Mode of delivery and neonatal respiratory morbidity among HIV-exposed newborns in Latin America and the Caribbean: NISDI Perinatal-LILAC Studies

Objective

To evaluate respiratory morbidity (RM) in HIV-exposed newborns according to mode of delivery.

Methods

The NISDI Perinatal/LILAC prospective cohort studies enrolled HIV-infected pregnant women and their newborns in Latin America and the Caribbean. Associations between RM and delivery mode or other characteristics were evaluated.

Results

Between September 2002 and December 2009, 1630 women were enrolled, and 1443 mother-infant pairs met the inclusion criteria. There were 561 vaginal (VD), 269 cesarean before labor and membrane rupture (SCS) for preventing mother-to-child transmission (SCS-PMTCT), 248 other SCS, and 365 cesarean after labor and/or ruptured membranes (NSCS) deliveries. In total, 108 (7.5%) newborns had RM: 49 had respiratory distress syndrome (RDS), 39 had transient tachypnea (TTN), and 28 had other events (7 newborns had > 1 RM event). Delivery mode was associated with RDS (P < 0.005) and TTN (P < 0.001). The proportion with RDS and TTN was lowest for VD (1.6% and 0.5%, respectively), highest for NSCS (4.9% and 4.7%), and intermediate for SCS-PMTCT (3.0% and 2.6%). Newborns with RDS or TTN were hospitalized longer (median + 1 day) than those without. A minority required ventilatory support (RDS, 24.5%-28.6%; TTN, 2.6%-15.4%).

Conclusions

SCS-PMTCT is relatively safe for newborns of HIV-infected women.     

Mode of delivery and lymphocyte beta 2-adrenoceptor density in parturients and newborns

Twenty-six women with uncomplicated pregnancy at term were selected for the study. Nine had spontaneous vaginal delivery without medication, 8 elective caesarean section under epidural and 9 under general anaesthesia. The results clearly demonstrate that newborns have lower lymphocyte beta 2-adrenoceptor density than their mothers. In vaginally delivered newborns the lymphocyte beta 2-adrenoceptor density was 38%, in the caesarean section group with general anaesthesia 27%, and with epidural anaesthesia 22% lower than in the corresponding mother group. Vaginally delivered newborns have lower lymphocyte beta 2-adrenoceptor density than those delivered by caesarean section. A plausible explanation is the down-regulation of the beta 2-adrenoceptors during labour and delivery.     

Fetal heart rate pattern and risk for respiratory disturbance in full-term newborns

Etiologic and pathogenetic factors responsible for respiratory disturbances in full-term infants are still unclear. The authors' intention was to analyze to what extent fetal stress, expressed in terms of abnormal fetal heart rate pattern, was reflected in neonatal respiratory disturbance. The study was performed prospectively over one year and included 157 term infants. Contrary to general belief, there was a significantly lower incidence of respiratory disturbances after ominous fetal heart rate pattern, ie, basal bradycardia, late or severe variable decelerations, and reduced variability than after a normal fetal heart rate pattern. It is suggested that these results may be due to a favorable effect on the fetal lung of systemic or local factors, produced in response to intrauterine stress.     

The evaluation of respiratory distress syndrome (RDS) risk factor evidence in newborns

The aim of this study was to evaluate RDS risk factors in newborns of mothers with define pregnancy complications. The study group included mothers with imminent preterm delivery, intrauterine growth retardation, gestation cholestasis, serological collision, oligo- and polyhydramnios and foetus life threatens risk factors. RDS appeared in newborns born up till 35 weeks of gestation, for the risk factors analysis only preterm delivery, which were ended until 36 weeks of gestation were taken into consideration. Hypertension appeared to be a significant risk factor increasing the risk of RDS evidence 5 times and asphyxia, which increased by 4. In the logistic regression analysis model hypertension showed to increase the risk of RDS evidence 6 times, even when the time of delivery was considered. A, when the time of gestation was prolonged even one week the risk of RDS was decreased by 30%. The was no significant increase in RDS evidence in offspring of mothers with diabetes mellitus, cholestasis gravidarum, hypotrophia foetus or oligo and polyhydramnios.     

Cesarean section in the absence of labor and risk of respiratory complications in newborns: a case-control study

Aim: To establish if labor and gestational age have an additive effect on the likelihood of newborn respiratory complications.

Methods: Case-control study on singleton pregnancies, delivered between 34 and 41 weeks. Cases were collected among newborns discharged with diagnoses of respiratory complications, as codified by ICD 9 1997. Subsequently, pneumonias, meconium aspiration syndromes, and pulmonary hemorrhage were excluded. Controls were all other newborns without respiratory complications. Multivariate analyses were performed hypothesizing and not hypothesizing a relationship between gestational age, labor and newborn adverse respiratory outcomes.

Results: Twenty thousand three hundred and ninety-seven living babies born at term or near-term between January 2006 and December 2010 were assessed. 16,084 infants were included in the analyses. 304 experienced a respiratory complication (cases group). Delivering by cesarean not in labor increases the odds ratio of adverse respiratory outcome by about 2, independently from other variables, among which is gestational age. The same increase of odds ratio of 2 is constantly observed at each week of gestation, from 35 to 39 gestational weeks.

Conclusions: Cesarean not in labor adds a constant risk of newborn respiratory complications at any gestational age near-term and early-term. The more the planned cesarean is delayed, the better is newborn respiratory outcome.     

Umbilical arterial pH < 7.00 in newborns delivered by nonelective cesarean delivery: risk factors and peripartum outcomes

The objective of this study was to compare the risk factors and peripartum outcomes among patients who had nonelective cesarean delivery with umbilical arterial pH < versus > or = 7.00. A case-control study of parturients who delivered by nonelective cesarean delivery and had a neonate with a pH < 7.00 were compared with the next four patients who delivered abdominally but had a newborn with a normal pH. Among 45 newborns with pH < 7.00 the rate of cesarean delivery for nonreassuring fetal heart rate was significantly more common in the case (56%) than control group (16%). The rates of end organ failure and neonatal death were similar for both groups. Although newborns with pH < 7.00 were significantly more likely to have cesarean delivery for nonreassuring fetal heart rate patterns and be admitted to the neonatal intensive care unit, there was no means to identify these patients until the abnormalities in tracing developed.     

The relationship between the time from rupture of the membranes to delivery and the incidence of respiratory distress syndrome in premature newborns

The records of 520 deliveries of low birth weight infants were reviewed. A significantly lower incidence of respiratory distress syndrome was seen in cases where the time interval between rupture of membranes and delivery exceeded 1 h as compared to neonates delivered within 1 h after rupture of membranes. Premature infants born after complicated pregnancies had higher rates of RDS than those delivered after uncomplicated pregnancies. It is concluded that postponement of delivery of premature infants for at least a few hours after ROM can reduce the probability of the development of a RDS.     

Mode of delivery and neonatal hematocrit

The objective of this paper is to test the hypothesis that the 2-h hematocrit (HCT) is lower in infants born by cesarean section (CS) than in infants born vaginally and that the postnatal rise of HCT is lower in infants born by CS than in infants delivered vaginally. We prospectively studied 31 infants delivered by elective CS, 21 infants delivered by CS because of arrest of descent and 30 vaginally delivered (VD) infants. All pregnancies were term, uncomplicated in nonsmoking mothers. Apgar scores were > 7 at 1 and 5 min. In all infants umbilical cord was clamped early. Umbilical vein and 2-h peripheral venous micro-HCT were measured by centrifugation. Cord-blood HCT, 2-h HCT, and rise in HCT were similar in the two CS groups and significantly lower than in the VD group. In multiple regression, gestational age, Apgar score, or the presence or not of labor did not influence cord-blood HCT, 2-h HCT, or the rise in HCT. Infants born by CS have lower HCT than infants born vaginally. Prediction of 2-h HCT from cord-blood HCT must take into account the mode of delivery.     

Mode of delivery in multiple pregnancies

The onset of labor in the pregnant women with multiple gestation brings the obstetrician and perinatologist to another decision point. What mode of delivery is most appropriate: cesarean section or vaginal delivery? The aim of the study was to analyze the twin pregnancy delivery, the mode of delivery and neonatal well being.     

Mode of delivery and future fertility

A cohort of 22,948 women from a stable homogeneous population who gave birth for the first time between 1964 and 1983 were followed up prospectively. Analysis by mode of delivery showed that of those delivered by caesarean section 23.2% fewer had another pregnancy than those who had a spontaneous vaginal delivery. Women delivered by forceps were in an intermediate group. Miscarriage was more common in women who had been delivered by caesarean section. The relative infertility after caesarean section could not be accounted for by early sterilization, was not associated with maternal height or social status, and was only partly attributable to age.     

Mode of delivery in pregnancies with gastroschisis according to delivery institution

Purpose: We aim to compare the mode of delivery in pregnancies with gastroschisis delivered in nonacademic institutions with those delivered in an academic center.

Material and methods: Chart review from 2008 to 2015 was performed. Cesarean delivery rate (CDR), attempted vaginal delivery rate (AVR), planned cesarean rate (PCR) and adverse neonatal outcomes were compared among pregnancies with gastroschisis delivered in nonacademic hospitals with those delivered in an academic institution. Parametric and nonparametric statistical analysis was performed when appropriate. A multivariable logistic regression mode was utilized to control for confounders. A p value?Results: Mode of delivery was documented in 94 cases (88%). CDR (76.7 versus 41.2%; odds ratios (OR), 4.7; 95%CI, 1.9–11.6) and PCR (55 versus 6.4%; OR 17.9; 95%CI, 4.8–67.4) were higher in those delivered in nonacademic centers. AVR was lower in the nonacademic group (45 versus 93.6%; OR 0.02; 95%CI, 0.01–0.2). Neonatal intensive care length of stay (56 days [IQR, 34–102 days] versus 36 days [IQR, 26–60 days; p?=?.018]) was longer in the nonacademic group. Other neonatal adverse outcomes studied were not statistically different between groups.

Conclusions: In our population, delivery at nonacademic institutions in pregnancies with gastroschisis may be associated with higher cesarean delivery rates. These findings may add information for the delivery planning of pregnancies complicated by this condition.

Rationale: In our study we aim to compare the mode of delivery in pregnancies with gastroschisis delivered in nonacademic institutions with those delivered in an academic center. Our results suggest, that delivery at nonacademic institutions in pregnancies with gastroschisis may be associated with higher cesarean delivery rates. These findings may add information for the delivery planning of pregnancies complicated by this condition.