Is primiparity a risk factor for advanced maternal age pregnancies?

Objective: Currently, more women are delaying childbearing until their 40s.This study compared the pregnancy and maternal features, pregnancy and foetal outcomes between multiparous and primiparous patients. We compared the same factors between assisted reproductive technology (ART) and non-ART primiparous patients because of the high proportion of ART used in the primiparous patients.

Methods: The study retrospectively examined 1680 patients, 35 years of age and older, between March 2008 and February 2015.

Results: Comparing the features of these two groups, there was an increased incidence of employment and the use of ART in primiparous patients, while birthweight tended to be higher in the multiparous group. There were no significant differences in pregnancy complications other than hypertension disorders, such as pre-eclampsia and HELLP syndrome, which were significantly more frequent in primiparous patients. The rates of foetal growth retardation and perinatal death were significantly higher in primiparous women. Comparison of the data between ART and non-ART primiparous patients indicated that the ART group had a higher initial body mass index and a lower smoking rate. No significant differences in pregnancy complications or foetal outcome were observed between these two groups.

Conclusion: Primiparity is associated with increased pregnancy and foetal complications in advanced age pregnancies. However, the use of ART in this age group does not seem to be an additional risk factor.     

Trial of labor in patients with a previous cesarean section: does maternal age influence the outcome?

OBJECTIVE: This study was undertaken to evaluate the effect of maternal age on the rate of vaginal delivery and the rate of uterine rupture in patients undergoing a trial of labor (TOL) after a prior cesarean delivery. STUDY DESIGN: A cohort study of all women with a live singleton fetus undergoing a TOL after a previous low-transverse cesarean delivery was performed between 1988 and 2002 in a tertiary care center. Patients were divided into 3 groups according to maternal age: less than 30 years old, 30 to 34 years old, and 35 years or older. Women with no prior vaginal delivery and with at least 1 prior vaginal delivery were analyzed separately. The rate of vaginal delivery and the rate of symptomatic uterine rupture were calculated. Multivariate logistic regression analyses were performed to adjust for potential confounding variables. RESULTS: Of the 2493 patients who met the study criteria, there were 1750 women without a prior vaginal delivery (659, 721, and 370, respectively) and 743 women with a prior vaginal delivery (199, 327, and 217, respectively). The rate of uterine rupture was comparable between the groups (2.0%, 1.1%, 1.4%, P=.404 and 0%, 0.3%, 0.9%, P=.312). Successful vaginal delivery was inversely related to maternal age (71.9%, 70.7%, 65.1%, P=.063, and 91.5%, 91.1%, 82.9%, P=.005). After adjusting for confounding variables, maternal age equal to or greater than 35 years old was associated with a lower rate of successful vaginal delivery in patients without prior vaginal delivery (odds ratio [OR] 0.73, 95% CI: 0.56-0.94), and in patients with a prior vaginal delivery (OR: 0.47, 95% CI: 0.29-0.74). CONCLUSION: Patients who are 35 years or older are more prone to have a failed TOL after a prior cesarean delivery.     

Risks and benefits of the skin-to-skin cesarean section – a retrospective cohort study

Objective: Comparing maternal and neonatal outcomes after conventional cesarean section (CS) versus a “natural” or “skin-to-skin” cesarean section (SSCS).

Methods: Retrospective cohort of women who underwent a SSCS (01-2013 until 12-2013) compared to conventional CS (08-2011 to 08-2012). CS before 37 weeks, under general anesthesia and in case of fetal distress were excluded. Main outcome measures were maternal blood loss, post-operative infection and admission; neonatal infection and admission; procedural outcomes.

Results: We analyzed 285 (44%) women in the SSCS-group and 365 (56%) in the conventional CS-group. There were no significant differences in surgical site infection (2.1% versus 1.6%; RR 1.1; 95%CI 0.64–2.0), or other maternal outcomes. Fewer neonates born after SSCS were admitted to the pediatric ward (9.5% versus 18%; RR 0.58; 95%CI 0.41–0.80) and fewer neonates had a suspected neonatal infection (2.0% versus 7.3%; RR 0.40; 95%CI 0.19–0.83). No differences were observed for other outcomes. Mean operation time was 4m42s longer in the SSCS-group compared to the conventional CS-group (58m versus 53m; 95%CI 2m44s–6m40s). Mean recovery time was 14m46s shorter (114m versus 129m; 95%CI 3m20s–26m).

Conclusion: Adverse maternal and neonatal outcomes were not increased after skin-to-skin cesarean compared to conventional cesarean delivery.     

Do risk factors for elective cesarean section differ from those of cesarean section during labor in low risk pregnancies?

AIMS: As the rate of cesarean sections has continuously increased over the last three decades, we sought to identify the factors related to elective cesarean section (ECS) and cesarean section during labor (LCS) in low risk pregnancies and to determine if they differ for the two types of cesarean. METHODS: We conducted an observational study that included all maternity units in metropolitan France. Using the sample from the National Perinatal Survey 2003, we included 5393 women who met the criteria of a low risk pregnancy. The odds ratios (OR) corresponding to ECS and LCS were calculated for various characteristics for the women, fetus and maternity units, using a multinomial logistic regression model. For each factor, the adjusted OR corresponding to ECS and LCS were compared using the Wald's test. RESULTS: The rates of ECS and LCS in our population were 2.9% and 4.3%, respectively. Maternal age >or=30 years, body mass index >or=25 kg/m(2), primiparity and nationality from an African country were associated with an increased risk for both ECS and LCS. Those maternity units registering a low volume of deliveries (<1000/year) and those with a high rate of cesarean section during the previous year had an increased rate of LCS. CONCLUSION: Women with low risk pregnancies at term may present several factors that appear to create an "environment" favorable for cesarean section, leading to an increase in the likelihood of both ECS and LCS. Furthermore, several characteristics concerning maternity units are associated with an increased likelihood of LCS. Understanding the impact of various factors on the decision about the mode of delivery is essential for obstetrical teams concerned with controlling the progressive increase in the rate of cesarean sections.     

Elective induction of labor in multiparous women. Does it increase the risk of cesarean section?

OBJECTIVE: To determine whether the medical initiation of labor places the multiparous woman at increased risk of cesarean section. STUDY DESIGN: This study was a retrospective, case-control assessment of the risk of cesarean section in multiparas with no medical or obstetric complications and vertex presentations whose induction of labor at term was judged to be elective by chart analysis. Case women were matched for age, parity, gestational age and staff obstetrician with controls in spontaneous labor, and the rates of cesarean delivery were compared. RESULTS: Three hundred four case-control pairs were studied. No significant difference was observed in the rate of cesarean delivery between the two groups. The rate of cesarean section in the electively induced group was 3.6% versus 4.3% in the control group (P = .6670). Neither cervical state nor use of cervical ripening agents significantly affected the rate of cesarean delivery. CONCLUSION: As compared with spontaneous labor, the elective induction of labor in multiparous women without complications does not predispose to cesarean delivery.     

Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced?

Objective.?To determine whether preeclampsia is associated with an increased risk of cesarean delivery if labor is induced.

Methods.?This retrospective cohort study of 3505 women ≥24 weeks gestation with singleton pregnancies undergoing labor induction compares cesarean delivery rates between preeclamptics and non-preeclamptics. Multivariable logistic regression analysis was used to control for potential confounders including unfavorable cervix (Bishop score ≤5), method of labor induction, maternal age, parity, gestational age, race/ethnicity, epidural use, medical insurance, and marital status.

Results.?Among term nulliparous women undergoing labor induction, preeclamptics had a higher cesarean delivery rate then non-preeclamptics (81/267, 30% vs. 363/1568, 23%; p?=?0.011), as did preeclamptic compared with non-preeclamptic women who were term and multiparous (10/64, 16% vs. 55/900, 6%, p?=?0.003). Preterm preeclamptics also had more cesarean deliveries compared with non-preeclamptics among nulliparous (48/164, 29% vs. 16/245, 7%; p?<?0.001) and multiparous (13/72, 18% vs. 18/225, 8%; p?=?0.015) women. In multivariable analysis, preeclampsia still conferred an increased risk of cesarean delivery if labor was induced (adjusted odd ratio?=?1.90, 95% CI 1.45–2.48).

Conclusion.?Women with preeclampsia undergoing labor induction had higher cesarean delivery rates compared with non-preeclamptics regardless of parity or gestational age. However, the majority of women with preeclampsia still had successful vaginal deliveries.     

Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London

Objective To determine the maternal and fetal risk of adverse outcome during pregnancy in relation to low maternal body mass index in an unselected population.
Design Retrospective analysis.
Methods Information for the years between 1988 and 1997 was extracted from a validated maternity database, including all but one of the maternity units in the North West Thames Region; 215,105 completed singleton pregnancies were studied. Comparison of pregnancy outcome was made on the basis of maternal body mass index at booking. There were 176,923 with a normal weight body mass index (= 20 < 25). There were 38,182 with an underweight body mass index (  < 20  ). Comparisons included antenatal complications (e.g. gestational diabetes, pre-eclampsia); intervention in labour, maternal morbidities (e.g. infection, postpartum haemorrhage, pulmonary thromboembolism); and neonatal outcome (admitted to special care baby unit at 24 hour of age, gestation at delivery, birthweight, stillbirth). Data are presented as percentages of outcomes in the normal and underweight groups with adjusted odds ratios and confidence intervals according to body mass index group.
Results In the underweight group only antenatal anaemia, preterm delivery and birthweight below the 5th centile were more frequent than in women of normal body mass index. The prevalence of certain complications, including development of gestational diabetes mellitus, pre-eclampsia, obstetric intervention and postpartum haemorrhage, were significantly lower in those with low body mass index.
Conclusion Low maternal body mass index is associated with increased prevalence of some pregnancy complications, notably preterm delivery and low birthweight, but overall the outcome is favourable and several adverse outcomes are less common in this group of women.     

Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London

Objective To determine the maternal and fetal risk of adverse outcome during pregnancy in relation to low maternal body mass index in an unselected population.Design Retrospective analysis.Methods Information for the years between 1988 and 1997 was extracted from a validated maternity database, including all but one of the maternity units in the North West Thames Region; 215,105 completed singleton pregnancies were studied. Comparison of pregnancy outcome was made on the basis of maternal body mass index at booking. There were 176,923 with a normal weight body mass index (= 20 < 25). There were 38,182 with an underweight body mass index (< 20). Comparisons included antenatal complications (e.g. gestational diabetes, pre-eclampsia); intervention in labour, maternal morbidities (e.g. infection, postpartum haemorrhage, pulmonary thromboembolism); and neonatal outcome (admitted to special care baby unit at 24 hour of age, gestation at delivery, birthweight, stillbirth). Data are presented as percentages of outcomes in the normal and underweight groups with adjusted odds ratios and confidence intervals according to body mass index group.Results In the underweight group only antenatal anaemia, preterm delivery and birthweight below the 5th centile were more frequent than in women of normal body mass index. The prevalence of certain complications, including development of gestational diabetes mellitus, pre-eclampsia, obstetric intervention and postpartum haemorrhage, were significantly lower in those with low body mass index.Conclusion Low maternal body mass index is associated with increased prevalence of some pregnancy complications, notably preterm delivery and low birthweight, but overall the outcome is favourable and several adverse outcomes are less common in this group of women.     

Maternal request: a reason for rising rates of cesarean section?

Objective

The rising rate of cesarean sections (CS), especially those on maternal request, is an important obstetric care issue. The aim of this two-point cross-sectional study was to evaluate the prevalence of CS and their indications.

Methods

We performed a retrospective chart review of the indications of all CS performed at a tertiary care clinic in Switzerland in 2002 and 2008. Chi-square, Student??s t and Mann?CWhitney U tests were performed to identify significant differences.

Results

The number of CS rose from 23.3% (371 out of 1,594 total life births) in 2002 to 27.5% (513 out of 1,866) in 2008 (p?=?0.005). Of all deliveries, the rate of CS on maternal request and, among these, especially those requested after previous CS, increased significantly (2.1 vs. 5.1% and 0.3 vs. 1.2%, respectively). The number of CS due to previous traumatic birth experience nearly doubled (0.7 vs. 1.2%, not significant). Maternal and fetal complications were rare but not negligible in the subset of low-risk patients requesting CS.

Conclusions

The study demonstrated a significant increase in CS on maternal request, especially in case of previous CS. The findings of this study support the need for specific counseling strategies for women requesting delivery by CS.     

Induction of labor in grand multiparous women and previous cesarean section: is it safe?

OBJECTIVE: To compare the outcome of induced and spontaneous labor in grand multiparous women with one previous lower segment cesarean section, so that the safety of labor induction could be assessed. METHOD: In 56 women labor was induced and their outcomes were compared with those of 177 women with spontaneous labor. All women were multiparous and had had one previous cesarean section. RESULTS: There were no significant differences in the incidences of 1- and 5-min Apgar scores, congenital malformation, cesarean section rates and uterine scar dehiscence or uterine rupture. There were 4 cases of intrauterine fetal death in the induction group, but no case of intrapartum or early neonatal death in the 2 groups. In the study group, 80.4% of the women delivered vaginally compared with 84.3% in the control group. CONCLUSION: In this moderate-sized study, we may conclude that when there is no absolute indication for repeating cesarean section, induction of labor may be a safe option in these high-risk women.     

Pregnant women’s preference for cesarean section and subsequent mode of birth – a six-country cohort study

Introduction: The rate of cesarean section (CS) for non-medical reasons has risen and it is a concern for health care. Women’s preferences may vary across countries for psychosocial or obstetric reasons.

Methods: A prospective cohort study of 6549 women in routine antenatal care giving birth in Belgium, Iceland, Denmark, Estonia, Norway or Sweden. Preference for mode of birth was self-reported in mid-pregnancy. Birth outcome data were collected from hospital records.

Results: A CS was preferred by 3.5% of primiparous women and 8.7% of the multiparous women. Preference for CS was associated with severe fear of childbirth (FOC), with a negative birth experience in multiparous women and with depressive symptoms in the primiparous. Women were somewhat more prone to prefer a cesarean in Iceland, odd ratio (OR) 1.70 (1.02–2.83), adjusted for age, education, depression, FOC, history of abuse, previous cesarean and negative birth experience. Out of the 404 women who preferred CS during pregnancy, 286 (70.8%) delivered by CS, mostly for a medical indication. A total of 9% of the cesareans in the cohort had a non-medical indication only.

Conclusions: Women’s preference for CS often seems to be due to health concerns. Both medical and psychological factors need to be addressed in antenatal counseling. Obstetricians need to convey accurately to women the risks and benefits of CS in her specific case. Maternity professionals should identify and explore psychosocial reasons for women’s preferences.     

Is intrauterine device a risk factor for failure of conservative management in patients with tubo-ovarian abscess? An observational retrospective study

Purpose

Tubo-ovarian abscess (TOA) is a serious and potentially life-threatening complication of pelvic inflammatory disease (PID). TOA formation may be an uncommon, but serious complication associated with the use of an intrauterine device (IUD). While the majority of TOA respond to antibiotic therapy, in approximately 25% of cases surgery or drainage is indicated. In the present study, we compared the failure rate of conservative management in patients with and without IUD, who were admitted with a diagnosis of TOA.

Methods

In this retrospective case–control study, 78 women were diagnosed with TOA. All patients were treated initially by broad-spectrum intravenous antibiotics. The failure of conservative management after 72 h was followed by surgical intervention.

Results

The patients were divided into two groups: 24 patients were IUD-carriers, and 54 did not use IUD. There was no significant difference in surgical intervention rate between IUD group (50%) and no-IUD group (43%), p = 0.32. The WBC count was significantly higher in IUD-carriers diagnosed with TOA than in patients without IUD (16.5 ± 6.6 vs. 13.1 ± 4.6, p = 0.001). The patients with IUD had significantly larger abscesses as revealed by ultrasound than patients without IUD (61.6 ± 21.4 vs. 49.6 ± 20.6 mm, p = 0.02).

Conclusion

The surgical intervention rate in TOA patients with and without IUD was similar.

     

Bacteruria with group-B streptococcus: is it a risk factor for adverse pregnancy outcomes?

Objective: To investigate pregnancy outcomes of patients with and without group-B streptococcus (GBS) bacteriuria. Methods: A retrospective study comparing pregnancy outcomes of women with GBS bacteriuria during pregnancy, those with positive GBS vaginal cultures and those without GBS colonization during pregnancy was conducted. Results: A significant linear association was found with regard to intrapartum fever (U-GBS 0.5%, V-GBS 0.3%, no GBS 0.1%, p?=?0.001) and chorioamnionitis (U-GBS 3.3%, V-GBS 1%, no GBS 0.7%, p?=?0.001). In addition preterm delivery (15.3% vs. 7.9%, p?=?0.001) and premature rupture of membranes (10.7% vs. 7.9, p?=?0.001) were significantly higher in the U-GBS group compared to no GBS. Woman with U-GBS had higher rates of diabetes mellitus, hypertensive disorders, and habitual abortions as well as a higher risk for intrauterine growth restriction (IUGR). In addition patients with U-GBS underwent induction of labor and cesarean delivery more frequently. Conclusions: Our study showed a significant association between U-GBS and adverse obstetrical outcomes. In addition a linear association was found between GBS culture location and obstetric complications. However, GBS was not associated with adverse perinatal outcome in our population.     

Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study

Purpose: The purpose of our study is to present clinical courses and outcomes of 50 first-trimester cesarean scar pregnancy (CSP) cases, which are managed either with transabdominal ultrasound (TAUS)-guided suction curettage alone or abdominal hysterotomy.

Methods: We retrospectively analyzed our records from 2011 to 2016 at a single-center. TAUS-guided suction curettage alone was preferred in hemodynamically stable patients when the myometrial thickness was ≥3?mm and there was no vascular invasion. If the myometrial thickness was <3?mm and/or vascular invasion was present, then hysterotomy was preferred.

Results: Statistical analysis of age, gravidity, parity, history of previous CS (≥3 or <3), presence of embryonic cardiac activity, complaints (vaginal bleeding, pelvic pain, or both), preoperative and postoperative hemoglobin levels (g/dl), blood transfusion, initial serum β-hCG levels, and duration to resolution of β-hCG demonstrated no significant difference between TAUS-guided suction curettage and abdominal hysterotomy groups. There was a significant difference between two groups in terms of postoperative length of stay in the hospital and gestational age.

Conclusion: TAUS-guided suction curettage in selected cases may be considered as a reliable first-line treatment option due to its low cost, ease of application, lower side-effect profile, and potentially minimal influence on future fertility in CSP patients that are hemodynamically stable.