adverse outcomes such as cerebral palsy, developmental delay, and requiring special education. [5][6][7] In a New Zealand (NZ) study, children born early term were at higher risk of requiring hospital admission in childhood and had lower educational scores. ...
... That babies born at early term had a doubled risk for NICU admission is consistent with the literature. 1,25,26 As elective CS birth is in itself a risk factor for NICU admission, 2,25 the previously published results may not be applicable to babies born following IOL. Exposure to labor contractions may be protective for babies, in terms of NICU admission and need for respiratory support, compared with babies born after elective CS. 27 In the present study, where babies were exposed to labor, and we adjusted for important clinical and demographic factors, a significant association remained with NICU admission for more than 4 hours, and any NICU admission. ...
... Previous studies have found an increased need for respiratory support in babies born at early term. [1][2][3]28 Although we did note a twofold increase in odds for early-term babies needing respiratory support compared with full-term babies, the finding was nonsignificant. We combined GW (37 with 38 GW and 39 with 40 GW) and the results may have been different if the need for respiratory support had been analyzed according to each separate GW, which the current study was unpowered for. ...
Introduction
Birth at early term (37⁺⁰–38⁺⁶ completed gestational weeks [GW] and additional days) is associated with adverse neonatal outcomes compared with waiting to ≥39 GW. Most studies report outcomes after elective cesarean section or a mix of all modes of births; it is unclear whether these adverse outcomes apply to early‐term babies born after induction of labor (IOL). We aimed to determine, in women with a non‐urgent induction indication (elective/planned >48 h in advance), if IOL at early and late term was associated with adverse neonatal and maternal outcomes compared with IOL at full term.
Material and methods
An observational cohort study as a secondary analysis of a multicenter randomized controlled trial of 1087 New Zealand women with a planned IOL ≥37⁺⁰ GW. Multivariable logistic regression was used to analyze neonatal and maternal outcomes in relation to gestational age; 37⁺⁰–38⁺⁶ (early term), 39⁺⁰–40⁺⁶ (full term) and ≥41⁺⁰ (late term) GW. Neonatal outcome analyses were adjusted for sex, birthweight, mode of birth and induction indication, and maternal outcome analyses for parity, age, body mass index and induction method. The primary neonatal outcome was admission to neonatal intensive care unit (NICU) for >4 hours; the primary maternal outcome was cesarean section.
Results
Among the 1087 participants, 266 had IOL at early term, 480 at full term, and 341 at late term. Babies born following IOL at early term had increased odds for NICU admission for >4 hours (adjusted odds ratio [aOR] 2.16, 95% confidence intervals (CI) 1.16–4.05), compared with full term. Women having IOL at early term had no difference in emergency cesarean rates but had an increased need for a second induction method (aOR 1.70, 95% CI 1.15–2.51) and spent 4 h longer from start of IOL to birth (Hodges–Lehmann estimator 4.10, 95% CI 1.33–6.95) compared with those with IOL at full term.
Conclusions
IOL for a non‐urgent indication at early term was associated with adverse neonatal and maternal outcomes and no benefits compared with IOL at full term. These findings support international guidelines to avoid IOL before 39 GW unless there is an evidence‐based indication for earlier planned birth and will help inform women and clinicians in their decision‐making about timing of IOL.
... Infants born by elective cesarean section (ECS) are at higher risk of developing respiratory dysfunction than those born vaginally at the same gestational age. In most cases, the symptoms are mild and temporary, but some infants develop severe respiratory illness [4][5][6]. This article provides an overview of fetal lung development, the etiology and pathophysiology of lung diseases associated with ECS, and current recommendations for their management. ...
... CS can roughly be divided into two categories, an emergency and elective cesarean section. Elective cesarean section (ECS) has been defined as a CS performed in the absence of labor or other recognized medical or obstetrical indications for delivery [5]. The main reasons for delivery by ECS are uterine scars, placenta previa, fetal malpresentation, or maternal request [29,30]. ...
... Infants born by ECS are at more risk for respiratory dysfunction shortly after birth than those born vaginally, and the incidence is inversely related to gestational age [1,[4][5][6]31]. To decrease the risk, it is recommended that ECS should not be performed before 39 weeks of gestation, unless medically indicated [29,[31][32][33]. ...
Purpose of Review
Infants born by elective cesarean section (ECS) are at increased risk for respiratory dysfunction due to inadequate lung fluid clearance, surfactant deficiency, and increased pulmonary vascular resistance. The purpose of this article is to give insight into the etiology and pathophysiology of lung diseases in neonates born by ECS, as well as current recommendations for their management.
Recent Findings
The diagnosis and management of respiratory disorders in neonates has improved in recent years with better diagnostic methods and treatment options. Antenatal corticosteroids (ACS) have been shown to decrease respiratory morbidity associated with ECS in near-term and term infants, but a recent systematic review of 30 studies showed a significantly higher risk for adverse neurocognitive and psychological outcomes in children with ACS exposure during late-preterm and full-term birth than non-exposed children.
Summary
This review focuses mainly on current treatment options for respiratory diseases in neonates born by ECS, and a brief review of pulmonary fetal development and postnatal adaption is also included. ACSs have been used to reduce respiratory morbidity associated with ECS but are associated with increased risk of adverse neurocognitive and psychological outcomes in children born term or near-term.
... Most of previous studies were conducted according to actual gestational week at delivery (7,11,15). ...
... One of the most important purposes of planning elective CS at late-term gestation is to reduce neonatal morbidities, especially respiratory complications. Two studies in United States have suggested that CS performed at 37 and 38 weeks of gestation is associated with an increased risk of adverse neonatal outcome (7,11). However, other studies have shown that although babies born by CS at 37 weeks of gestation have a higher risk of neonatal adverse outcomes, especially respiratory complications and NICU admission, there is no difference in such risk between babies born by CS at 38 and 39 weeks of gestation (15,(23)(24)(25)(26)(27). ...
... Discrepancies between previous studies, including ours, might be due to the following reasons. First, while subjects were grouped by gestational week of actual birth in previous studies (7,11,15,24,26), subjects were grouped by planned weeks of elective cesarean section in our study. We hypothesized that analyzing outcomes by planned gestational week for CS might be more important than the actual gestational week at delivery because we do not know the actual time of delivery at the time when we counsel patients about scheduling an elective CS. ...
Background: The objective of this study was to compare maternal and neonatal outcomes in women with non-complicated singleton pregnancies according to timing of planned elective cesarean section (CS).
Methods: This was a retrospective cohort study of 2,365 women with singleton pregnancies who were planned for elective CS at term pregnancy in a single institution between 2010 and 2021. Pregnant women with preterm delivery, multiple gestation, vaginal delivery, complicated pregnancy, or non-scheduled emergency CS were excluded. Subjects were categorized into three groups according to planneddate of CS: 37 (37+0‒37+6) weeks (n = 147), 38 (38+0‒38+6) weeks (n = 1,486), and 39 (39+0‒39+6) weeks (n = 732) of gestation. Primary outcomes of this study were emergency CS rate and maternal and neonatal composite morbidity.
Results: The rate of emergency CS significantly increased with an increase in planned week of CS. After controlling for confounding factors, the rate of emergency CS significantly higher in the 38-week group (adjusted odds ratio (aOR): 4.70, 95% confidence interval (CI): 1.71‒12.95) and the 39-week group (aOR: 8.78, 95% CI: 3.16‒24.37) than in the 37-week group. The rate of maternal composite morbidity (aOR: 3.22, 95% CI: 1.65‒6.32) was significantly higher in the 37-week group, but not in the 38-week group, than in the 39-week group. Rates of neonatal ventilator use and respiratory distress syndrome significantly decreased, whereas neonatal meconium staining significantly increased with an increase in planned week of CS. The rate of neonatal composite morbidity (aOR: 2.69, 95% CI: 1.22‒5.96) was significantly higher in the 37-week group, but not in the 38-week group, than in the 39-week group.
Conclusion: In non-complicated singleton pregnancy, planning elective CS at 37 weeks of gestation was associated with a higher risk of adverse pregnancy outcome. However, planning elective CS at 38 weeks of gestation showed no worse pregnancy outcome than that at 39 weeks of gestation.
... Th e timing of the elective repeat caesarean section is controversial. Although poor neonatal outcomes of elective delivery before 39 weeks ' gestation have been reported, delivery rates before 39 weeks ' gestation are still high (Wilmink et al. 2010;Tita et al. 2009). Despite the fact that every delivery from 37 ϩ 0 weeks on is defi ned as a term birth, experience has shown that children electively delivered before 38 ϩ 0 weeks still show diverse adjustment disorders , Ehrenthal et al. 2011, thereby provoking some authors to consider this period as a subcategory of births called ' early term ' (Fleischman et al. 2010). ...
... In recent years, timing of elective caesarean delivery has been a topic of increasing interest. A variety of studies have demonstrated that caesarean deliveries bear more risks for NICU admission than vaginal births and if elective repeat caesarean delivery is performed before 39 weeks ' gestation, this risk increases even more (Tita et al. 2009;Ashton 2010;Ersch et al. 2007;Gerten et al. 2005). In addition, it is of economic interest considering the enormous escalation of health care costs associated with admission of neonates to the NICU (Robinson et al. 2010). ...
... Our study population of elective caesareans is smaller than other study populations previously reported as we applied a stricter defi nition of ' elective caesarean ' (Tita et al. 2009, Hansen et al. 2008. We consequently excluded otherwise elective repeat caesareans performed aft er the onset of labour. ...
Five hundred and three elective repeat caesarean sections were analysed to examine the impact of timing of delivery between 37 and 40 weeks’ gestation on foetal and maternal short-term outcome. Gestational age, Apgar scores and admission to the neonatal intensive care unit (NICU)-based foetal outcome. Maternal complications were comparatively evaluated. Due to the increasing incidence of gestational diabetes a subgroup analysis on this issue was performed. Neonates born by elective repeat caesarean in early term had a 3.2 times increased risk of being admitted to the NICU due to foetal adaption disorders
in the early post-natal phase. Overall maternal peri-operative risks were low and did not differ significantly between 37 and 41 weeks’ gestation. Maternal gestational diabetes constituted an additional independent risk factor in early term. In summary, elective early-term caesarean delivery appears to negatively impact immediate neonatal outcome. Waiting at least until 38 completed weeks’ gestation improves foetal outcome, especially in diabetic patients.
... Lower result in Vered et al (13) but still representing the highest proportion being delivered by ECS at early term (56.4%). Even further lower result in Tita et al (14) with (35.8%) neonates were early term. This high result in our study can be attributed to the lack of accurate gestational age assessment whether by LMP or US and variation in sample size with maternal preference in our country for early delivery. ...
... A similar result was found by Hourani et al (3) regarding hypoglycemia. While in the study of Tita et al (14) , a reduction in the incidence of hypoglycemia with advancing gestational age was found. ...
... Tita et al. demonstrated significantly higher incidence of adverse neonatal outcome such as neonatal respiratory problems, hypoglycemia, sepsis, seizures and intensive care unit admission at planned repeat CD before 39 weeks of gestation and after 40 weeks of gestation [7]. In the contrary, Shinar et al. demonstrated that incidence of neonatal composite adverse outcome was comparable for elective delivery at 38 + 0 to 39 + 6 weeks gestation and expectant management [8]. ...
... Previous studies demonstrated that performing elective repeat caesarean delivery before 39 weeks, was associated with higher rates of neonatal respiratory morbidity, as well as metabolic, infectious and neurologic morbidity and intensive care unit admission [7,16]. These findings are not in line with our findings. ...
Objectives
The timing of planned repeat cesarean delivery (CD) is debateful in clinical practice. Planned repeat CD is typically scheduled before the spontaneous onset of labor to minimize the risk of uterine rupture during labor and the associated risk for fetal compromise. This timing should be balanced with the potential risk of delivering an infant who could benefit from additional maturation in utero. We aim to study the influence of gestational age at the time of repeat CD on maternal and fetal complications.
Study design
A population-based retrospective cohort study including all term singleton third CDs (≥ 37 weeks of gestation), between February-2020 and January-2022 at a tertiary medical center was conducted. Maternal and neonatal adverse outcomes were compared by gestational age at the time of the CD. A logistic regression models were constructed to adjust for confounders.
Results
The study population included624 third CDs. Among them, two study groups were defined: 199 were at 37 + 0 to 37 + 6 weeks of gestation, and 44 were at ≥ 39 weeks of gestation at the time of delivery. 381 were at 38 + 0 to 38 + 6 weeks. Since our routine practice is to schedule elective CD at 38 + 0 to 38 + 6 weeks of gestation, we defined this group as the comparison group. In a multivariate analysis, both study groups were associated with significantly higher rates of emergent CDs after adjusting for maternal age, parity, ethnicity, premature rapture of membranes, spontaneous onset of labor and birthweight. After adjusting also for emergent CDs, CDs at 37 + 0 to 37 + 6 weeks of gestation were significantly associated with maternal and neonatal length of stay exceeding 4 days. Additionally, CDs at 37 + 0 to 37 + 6 weeks of gestation were also associated with composite of adverse neonatal and maternal outcomes.
Conclusions
Our study demonstrated that scheduling third CD at 38 + 0 to 38 + 6 weeks is associated with reduced risk of emergent CD, as well as beneficial maternal and neonatal outcomes.
... Of the 226 pregnant women included in their study, 19 (8.4%) presented low birth weight and 201 (88.9%) had a baby with normal birth weight for gestational age [16] . In contrast to our findings, Viṧnjevac et al., (2011) [17] conducted a prospective study of healthy pregnant women between 30 and 32 gestational weeks, who were estimated for ferritin values. Out of 210 pregnant women who completed the investigation, 17 (8.1%) ...
... gave birth to infants of small for gestational age birth weight (birth weight less than 10th percentile adjusted for gestational age), whereas 193 (91.9%) delivered infants appropriate for gestational age. The deviation from our findings may be attributed to difference of participant ethnicity as we assessed Egyptian women while Viṧnjevac et al., (2011) [17] evaluated Serbian women. Also, different sample size which affect the results. ...
... The results of the subgroup analysis performed in this study showed that both types of CS were a risk factor for ASD/ADHD. The timing of performing CS may affect neonatal brain development, with elective CS often performed at 37-39 weeks [112]. The last few weeks may have an important role in neonatal brain development, which some studies suggest may have detrimental effects on children [112]. ...
... The timing of performing CS may affect neonatal brain development, with elective CS often performed at 37-39 weeks [112]. The last few weeks may have an important role in neonatal brain development, which some studies suggest may have detrimental effects on children [112]. In recent years, CS by maternal choice under non-medical indications has become increasingly popular [113]. ...
Purpose
This study was conducted to investigate the relationship between cesarean section (CS) offspring and autism spectrum disorders (ASD)/attention deficit hyperactivity disorder (ADHD).
Methods
Searching of the databases (PubMed, Web of Science, Embase, and Cochrane Library) for studies on the relationship between mode of delivery and ASD/ADHD until August 2022. The primary outcome was the incidence of ASD/ADHD in the offspring.
Results
This meta-analysis included 35 studies (12 cohort studies and 23 case–control studies). Statistical results showed a higher risk of ASD (odds ratio (OR) = 1.25, P < 0.001) and ADHD (OR = 1.11, P < 0.001) in CS offspring compared to the VD group. Partial subgroup analysis showed no difference in ASD risk between CS and VD offspring in sibling-matched groups (OR = 0.98, P = 0.625). The risk of ASD was higher in females (OR = 1.66, P = 0.003) than in males (OR = 1.17, P = 0.004) in the CS offspring compared with the VD group. There was no difference in the risk of ASD between CS under regional anesthesia group and VD group (OR = 1.07, P = 0.173). However, the risk of ASD was higher in the CS offspring under general anesthesia than in the VD offspring (OR = 1.62, P < 0.001). CS offspring developed autism (OR = 1.38, P = 0.011) and pervasive developmental disorder-not otherwise specified (OR = 1.46, P = 0.004) had a higher risk than VD offspring, but there was no difference in Asperger syndrome (OR = 1.19, P = 0.115). Offspring born via CS had a higher incidence of ADHD in different subgroup analyses (sibling-matched, type of CS, and study design).
Conclusions
In this meta-analysis, CS was a risk factor for ASD/ADHD in offspring compared with VD.
... 12,13 The early term neonates are also at a higher risk of low birth weight, low Apgar score at 5-minutes (<7) when compared with full or post term. 14,15 The American College of Obstetricians and Gynecologists recommends that no elective delivery should be conducted before 39 weeks of gestation as these newborns are at an increased risk of neonatal adverse respiratory outcome, e.g., transient tachypnea of newborn and risk of neonatal intensive care unit admission. 12 In addition to apparent health concerns, there is also a growing recognition that this neonatal population may have more subtle neurodevelopmental issues such as inferior academic performance or behavioral problems when they grow-up. ...
... 13 Another study showed the incidence of respiratory distress was found to be more in early term as compared to full term neonates (37% versus 0.9%). 15 Correspondingly, the risk of 5-minute Apgar score (<7) decreased from 1.01% at 37 weeks of gestation to 0.69% at 39 weeks of gestation. However, the risk of birth weight greater than 4,000 gm increased from 2.0% at 37 weeks of gestation to 7.9% at 39 weeks of gestation. ...
Background: Pre and early term birth are one of the major causes of neonatal mortality and morbidity as compared to term infants. The risk of neonatal morbidity and mortality decreases with gestational age. Thus, this study aimed to determine the association of neonatal outcomes among early term and full-term elective deliveries. Methods: A prospective cohort study was conducted at the department of obstetrics and gynecology, Aga Khan University Hospital, Pakistan. A total of 390 women, 195 in each study group were selected using a non-probability consecutive sampling. Demographic was presented as simple descriptive statistics giving mean and standard-deviation. Pearson’s chi-square and Fisher-Freeman-Halton exact test were used to compare qualitative data. Risk-ratios (RR) and confidence-intervals (CI) were calculated by using binary logistic regression. STATA V.17 SE software was used for data analysis. Results: A total of 390 participants were recruited, including 195 patients in each group. The high prevalence of low Apgar score 5.6%, low birth weight 5.6% was found among early term when compared with full term. The respiratory distress was also reportedly high in early term neonates with 7.2%. Likewise, the prolonged hospital stays and NICU admissions were also more evident in early term elective deliveries i.e. 8.7% and 5.6%. Conclusions: Early-term births are associated with adverse neonatal outcome of low APGAR score, low birth weight, hospital stay, NICU admission and respiratory distress when compared with neonates born as full term through elective deliveries. Similarly, the risk of prolonged hospital stay and NICU admissions were higher among the early term neonates.
... Por otro lado, Sandall et al. (2018Sandall et al. ( , p. 1352 señalan que las criaturas nacidas por cesárea «están sujetas a diferentes intervenciones hormonales, físicas, bacterianas y médicas (como los antibióticos intraparto y los uterónicos) (…) [con] potencial para alterar sutilmente la fisiología [produciendo] consecuencias a corto y largo plazo» 53 . Además, destacan los impactos negativos que experimentan las criaturas nacidas por cesárea cuando esta se programa a -lo que según cálculos se estimen-las 39 semanas (Tita et al., 2009;Wilmink et al., 2010). ...
... La privación del parto y el nacimiento por cesárea produce desarrollo inmunológico alterado, alergia, atopia, asma y diversidad microbiana intestinal reducida. Los estudios muestran que nacer por cesárea se asocia con síndrome metabólico en la infancia (Sandall et al., 2018;Tita et al., 2009). ...
La mortalidad materna se distribuye de forma desigual en Nicaragua, afectando posiblemente en mayor medida a pueblos afrodescendientes y originarios. En base a los datos más recientes, en las instituciones de salud se producen tres de cada cuatro muertes maternas (2019-2020), una de cada dos mujeres experimenta morbilidad durante su primer parto y una de cada cuatro complicaciones potencialmente fatales para la vida (2010-2011). Dentro de las limitaciones del sistema de salud propias al nivel de desarrollo del país, los déficits en la calidad técnica y relacional de los cuidados profesionales, comunitarios y familiares durante el embarazo, parto o cesárea, y postparto (epcp) podrían explicar una parte significativa de la morbimortalidad materna.
En este marco, la presente tesis por compendio de publicaciones se fija como objetivo identificar para Nicaragua cómo los determinantes estructurales de género, raza y clase social están limitando el acceso de las mujeres y criaturas a cuidados de calidad durante el epcp. Como objetivos específicos, plantea (OE1) valorar la calidad técnica y relacional de los cuidados profesionales durante el parto, (OE2) determinar cómo el sistema de género impacta en la configuración y operativa del sistema de cuidados y el modelo de atención durante el epcp, y (OE3) identificar cómo la intersección de las opresiones impacta sobre la calidad de la atención y cuidados.
Se desarrolló una investigación de tipo exploratorio tomando las experiencias de parto y cesárea de las mujeres en el país como objeto de estudio. Se obtuvieron datos cuantitativos y cualitativos mediante un cuestionario en el que participaron 24 mujeres. Además, se llevó a cabo un análisis interdisciplinario de la episiotomía como práctica integrada en el modelo de atención durante el parto prevalente a nivel mundial, la que fue seleccionada por practicarse sin sostén de la Medicina Basada en Evidencia y por sus impactos. Para ello, se aplicó un análisis bibliográfico sobre 116 documentos en base a los términos: «episiotomía», «Mutilación genital femenina», «género», «raza», «poder», «paradigma tecnocrático», «modelo biomédico», «parto», «patriarcado», «colonialidad», «dispositivo», «biopoder» y «biopolítica». Finalmente, la respuesta del sistema de género y del sistema de cuidados a las necesidades de las mujeres y criaturas durante el epcp en el país fue analizada durante el curso de la epidemia del zika, aplicando un análisis crítico feminista sobre los discursos construidos por actores públicos y privados de peso en la arena política nacional. Este análisis se aplicó sobre 30 productos comunicacionales.
Los resultados señalan que la calidad de los cuidados profesionales a las mujeres y criaturas durante el parto en Nicaragua presenta deficiencias, mostrando intervencionismo obstétrico, violencia obstétrica y prácticas sin consentimiento, generando impactos sobre la salud física y psicológica de las mujeres y sobre la construcción social del género. Ante la crisis del zika, el sistema de género se fortaleció, reforzando la violencia de género en el campo simbólico, así como la violencia estructural y la desigualdad social en el sistema de cuidados y, por tanto, para el conjunto de las macroestructuras sociales. Dentro del paradigma tecnocrático de atención, la tesis sostiene que la episiotomía se practica como una mutilación genital femenina que refuerza la colonialidad y la construcción social del género, la raza y la clase social. En conjunto, los hallazgos indican que la desigualdad en salud y derechos sexuales y reproductivos en Nicaragua se nutre de la adscripción de este campo a la esfera de lo privado, lo que faculta y exacerba la discriminación sexista, racista y clasista sobre las mujeres que caen fuera de la categoría de la blanquitud. En tal caso, desintegrar la política sexual y reproductiva que a efectos pragmáticos se observa desplegada a nivel mundial ―centrada en el hacer vivir a ciertas mujeres y criaturas y dejar morir a otras― y dotar esta problemática del estatus de problema público requieren situar como prioridad desarticular el sistema de género.
... Current epidemiological studies largely focus on serum hormone levels, overlooking breast milk as a crucial excretion route, highlighting the need for further research. Deeper exploration into areas such as dose-dependent effects of exogenous hormones, obesity-related milk production issues, and optimal timing for hormonal contraceptives in breastfeeding women shed light on the complexities of lactation endocrinology and provide critical insights for improving lactation support [24,25,28]. ...
Breastfeeding is universally recognized as the optimal form of infant nutrition, offering critical health benefits for both mother and child. Despite its importance, many mothers face challenges related to insufficient maternal milk production (IMMP), a multi-factorial issue influenced by physiological, psychological, and environmental factors. This chapter explores the clinical causes of IMMP, emphasizing the interplay of hormonal, anatomical, and behavioral factors that can disrupt lactation. Key contributors include endocrine disorders, breast conditions, maternal health issues, poor breastfeeding techniques, and socio-cultural barriers. The importance of early breastfeeding initiation, proper latch, and frequent feeding to sustain milk supply are also highlighted. Maternal nutrition, hydration, and the use of galactogogues are discussed as potential remedies to enhance lactation. Additionally, the chapter addresses the role of healthcare providers in offering evidence-based interventions, such as lactation support, nutritional guidance, and emotional counseling, to overcome breastfeeding challenges. By understanding the underlying causes of IMMP and implementing targeted strategies, healthcare professionals can empower mothers to achieve successful breastfeeding, ultimately improving maternal and infant health outcomes. The chapter underscores the need for continued research, awareness, and supportive policies to promote breastfeeding as a cornerstone of early childhood development and maternal well-being.
... kardialen Operationen, mechanischer Klappenersatz) und bestehende Notfallsituation (Herz-Kreislauf-Versagen, akute Aortendissektion) terminiert (Kapoor 2014;van Steenbergen et al. 2022 . Zudem führt eine primäre Sectio zu einer erhöhten fetalen Morbidität und Mortalität, wobei postpartal respiratorische Symptome im Vordergrund stehen (Tita et al. 2009;Mylonas und Friese 2015). ...
... The proportion of caesarean section in the US is the highest in the world as compared to other developed countries. 11 Postoperative ileus (POI) refers to the in tolerating oral intake and extreme constipation that results from a nonautomated insult and it disturbs the activity of gastrointestinal tract that is related to normally coordinated propulsive motor activity. [12][13] An overall consensus among surgeons is that a compulsory, normal and physical reaction to the abdominal surgery is always accompanied by POI. 14 Nonabdominal surgery and related mechanisms are a cause of Paralytic ileus, such as pelvic surgery, knee surgery, spinal surgery, basal lung consolidation, drug use and generalized or localized peritonitis. ...
A b s t ract Objective: To compare mean time to return of bowel motility and passage of first flatus after elective caesarean section between gum chewing and control group. Study Design: Randomized controlled study Place and Duration: Department of Obstetrics and Gynecology, DHQ Teaching Hospital, Rawalpindi, from 30th Dec, 2016 to 30th Jun, 2017. Methodology: After taking approval from the Ethical Review Committee of DHQ hospital and permission from all concerned authorities, study was initiated. All patients fulfilling the above mentioned inclusion criteria were explained the purpose and procedure of the study. Written informed consent was taken from the patient. A detailed history was taken and thorough physical examination was performed. Women were randomized by lottery method into two groups; group A (gum-chewing group) who had received one stick of sugar free gum for 15 minutes every 2 hours after surgery, and group B had a control group (non gum-chewing group). The two groups were followed up postoperatively and were monitored and compared for return of bowel activity by auscultation of bowel sounds every 2 hours and recording time to first pass of flatus. Results: Total 160 patients were included in the study according to the inclusion criteria of the study. Mean age (year) was 25.39+3.60. Mean time to return of bowel motility after elective caesarean section in both the group was 7.23+1.06 and 27.00+1.03 which was statistically significant (p-value 0.000). Similarly, mean time of passage of flatus after elective caesarean section in both the group was 8.39+0.94 and 28.15+1.13 which was statistically significant (p-value 0.000). Conclusion: The study concludes that mean duration of appearance of return of bowel motility and mean time of passage of stool after elective caesarean section in patients of chewing gum group was less than in control group. Thus, at the very least, gum-chewing immediately after surgery is more effective and harmless intervention to reduce postoperative ileus
... Both showed a decreasing incidence of the composite outcome with increasing gestational age from 37 to 39 completed weeks of gestation. 8,9 In contrast, any maternal benefit of postponing elective caesarean section to 39 completed weeks has not been shown, but knowledge is sparse when it comes to maternal consequences of elective caesarean section timing. 10,11 We therefore conducted a prospective cohort study of neonatal and maternal morbidity after elective caesarean section scheduled before 39 weeks compared with those at 39 or after 39 weeks of gestation. ...
... It is worth noting that infants who are delivered through a cesarean section are particularly susceptible to adverse respiratory outcomes, especially if the delivery occurs before the onset of labor. As a result, it is not recommended to opt for prelabor elective delivery before 39 weeks of gestation unless there is confirmation of fetal lung maturity [5] . The evaluation of respiratory morbidity risk in planned cesarean births for term infants is of utmost importance when considering the possible advantages of prenatal steroids in comparison to postponing delivery till 39 weeks of gestation. ...
... Hook et al. also found increased respiratory issues in infants born by elective repeat CS compared to TOLAC, with higher sepsis rates only after failed TOLAC [18]. Scheduled repeat CS has also been associated with other adverse neonatal outcomes compared to planned vaginal birth [19]. ...
Objective: To investigate the timing of elective repeat cesarean deliveries at Al-Batool Teaching Hospital in Diyala, Iraq. Methods: A retrospective analysis was conducted of 100 women who underwent elective repeat cesarean delivery at 37-40 weeks gestation at Al-Batool Teaching Hospital. Emergency cesarean deliveries were excluded. Results: The majority of elective repeat cesarean deliveries (78%) were performed at 37 weeks gestation. Cesarean deliveries at 38, 39, and 40 weeks accounted for 4%, 2%, and 16% of the sample, respectively. Conclusions: In this cohort, most elective repeat cesarean deliveries were conducted at 37 weeks gestation, rather than the recommended 40 weeks. Delivering earlier than 39-40 weeks in the absence of medical indications reduces the chances of successful vaginal birth after cesarean. These findings suggest that evidence-based protocols were not consistently followed for timing of elective repeat cesarean sections at this institution. Further research is needed to identify barriers to adhering to delivery guidelines and implement quality improvement initiatives to optimize cesarean delivery timing when clinically appropriate.
... For this justification, it was believed that additional classifications would be assumed into early term (37 0/7 -38 6/7 gestational weeks), full term (39 0/7 -40 6/7 gestational weeks), and late term (41 0/7 -41 6/7 gestational weeks) [78]. This 5-week span is also considered crucial as the foetal maturation pathway seems to be ongoing [79] which is subsequently linked to the children's short-and long-term morbidity [80,81]. ...
Overweight and obesity in children and adolescents and its negative effects on health, including increased risks of long-term diseases like type II DM, CVD, dyslipidemia, , stroke, hypertension, respiratory issues, gallbladder disease, sleep apnea, osteoarthritis, along with certain malignancies, which are already identified during the perinatal and prenatal period is one of the most important worldwide health concerns of the twenty-first century. To overcome the current epidemic of overweight and obesity, obstructing their risk factors is important in an effort to prevent the development of obesity and overweight. Multiple epidemiological research studies have shown a connection between BMI acquired later in life and birth weight; however, the results are constrained by the absence of information on gestational age. Majority of studies reported relation of childhood obesity with the preterm born children in study of relation with the gestational age. Although more likely to become obese in later adulthood, preterm and low birth weight born child are small and/or lean at birth, whereas post-term usually not and above all, children born postterm showed signs of a rapid weight gain that led to obesity decades early. Thus, the purpose of this review study is to determine the impact of the gestational age at delivery and to provide an overview of the evidence supporting the link between childhood obesity and post-term birth.. Thorough systemic review conducted on online database Pubmed, Google Scholar and found only few studies on association with the post- term born children. Limited evidence necessitated the studying of additional adult post-term cohorts to accurately determine future risks to health and to investigate these potential metabolic alterations, as well as if the alterations in adiposity continue or get worse throughout adulthood, and how these correlations vary in adult born post-term in terms of pattern and amplitude.
... Prior research (16)(17)(18) has indicated that exceeding the WHO suggested range for cesarean delivery rates could lead to a higher likelihood of encountering other public health issues for both mothers and infants. Some more recent studies have concluded that the 1985 WHO publication analyzed incomplete studies, often drawing from restricted datasets and primarily investigating outcomes in more affluent nations (15,19). ...
Objective: A cesarean delivery is regarded as a comparatively favourable and secure approach to childbirth when contrasted with vaginal delivery. Over the past decade, its frequency has risen in both industrialized and developing nations. Maternal request for cesarean delivery has been explained for the escalating rate along with other factors like anxiety, fear of childbirth, previous cesarean delivery, previous negative vaginal birth experience, maternal age, maternal education, and socioeconomic factors. Hence, this study was undertaken to assess pregnant women's tendency to have a cesarean birth and to investigate the factors associated with the inclination for cesarean delivery. Materials and methods: A hospital-based cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of a tertiary care hospital, a systematic sampling procedure was utilized, and 368 antenatal mothers after 36 weeks of gestation, who do not have any specific medical reasons against vaginal delivery were included in the study. Data collection was done by questionnaire. The information regarding socio-demographic factors, preexisting comorbidities, current obstetric risk factors, emotional factors, previous delivery experience, and their information preference toward the mode of delivery were collected. Univariate and multivariate analysis were performed to identify the independent variables associated with preference for cesarean delivery. Results: The preference for cesarean delivery and non-preference for cesarean delivery was 114 (30.9%) and 201 (54.6%), respectively whereas 53 (14.4%) participants remained neutral. The Chi-square analysis revealed a notable connection between the inclination towards a preference for cesarean delivery and factors such as obstetric score, parity, comorbidities, and among obstetric risk factors such as pregnancy after in-vitro fertilization (IVF), with a history of abortion, and having a prior history of cesarean delivery. Nevertheless, no meaningful association was observed between the preference for cesarean delivery and the remaining variables. On multivariate logistic analysis, independent variables like preexisting anxiety or depression, pregnancy through IVF, and having a history of previous cesarean delivery have increased the odds of preferring cesarean delivery. The independent variables like increasing gestational age, graduates, and unemployed have decreased the odds of preferring a cesarean delivery. Conclusion: In conclusion, the prevalence of cesarean delivery is influenced by a complex interplay of medical, cultural, socioeconomic, and healthcare system factors. While cesarean delivery is essential in cases of medical necessity, efforts should be made to avoid unnecessary cesarean delivery that does not provide clear benefits over vaginal delivery. Balancing the risks and benefits of cesarean delivery and promoting evidence-based obstetric practices are crucial for ensuring optimal maternal and infant outcomes.
... Algunos estudios, dan cuenta que el parto de una adolescente, independientemente de su entorno socio-económico, incrementa el riesgo de complicaciones (21,22,23) y otros, reportan todo lo contrario: que el embarazo en adolescentes, salvo contadas excepciones, no se diferencia del embarazo de la mujer adulta (24,25). ...
OBJETIVODeterminar la incidencia y factores asociados a cesárea iterativa, en adolescentes atendidas en el Hospital Nacional Sergio E. Bernales desde enero 2005 a diciembre 2009.MATERIAL Y MÉTODODiseño transversal y descriptivo, en el que se revisó todas las historias clínicas de adolescentes multigestas, determinando la incidencia de cesáreas iterativas, así como los factores asociadosRESULTADOSSe registró 584 partos de adolescentes multigestas. 264 correspondieron a cesáreas iterativas, lo que significó una incidencia de 45 cesáreas iterativas por cada 100 gestaciones (45%). El promedio de edad fue de 18.2 ± 1.1 años (14 a 19 años). Por modelo de regresión logística multivariante, se identificó como factor de riesgo la desproporción céfalo-pélvica (ORa, 166.39; IC95%: 60.25 – 459.53; p <0.001), y como factores protectores el número de hijos vivos (ORa, 0.18; IC95%: 0.01– 0.04; p <0.001) y abortos (ORa, 0.08; IC95%: 0.04 – 0.16; p <0.001).CONCLUSIONESLa incidencia de cesáreas iterativas en adolescentes multiigestas, fue de 45%. Asociado a desproporción céfalo- pélvica y con menor indicación por el mayor número de hijos vivos y abortos previos. (Rev Horiz Med 2011;11(2):75)
... Hook et al. also found increased respiratory issues in infants born by elective repeat CS compared to TOLAC, with higher sepsis rates only after failed TOLAC [18]. Scheduled repeat CS has also been associated with other adverse neonatal outcomes compared to planned vaginal birth [19]. ...
... There could be other factors accounting for less severity of RDS like trial of labor (29) or unknown constitutional factors at advanced gestational age despite low surfactant levels as revealed by low AFOD values. How ever the severity could be more than expected on rare occasions (30). AF Lecithin levels increase from 43 micro grams\ml at 34-35 wks gestation to 147 micro grams/ml at term before labor. ...
Objective: To establish the correlation between the
Amniotic fluid (AF) Optical density (OD) at the
onset of spontaneous labor and the functional
maturity, gestational age and birth weight of the
newborn.
Methods: Uncentrifuged fresh amniotic fluid
samples from 360 singleton pregnancies were
collected during artificial rupture of membranes or
amniotomy at LSCS after onset of labor for AFOD
estimation at 650 nm .
Results: The mean AFOD at spontaneous labor
was found to be 0.98±0.27 (n=360). The study
population was divided into 7 different groups
according to gestational age (GA) (35 1/7 -36 wks,
36 1/7-37wks, 37 1/7-38 wks, 38 1/7-39 wks, 39
1/7-40 wks , 401/7-41wks, and above 41 wks of
GA respectively). In different GA groups, the mean
AFOD at spontaneous labor ranged from
0.50±0.13 to 1.03±0.24. Between any two groups
among 2 to 7 (i.e. after 36 wks GA) when cases of
respiratory distress syndrome (RDS) was
excluded, there is no essential change in mean
AFOD values (range 0.85 to 1.03). The results
were same after adjusting for birth weights. All the
babies delivered at AFOD value of mean ± SD
0.98 ±0.27 (0.40 to 1.55 CI 95 %) ,were fully
functionally mature and did not develop RDS.
Babies born with AFOD < 0.40 (n=8) had varying
degrees of RDS with birth weights ranging from
2300 to 3000 gms. Also they had more vernix on
their body than the non RDS babies The mean
birth weights progressively increased from group 1
to 7.
Synopsis: Spontaneous normal labor takes
place with complete fetal functional maturity at an
optimum AFOD value of 0.90 irrespective of the
GA and birth weight in our study population. The
correlation of AFOD with functional maturity
supports the concept of individual term
... 1,2 This principle has been commonly applied in maternity care to address critical issues such as the cesarean birth rate, use of episiotomy, and planned childbirth before 39 weeks of gestational age. [3][4][5] Identifying this variation is the first step in increasing adherence to evidencebased practices and improving the quality of care for all birthing patients and their infants. ...
Background
We describe variation in postpartum opioid prescribing across a statewide quality collaborative and assess the proportion due to practitioner and hospital characteristics.
Methods
We assessed postpartum prescribing data from nulliparous, term, singleton, vertex births between January 2020 and June 2021 included in the clinical registry of a statewide obstetric quality collaborative funded by Blue Cross Blue Shield of Michigan. Data were summarized using descriptive statistics. Mixed effect logistic regression and linear models adjusted for patient characteristics and assessed practitioner‐ and hospital‐level predictors of receiving a postpartum opioid prescription and prescription size. Relative contributions of practitioner and hospital characteristics were assessed using the intraclass correlation coefficient.
Results
Of 40,589 patients birthing at 68 hospitals, 3.0% (872/29,412) received an opioid prescription after vaginal birth and 87.8% (9812/11,177) received one after cesarean birth, with high variation across hospitals. In adjusted models, the strongest patient‐level predictors of receiving a prescription were cesarean birth (aOR 899.1, 95% CI 752.8–1066.7) and third−/fourth‐degree perineal laceration (aOR 25.7, 95% CI 17.4–37.9). Receiving care from a certified nurse‐midwife (aOR 0.63, 95% CI 0.48–0.82) or family medicine physician (aOR 0.60, 95%CI 0.39–0.91) was associated with lower prescribing rates. Hospital‐level predictors included receiving care at hospitals with <500 annual births (aOR 4.07, 95% CI 1.61–15.0). A positive safety culture was associated with lower prescribing rates (aOR 0.37, 95% CI 0.15–0.88). Much of the variation in postpartum prescribing was attributable to practitioners and hospitals (prescription receipt: practitioners 25.1%, hospitals 12.1%; prescription size: practitioners 5.4%, hospitals: 52.2%).
Discussion
Variation in postpartum opioid prescribing after birth is high and driven largely by practitioner‐ and hospital‐level factors. Opioid stewardship efforts targeted at both the practitioner and hospital level may be effective for reducing opioid prescribing harms.
... Intense pain during childbirth can cause a number of side effects in women, including a physiological reac tion to stress, uncoordinated uterus contractions, increase of labor duration, and even post traumatic stress disorder or postpartum depression [1][2][3][4][5][6]. In addition, pain of child birth can have a direct or indirect negative impact on the fe tus and newborn, for example, aggravate hypoxia and meta bolic acidosis, as well as cause cognitive and emotional child development disorders in the future [6,[7][8][9][10]. ...
INTRODUCTION: When performing epidural analgesia in childbirth, if surgical delivery is necessary, the question arises about the choice of further tactics of regional anesthesia. The article discusses the peculiarities of the effect of local anesthetics on the condition of a newborn during the conversion of epidural analgesia into anesthesia when caesarean section is necessary, depending on the local anesthetic used. OBJECTIVE: To assess the condition of a newborn baby during the conversion of epidural analgesia in childbirth through the natural birth canal into anesthesia during cesarean section, depending on the local anesthetic used. MATERIALS AND METHODS: A prospective randomized study of 143 children born to mothers who underwent the conversion of epidural analgesia into anesthesia for operative delivery by caesarean section was conducted. Depending on the local anesthetic used, the patients were divided into three groups, in the first group 20.0 ml of 2 % lidocaine in combination with 0.1 mg of epinephrine was injected into the epidural space, in the second group — 20.0 ml of 0.5 % bupivacaine, in the third — 20.0 ml of 0.75 % ropivacaine. The assessment of the condition of newborns was carried out on the Apgar scale at the 1st and 5th minutes of life and on the NACS scale in the first 15 minutes, 2, 24 and 72 hours after birth. RESULTS: The assessment of newborns on the Apgar scale, regardless of the local anesthetic used during epidural anesthesia at the first and fifth minutes, corresponded to 7 or more points (p > 0.05). The neuropsychiatric state of newborns when assessed on the NACS scale did not differ statistically significantly in all groups and at all stages of the study. Within each group, between the study stages, the average values of the NACS scores increased statistically significantly compared to the previous one. CONCLUSIONS: The conversion of epidural analgesia in childbirth through the natural birth canal into anesthesia during cesarean section is safe for the fetus and newborn when using 20.0 ml of 2 % lidocaine in combination with 0.1 mg of epinephrine or 20.0 ml of 0.5 % bupivacaine, or 0.75 % ropivacaine in a volume of 20.0 ml.
... Mortality is increased in these cases. Neonatal intensive care unit (NICU) admission probability compared to term infants is significantly higher (1,2) .There appears to be a sustained relationship between neonatal morbidity and gestational age in specific term and preterm labors (3) . For the fetus, the effects of labor on the baby are not clear. ...
Objective:
The aim of this study was to evaluate the short-term results of perinatal health in vaginal and cesarean deliveries and the indications for admission to the neonatal intensive care unit (NICU) in terms of healthy singleton pregnancies.
Materials and methods:
In this study, 300 pregnant women who gave birth in our tertiary hospital was included. The records of newborns admitted to the NICU of these pregnant women were reviewed between January 1, 2019 and January 1, 2021. Durations of newborn hospitalizations and problems encountered during admission were recorded. The results were statistically evaluated.
Results:
There was no significant difference between vaginal delivery and cesarean section groups in terms of the indications for admission to the NICU of term low-risk pregnant women (p=0.91, p=0.17). A higher admission in the NICU was found in the early term group. The early term group required more respiratory support compared to the full term group (p=0.02). When the groups were compared in terms of IV fluid treatment support, hypoglycemia or feeding difficulty, and jaundice requiring phototherapy, no significant difference was found.
Conclusion:
Withlimited data available for admission indications to the NICU of newborns born from term pregnancies, we found that the mode of delivery affects hospitalization indications of newborns, need for support, and Apgar scores. Early term delivery is associated with higher rates of neonatal morbidity and admission to the NICU. Better maternal care and prevention of factors that may lead to preterm birth will provide the prevention and management of these problems.
... After 38 completed weeks of pregnancy, elective caesarean sections are generally associated with a lower incidence of immediate respiratory problems in term newborns (1). Kadour et al. reported that neonates born by elective caesarean section at 38 weeks gestation had a nearly 3-fold higher rate of neonatal respiratory morbidity then neonates born at 39 weeks gestation (5.8% vs. 2.1%) (2). ...
Purpose: The aim of the current study was to determine if the decision to strictly follow clinical guidelines recommending elective caesarean section at or after 39 weeks gestation (late– term) in an effort to reduce respiratory disorders in term neonates influence the incidence of early–term elective caesarean sections and the rate of neonatal respiratory disorders. Methods: Hospital records pertaining to elective caesarean section after 37 weeks gestation from 1 January 2007 to 31 December 2016 were analyzed. Two subgroups were established (“before” and “after”). The rate of elective caesarean section before 39 weeks gestation, the rate of neonatal respiratory disorders, and admissions to the neonatal intensive care unit were compared between the subgroups. Results: A total of 1881 elective caesarean sections were performed from 37 weeks gestation (1.083 [57.6%] in the before sub–group and 798 [42.4%] in the after sub– group). In the after sub–group there was a 9.8% reduction of procedures performed before 39 weeks gestation. Of the newborns, 1.59% had various respiratory problems (2.3% and 1.00% in the before and after sub–groups, respectively; p = 0.08). Six of 30 (20.0%) newborns were transferred to the neonatal intensive unit (4/22 [18.2%] and 2/8 [25.0%] in the before and after sub–groups, respectively). Conclusion: The policy reduced the rate of elective caesarean sections before 39 weeks gestation and the rate of neonatal respiratory disorders, even though the incidence of these disorders was rather low, even before the new policy.
... These studies highlight the existence of heterogeneity in the group of full term pregnancies, proposing that pregnancies with GA of 37 ≥ and < 39 weeks should be classified as an early term. 10,11 In 2001, Robson developed a simple methodology classification that categorizes pregnant women into ten groups using the information on five obstetric characteristics: parity, previous obstetric history, gestation type, onset of labor, fetal presentation, and gestational age. It is a practical, reproducible, fully inclusive, and mutually exclusive method that allows an understanding of the internal structure of cesarean rates in a health institution and the identification of strategic groups that can be addressed to prevent unnecessary cesareans. ...
Objectives: to evaluate cesarean taxes by looking at Robson classification on 10 groups (G) and the principal indications at the prevalent groups and at G10. Methods: cross-sectional, observational, retrospective study, including all deliveries performed in a public hospital in Distrito Federal in 2019. Data were collected from medical records and pregnant women were classified in 10 groups. Pearson’s chi-squared test was used to calculate the p-value. The risk estimate for cesarean was defined by common odds ratio of Mantel-Haenszel, with calculation of odds ratio (OR) and 95% confidence interval (CI95%). Results: there were 2,205 deliveries, 1,084 (49.1%) of which were cesarean and 1,121 (50.9%) vaginal deliveries. The principal factors for cesarean were G5 (39.3%), G2 (21.2%) and G1 (13.6%). At G10, cesarean had 51.5% of births, not differing statistically from the other groups (p>0.05). Considering all preterm births, G6 to G10 and the other groups, there is a bigger chance of cesarean happening in relation to normal labor (OR=1.4; CI95%= 1.011-2.094; p=0.042). Dystocia remained at G1 and G2, previous cesarean at G5 and hypertensive syndrome at G10. Conclusion: cesarean was most prevalent delivery route, showing elevated rates even in primiparous and preterm births. Preponderance of dystocia and acute fetal distress suggests better evaluation of the diagnostic criteria, mainly in G1, G2 and G10.
... In cases when HIV RNA is less than1000 copies/ml, the timing of vaginal delivery can be decided considering the regular obstetric guidelines. If a elective cesarean delivery is performed for routine indications (other than HIV prevention) and HIV RNA is less than 1000 copies/mL, it should be performed at 39 weeks [23]. ...
... Using data on all births in the U.S. from 1990 to 2000 they confirmed that families respond to the financial incentives (tax benefits) by electing to give birth in December rather than January and found that most of the manipulation comes from changes in the timing of caesarian sections. Scheduling births has negative health consequences (lower birthweight, a lower Apgar score, and an increase in the likelihood of being low birthweight) for the newborn from accelerating deliveries, including short-term movements within "full-term" pregnancies (Schulkind & Shapiro, 2014;Tita et al., 2009). There have been several research studies related to auspicious birth dates. ...
We study the influence of numerological superstitions on family-related choices made by people in Denmark. Using daily data on marriages and births in Denmark in 2007-2019 we test hypotheses associated with positive perception of numbers 7 and 9 and a negative perception of number 13, as well as the impact of February, 29, April 1, St. Valentine’s Day and Halloween. There is significant negative effect of the 13 th on the popularity of both wedding and birth dates. However, some other effects associated with special dates and the cultural representations of unofficial holidays have a stronger effect. In addition, after controlling for many factors, February 29 and April 1 turn out to be desirable for weddings, but not for childbirth, implying the context dependence of cultural stereotypes. Evidence of birth scheduling for non-medical reasons is especially worrisome because of the associated adverse health outcomes associated with elective caesarian sections and inductions.
... Despite the life-saving benefits, women undergoing CS are at risk of haemorrhage, anaesthetic complications, obstetric shock, renal failure, puerperal infection, and complications in subsequent pregnancies [6][7][8][9]. Similarly, babies born through CS have increased risk of respiratory problems, hypoglycaemia, allergies and altered immunity [10][11][12]. Therefore, optimising use of CS is critical to maximise benefits and avoid unnecessary risks for women and babies. ...
Background
Rapid increases in caesarean section (CS) rates have been observed globally; however, CS rates exceeding 15% at a population-level have limited benefits for women and babies. Many interventions targeting healthcare providers have been developed to optimise use of CS, typically aiming to improve and monitor clinical decision-making. However, interventions are often complex, and effectiveness is varied. Understanding intervention and implementation features that likely lead to optimised CS use is important to optimise benefits. The aim of this study was to identify important components that lead to successful interventions to optimise CS, focusing on interventions targeting healthcare providers.
Methods
We used Qualitative Comparative Analysis (QCA) to identify if certain combination of important intervention features (e.g. type of intervention, contextual characteristics, and how the intervention was delivered) are associated with a successful intervention as reflected in a reduction of CS. We included 21 intervention studies targeting healthcare providers to reduce CS, comprising of 34 papers reporting on these interventions. To develop potential theories driving intervention success, we used existing published qualitative evidence syntheses on healthcare providers’ perspectives and experiences of interventions targeted at them to reduce CS.
Results
We identified five important components that trigger successful interventions targeting healthcare providers: 1) training to improve providers’ knowledge and skills, 2) active dissemination of CS indications, 3) actionable recommendations, 4) multidisciplinary collaboration, and 5) providers’ willingness to change. Importantly, when one or more of these components are absent, dictated nature of intervention, where providers are enforced to adhere to the intervention, is needed to prompt successful interventions. Unsuccessful interventions were characterised by the absence of these components.
Conclusion
We identified five important intervention components and combinations of intervention components which can lead to successful interventions targeting healthcare providers to optimise CS use. Health facility managers, researchers, and policy-makers aiming to improve providers’ clinical decision making and reduce CS may consider including the identified components to optimise benefits.
... 16 Given the significance of RDS as an etiology of infant morbimortality in late preterm and early term births, assessing FLM prior to labor seems reasonable. 17 The use of corticosteroids during pregnancy hastens lung maturation. The typical weakening of the double capillary loops, which results in the thin gas-exchanging walls of alveoli, is accelerated, leading in rapid alveolisation. ...
Background: Newborn respiratory complication is one of the most prevalent and life-threatening disorders. The clinical indications of early newborn respiratory distress with consistent radiologic features. The Doppler examination of the primary pulmonary artery in the foetus has been proven to be beneficial. The foetal pulmonary artery At/Et ratio is linked to foetal gestational age and amniotic fluid foetal lung maturity (FLM) tests. The aim of the study was to assess the accuracy of foetal main pulmonary artery (MPA) Doppler indices in prediction of the development of neonatal respiratory distress syndrome (RDS) in diabetic mothers.Methods: This was a prospective observational study carried out on 100 cases of diabetic mothers in obstetrics and gynecology department, Tanta University during one year from the approval of the university counsel. The physician evaluated the foetal heart in a methodical manner after a regular ultrasound assessment that included foetal biometry, anomaly scan, measured foetal weight, and amniotic fluid index. Classic chest radiological features include reticulogranular patterns, air bronchogram and ground glass look, as well as the need for surfactant.Results: PI and RI were significantly higher in newborns with RDS than those without RDS (p=0.025 and 0.036 respectively) PSV and At/Et ratio were significantly reduced in neonates with RDS compared with RDS free ones (p=0.004 and <0.001 respectively). RI was significantly higher in neonates with RDS than those without RDS (P = 0.048) PSV and At/Et ratio were significantly reduced in newborns with RDS compared to RDS free ones (p=0.008 and <0.001 respectively). The ROC curve displayed that the cut off value of ≤0.25 for At/Et ratio was associated with a sensitivity of 76.92%, a specificity of 100.0%, a PPV of 100.0% and a NPV of 96.7% for prediction of neonatal RDS with AUC of 0.925 and p≤0.001.Conclusions: development of neonatal RDS in foetus of diabetic mothers with a cut off value of ≤0.25, a sensitivity of 76.92%, a specificity of 100.0%, a PPV of 100.0%, a NPV of 96.7% and AUC of 0.925 The usage of corticosteroids improved the Doppler indices of main pulmonary artery and is accompanied by less morbimortality related to RDS.
... The neonatal risks of early-term births and the potential neonatal complications associated with elective delivery prior to 39 weeks are well described. 25,26 Therefore, it is an interesting finding that early- Award. ...
Introduction
Use of labor induction has increased rapidly in most middle‐ and high‐income countries over the past decade. The reasons for the stark rise in labor induction are largely unknown. We aimed to assess the extent to which the rising rate of labor induction is explained by changes in rates of underlying indications over time.
Material and methods
The study was based on nationwide data from the Icelandic Medical Birth Register on 85 620 singleton births from 1997 to 2018. The rate of labor induction and indications for induction was calculated for all singleton births in 1997–2018. Change over time was expressed as relative risk (RR), using Poisson regression with 95% confidence intervals (CI) adjusted for maternal characteristics and indications for labor induction.
Results
The crude rate of labor induction rose from 12.5% in 1997–2001 to 23.9% in 2014–2018 (crude RR = 1.91, 95% CI 1.81–2.01). While adjusting for maternal characteristics had little impact, adjusting additionally for labor induction indications lowered the RR to 1.43 (95% CI 1.35–1.51). Induction was increasingly indicated from 1997–2001 to 2014–2018 by gestational diabetes (2.4%–16.5%), hypertensive disorders (7.0%–11.1%), prolonged pregnancy (16.2%–23.7%), concerns for maternal wellbeing (3.2%–6.9%) and maternal age (0.5%–1.2%). No indication was registered for 9.2% of inductions in 2014–2018 compared with 16.3% in 1997–2001.
Conclusions
Our results show that the increase in labor induction over the study period is largely explained by an increase in various underlying conditions indicating labor induction. However, indications for 9.2% of labor inductions remain unexplained and warrant further investigation.
... The severe continuous breathing issues of the caesarean babies lead to asthma and the babies become often affected by different Vol.12; Issue: 9; September 2022 allergies. Affected immune development, allergy, atopy, asthma, and diminished intestinal gut microbiota diversity are among the short-term concerns (Tita et al., 2009). The persistence of these early childhood impacts into adulthood has received little attention. ...
The number of caesarean deliveries in Bangladesh, like other developed countries in the world, has increased at an alarming rate. Contrary to conventional deliveries, C-section births are more dangerous and difficult, albeit they are occasionally unavoidable. This paper aimed at exploring the health risks and complexities of caesarean mothers and babies in Bangladesh. Researchers organized a field study in Sylhet district, the northeastern part of Bangladesh, and interviewed in persons with 45 participants including doctors from two medical college hospitals and mothers who underwent caesarean sections applying purposive sampling technique. Researchers used thematic analysis method for analyzing primary data. Researchers applied two cycle coding (open coding and selective coding) to formulate the large themes. Research findings reveal that most of the mother participants got caesarean delivery only for avoiding pain without having any pregnancy complexities. This unplanned decisions regarding the birth style lead to serious concerns on the health systems of mother and babies including bleeding, over pain, increased infections, injury to the organs, problems in the future pregnancy, premature birth, asthma, diabetes-1 and other physical and psychological problems. Besides, these risks tend to be higher in Bangladesh due to lack of expertise doctors, technology, infrastructure, awareness and weak management systems. Hopefully, this study findings would be a guideline for the future researchers, policy makers, practitioners, and relevant communities to avoid unplanned Caesars and minimize the health risks of caesarean mothers and babies. Key words: Caesarean, risks, complexities, mother, babies, and Bangladesh
... The primary outcome is a composite adverse neonatal outcomes, stratified by GA, chorionicity and delivery indication, including neonatal death, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), mechanical ventilation, hypoglycemia, newborn sepsis, confirmed seizures, stroke, intraventricular hemorrhage (IVH), cardiopulmonary resuscitation, umbilical-cord-blood arterial pH < 7.0 or base excess < − 12.5, a 5-minute Apgar score ≤ 3, NICU length of stay ≥5 days. As indicated by previous studies, these outcomes are associated with significant risks of neonatal mortality or long-standing adverse health complications, including hypoxic ischemic encephalopathy [23]. Neonatal ipoglicemia was defined as low blood glucose level < 40 mg/dl before 48 hours age [24]. ...
Abstract Background Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16–50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications. Methods Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013–2015. The primary outcome was a composite of adverse perinatal outcomes. Results Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age (p
... The American College of Obstetrics and Gynecology has thus recommended designating 37 +0 to 38 +6 completed weeks' gestation as "early term" and 39 +0 to 40 +6 weeks' gestation as "full term" [5]. Both the reason and gestational age at delivery are likely important factors contributing to morbidity, as neonatal morbidity has been found to vary depending on the underlying indication for delivery [6]. Although early term babies are a category known for its high mortality and diverse morbidities, the overall incidence of prematurity related complications decreases significantly with increasing gestational age. ...
Background: Neonatal morbidity due to physiologic immaturity has been extensively studied in preterm infants delivered in less than 37 weeks gestation. However, evidence indicates that the infants delivered between 37+0 and 38+6 weeks gestation are also at increased risk for morbidity compared with the infants delivered at 39+0 to 40+6 weeks. Methodology: The present hospital-based prospective observational study was conducted among 150 neonates [75 babies each of early term (37+0 to 38+6 weeks) and full term (39+0 to 40+6 weeks)], born to consenting mothers in a tertiary care referral and teaching hospital, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly. Apart from maternal demographic and obstetric factors, features of the newborn - APGAR score at 1 & 5 minutes, admission to NICU, and other morbidity indicators such as respiratory distress, hyperbilirubinemia, neonatal sepsis, and prolonged hospital stay (>7 days), etc were recorded and compared. SPSS v21.0 was used for statistical analysis. Results: The mean age of mothers was 25.27+3.93 years (age range 19-40 years). Early term deliveries were common among older age groups, and full term among younger ones. Full term neonates had a higher APGAR 1-minute score than early term (p = 0.049), but this difference was not significant at 5-minute score (p > 0.05). NICU admission, respiratory distress and jaundice were more common among early term as compared to full term neonates (*p < 0.05). Conclusion: Early term neonates have a significantly higher morbidity and distress as compared to full term neonates. Studies are recommended to develop strategies to reduce early delivery of high-risk pregnancies.
The relationship between gestational age throughout the entire term period (37–41 weeks) and the occurrence of respiratory illness remains not fully understood. This population-based cohort study used birth data submitted by 50 states and the District of Columbia to the National Vital Statistics System database in USA to assess the association between gestational age and the incidence of neonatal respiratory failure (NRF) in term infants. Term singleton infants born from January 2021 to December 2022 were included in the analyses. The exposure variable of interest was the gestational age at birth. Primary outcome was NRF, defined by the need for assisted ventilation for over 6 h within the first days of life. Adjusted Odds ratios (aORs) compared NRF risk across gestational ages, with 39 weeks as the reference, adjusted for maternal and perinatal factors. In 4,978,703 term infants, NRF incidence at 37, 38, 39, 40, and 41 weeks was 1.7%, 0.9%, 0.6%, 0.7%, 0.8%, respectively. Compared to 39 weeks, the risk of NRF was higher at 37 weeks (aOR 2.08; 95% CI, 2.02–2.14), 38 weeks (aOR 1.27; 95% CI, 1.23–1.30), 40 weeks (aOR 1.18; 95% CI, 1.15–1.22), and 41 weeks (aOR 1.30; 95% CI, 1.25–1.35). Subgroup analyses confirmed similar trends across sex (male: aOR 2.07 at 37 weeks, 1.37 at 38 weeks, 1.12 at 40 weeks, 1.39 at 41 weeks; female: aOR 2.00 at 37 weeks, 1.34 at 38 weeks, 1.12 at 40 weeks, 1.40 at 41 weeks), delivery mode (vaginal delivery: aOR 1.96 at 37 weeks, 1.33 at 38 weeks, 1.10 at 40 weeks, 1.34 at 41 weeks; cesarean section: aOR 2.10 at 37 weeks, 1.37 at 38 weeks, 1.15 at 40 weeks, 1.48 at 41 weeks), and in infants born via elective cesarean section (aOR 2.51 at 37 weeks, 1.37 at 38 weeks, 1.09 at 40 weeks, 1.35 at 41 weeks). These findings highlight associations between gestational age within the term range and NRF risk, suggesting that careful consideration of delivery timing may be important for reducing respiratory complications in term infants.
Background : A cut-off weight of 2500 g in infants, which is commonly referred as low birth weight infants, was established as an indicator of perinatal prognosis several decades ago. However, perinatal medicine developed dramatically since then and theoutcomes are discussed using other factors including fetal growth nowadays. This study was conducted to assess the present perinatal situation with recent assessment scales and reconsider the indicators used for perinatal outcome. Methods : This is a retrospective descriptive study analyzing whole Japanese birth certificate data between 1992 and 2018. Trend in prenatal outcomes including birth weight, gestational age, presence of fetal growth restriction, preterm birth and birth weight-to-gestational age z-score were calculated. Fetal growth restriction was defined as birth weight-to-gestational age z-score less than 10 percentile. Results : A total of 48,235,783 births in Japan were included. The proportion of infants with birth weight under 2500 g was constant while mean birth weight stopped declining and mean gestational age continued to fall. In contrast, the incidence of fetal growth restriction and the mean birth weight-to-gestational age z-score were improving. In detail, proportion of early term infants (between 37 weeks 0 day and 38 weeks 6 days of gestational age) was increasing while that of late preterm infants (between 34 weeks 0 day and 37 weeks 6 days of gestational age) was constant. Conclusions : Over all perinatal outcome was improving. Shortened gestational age result from change in perinatal management policy due to progress in perinatal medicine that enabled smaller infants and/or infants born at shorter gestational age to survive. However, even if delivered with a shorter gestational period with an aim to achieve good outcomes, considering that the 10th percentile weight of a baby boy born to a primiparous mother at 37 weeks 0 days gestation, a full-term delivery, is 2203 g, for example, the infants would be classified as a low birthweight infant which is an indicator for poor prognosis. Therefore, low birth weight no longer reflects perinatal outcome appropriately and other factors like fetal growth should be considered as indicators for overall perinatal context.
This study aimed to assess the adherence to the NICE guidelines for prescribing corticosteroids to pregnant women before elective cesarean section delivery at Al-Karak Hospital. A retrospective audit was conducted on a group medical records of women who underwent elective cesarean section between January and June 2019. The results showed that 57% were not offered any shot whereas 35% had took the two shots. However, the rest 0.08% took only one-shot.The main reasons for non-adherence were lack of awareness, unavailability of drugs, and late referral. The study recommended implementing educational interventions, ensuring drug availability, and improving referral system to improve the quality of care.
Background: To achieve the sustainable development goal of lowering maternal death rates, it's crucial to enhance the availability of obstetric procedures, including cesarean sections. The restricted access of women to both routine and emergency obstetric care in Nigeria significantly contributes to the worldwide maternal mortality rates. Objectives: The aim of the study was to determine the prevalence of primary caesarean section among primigravida and multiparous women in a tertiary health facility in Nigeria. Methodology: This was a cross-sectional study carried out among 142 women at Specialist teaching hospital Irrua, Employing a systematic and random sample technique. Data was analyzed using IBM SPSS version 21.0 software for descriptive statistics. The Chi square test was used to test for association, the level of significance was set as p < 0.05. Results: It was discovered that Two-third (63%) of the participants has had caesarean section, As regards the prevalence of primary Caesarean section among multiparous women, this study observed that about a few of the respondents (11.3%) had Caesarean section for the first time in their pregnancy. On the financial implications, this study revealed that two-third (66.7%) paid between ₦10,000-₦49,000 (33 and majority (80.3%) that did Cesarean section paid about ₦100,000-₦299,000 (197) this was due to the circumstance surrounding the Caesarean section done or peculiar to each woman and depending on the complication that resulted. The study revealed that the statistical significance (p=0.04) for the method of payment, childbirth, and caesarean section from pocket money was more. Conclusion: Findings from this study shows that prevalence of Cesarean section is more common in the primigravida than in the multiparous women as being pregnant for the first time as they are more prone to conditions like prolong labor, fetal distress and obstructed labor. The study also indicates that majority paid out of pocket and a few respondents were insured.
The postpartum period can be a joyous and
exciting time for new mothers, but they may also be
times of stress, depression, and difficulty for some
women. Some psychological changes are associated
with pregnancy and delivery, and parents must cope
with several distinct challenges during this time. Thus,
pregnancy and postpartum periods are periods of
elevated vulnerability to mental illnesses. The most
common maternal mental health during pregnancy
and after birth is depression and anxiety, with
symptoms ranging from mild to severe. However,
there is still a lack of knowledge as to why some
mothers are more prone to severe depression or
anxiety symptoms than other women who can cope
under adverse circumstances even when the odds are
stacked against them.
Objective: Late preterm newborns are defined as infants born at 34-36 weeks of gestation, while early term newborns are those born at 37-38 weeks. Late preterm and early term newborns have higher risks of morbidity and mortality compared to term infants. The aim of this study was to investigate the causes of neonatal morbidity and mortality in late preterm and early term newborns with reference to term newborns. Materials and Methods: A total of 1000 newborns born between 34 and 42 weeks of gestation in our hospital were included in this study. These cases were evaluated according to maternal age, birth weight, APGAR score, mode of delivery, need for postnatal resuscitation, family income, hospitalization rate, and need for mechanical ventilation. Results: Among the 1000 newborns included in the study, respiratory problems were more common in male newborns. As income levels increased, the rate of births closer to term increased. The hospitalization rate of late preterm newborns was higher compared to early term and term newborns while APGAR scores were lower. Finally, the need for mechanical ventilation was higher among late preterm newborns. Conclusion: In evaluations of late preterm and early term newborns, their physiological immaturity should be considered and it should not be forgotten that they have higher risks in terms of morbidity and mortality. Delivery should not be planned before the 39th week of gestation unless there is a medical indication.
Adolescence and pregnancy are two episodes that involve large psychological and identity changes. Teenage pregnancies are often considered to be a result of confusion between these periods. The circumstances of pregnant adolescents and early motherhood vary and sit within the wider context of the psychopathology of adolescence, the diversity of family structure, and social changes. The current data showed that about 12 million girls aged 15–19 and at least 777 000 girls under 15 years give birth yearly in developing regions (World Health Organization, 2022). Unfortunately, being pregnant during adolescence is challenging due to immature physical, emotional and mental conditions. As pregnancy and postpartum bring a lot of changes, the impact of these changes might impact adolescent mental health. Adolescent women frequently experience complications during pregnancy and after birth because they are psychologically and physically immature. Teenage mothers experienced greater rates of depression during pregnancy (9.8%) than mothers aged 20 to 34 (5.8%) and mothers aged 35 or older (6.8%; P .001). Additionally, adolescent women consumed more alcohol, marijuana, and tobacco throughout pregnancy (P.001). Although it is mostly unrelated to poor birth outcomes, teenage pregnancy is linked to a higher risk of socioeconomic disadvantage, mental health issues, and substance use during pregnancy (Wong et al., 2020). Adolescent pregnancy impacted premature, low birth weight, subsequent developmental delays, and behavioral disorders among their children. The mothers also risk experiencing postnatal depression, school dropout, and poor socioeconomic position. Pregnant and parenting teenagers are more likely than pregnant and postpartum adult women to experience depressive symptoms. Young women are more likely to experience postpartum depressive symptoms, highlighting the importance of pre- and postnatal healthcare programs. Understanding mental health problems that are related to adolescent pregnancy is essential. This chapter aimed to identify the potential problems among pregnant adolescents and the steps to address these problems.
Background:
The morbidity of early-term newborns (ETNBs) is associated with the immaturity of their organs and maternal biological factors (MBF). In this study, we determined the relationship between MBF and early-term birth. In addition, we assessed the role of gestational age (GA) and MBF in the morbidity of ETNBs compared with full-term newborns (FTNBs).
Methods:
This retrospective cohort included ETNBs and FTNBs. The frequency of morbidities was compared between groups stratified by GA with the X2 test or Fisher's exact test. The association of MBF with GA and morbidity was calculated using binomial regression models between the variables that correlated with the morbidity of the ETNBs using Spearman's correlation. A significance level of 5% was estimated for all analyses.
Results:
The probability of morbidity at birth for ETNBs was 1.9-fold higher than for FTNBs (37.5% vs. 19.9%), as they required more admission to the neonatal unit and more days of hospitalization; the most frequent pathology was jaundice. The MBF associated with early term birth were hypertensive disorders of pregnancy (aRR = 1.4, 95% confidence interval (CI): 1.3-1.6), intrauterine growth restriction (aRR = 1.5, 95% CI: 1.3-1.6), and chronic hypertension (aRR = 1.6, 95% CI: 1.4-1.8). No association was found between MBF and morbidity at 37 and 38 weeks.
Conclusions:
The morbidity among ETNBs is related to physiological immaturity. The adverse MBF favor a hostile intrauterine environment, which affects fetal and neonatal well-being.
Objective
To identify the optimal gestational age of planned delivery in pregnancies complicated by chronic hypertension requiring antihypertensive medications that minimizes the risk of adverse perinatal events and maternal morbidity.
Methods
Retrospective cohort study of singleton pregnancies after 37 weeks of gestation complicated by chronic hypertension on antihypertensive medication, delivered at 7 hospitals within an academic health system in New York from 12/1/2015 to 9/3/2020. Two comparisons were made (1) planned deliveries at 37–376/7 weeks versus expectant management, (2) planned deliveries at 38–386/7 weeks versus expectant management. Patients with other maternal or fetal conditions were excluded. The primary outcome was a composite of adverse perinatal outcomes including stillbirth, neonatal death, assisted ventilation, cord pH < 7.0, 5-minute Apgar ≤5, diagnosis of respiratory disorder, and neonatal seizures. The secondary outcomes included preeclampsia, eclampsia, primary cesarean delivery, postpartum readmission, and infant stay greater than 5 days. Odds ratios were estimated with multiple logistic regression and adjusted for confounding effects.
Results
A total of 555 patients met inclusion criteria. Patients who underwent planned delivery at 37 weeks compared to expectant management did not appear to be at higher risk of adverse perinatal outcomes (14.9% vs 10.4%, aOR 1.49, 95% CI: 0.77–2.88). Similarly, we did not find a difference in the primary outcome in patients who underwent planned delivery at 38 weeks versus those expectantly managed (9.7% vs 10.1%, (aOR 0.84, 95% CI: 0.39–1.76). There were no differences in the rates of primary cesarean or preeclampsia at 37 and 38 weeks.
Conclusion
Our findings suggest that there is no difference in neonatal or maternal outcomes for chronic hypertensive patients on medication if delivery is planned or expectantly managed at 37 or 38 weeks’ gestation.
Background: Fertility is a topic of concern in every country, and all the countries are advocating fertility and improving their fertility policies. The aim of this study was to investigate the effects of parity on pregnancy outcomes, and provided reasonable prevention and intervention of risk factors to reduce the incidence of adverse maternal and infant pregnancy outcomes. Methods: A total of 1,200 women were randomly selected by parity and they were divided into three groups. The pregnancy outcomes of the three groups were compared by using Partition of Chi-square. Logistic regression was conducted to estimate the association between parity and pregnancy outcomes after adjusting for other confounding influencing factors. Results: Age (28.82 ± 4.01 vs 32.33 ± 4.30 vs 33.80 ± 4.49), BMI (26.31 ± 3.04 vs 27.08 ± 3.17 vs 27.57 ± 3.36), gestational weeks (39.13 ± 1.67 vs 38.70 ± 1.71 vs 38.36 ± 1.82), days from admission to delivery (0.89 ± 1.20 vs 0.89 ± 1.28 vs 1.13 ± 1.18), scar uterus (0.8% vs 37% vs 62%), fertilization way, and delivery way were significantly different among the three groups of women. Multi parity is a risk factor for the occurrence of preterm birth (OR = 1.602, 95% CI: 1.181–2.173), perinatal anemia (OR = 1.468, 95% CI: 1.099–1.963), and uterine rupture (OR = 2.752, 95% CI: 1.261–6.007). It is a protective factor for low birth weight (OR = 0.564, 95% CI: 0.321–0.992), amniotic fluid turbidity (OR = 0.556, 95% CI: 0.418–0.739), and fetal distress (OR = 0.171, 95% CI: 0.080–0.365) (P < 0.05). Conclusion: Multi parity is not an independent risk factor for adverse pregnancy outcomes, but mostly combined with scar uterus, advanced age, obesity, IVF, and other risk factors that lead to adverse pregnancy outcomes. Strictly controlling the indications of cesarean section, early fertility, and reasonable weight gain during pregnancy are the most effective measures to prevent adverse pregnancy outcomes after the opening of the three-child policy in China.
Introducción: Los recién nacidos a término precoz tienen mayor riesgo de complicaciones y morbilidad que los neonatos a término tardío. El objetivo fue determinar la incidencia de recién nacidos a término precoz en el Hospital Hipólito Unanue de Tacna. Material y Método: Estudio descriptivo, retrospectivo, de corte transversal. Se analizó 10587 recién nacidos vivos con edad gestacional de 37 a 38 semanas, de embarazo único, nacidos en el hospital Hipólito Unanue de Tacna durante los años 2000 a 2013. SE presenta incidencia por año. Se utilizó base de datos del Sistema Informático Perinatal. Resultados: Durante los años 2000 a 2013 en el hospital Hipólito Unanue de Tacna, se atendieron 46783 recién nacidos vivos, de los cuales 22,6% fueron a término precoz, lo que representan 25% de todos los a término. La incidencia oscila entre 19,7% en el año 2000, hasta el 24,6% en el año 2013, con discreta tendencia ascendente. Conclusión: La incidencia de recién nacidos a término precoz en el Hospital Hipólito Unanue de Tacna se encuentra en el promedio nacional e internacional.
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