3. [Neonatal outcome after cesarean section]. [Review] [Polish] Kornacka MK. Kufel K. Ginekologia Polska. 82(8):612-7, 2011 Aug. [English Abstract. Journal Article. Review] UI: 21957607

Cesarean section is the most commonly performed procedure all over the

world. Both American and European data reveal constant and steady increase

of pregnancies resolved by a cesarean section. The reasons include:

growing number of medical indications or requests of the pregnant women.

Regardless of the fact that elective cesarean section decreases the risk

of intrauterine hypoxia, meconium aspiration and injury during labor it

remains a significant risk factor for respiratory failure in the course of

transient tachypnea of the newborn, infant respiratory distress syndrome

and pulmonary hypertension, both for term and late preterm infants. As a

consequence, the infant requires a prolonged stay in the intensive care

unit, together with advanced and often expensive medical procedures such

as mechanical (often high-frequency) ventilation, nitric oxide therapy and

extracorporeal membrane oxygenation. The American Association of

Obstetricians and Gynecologists and the European Association of Perinatal

Medicine recommend for a cesarean section due to medical indications to be

performed after 39 weeks gestation, preferably after uterine contractions

started, and elective cesarean section, particularly if there are

indications to finish the pregnancy before 39 weeks gestation, after lung

maturity has been assessed (in other case steroids ought to be

administered prenatally to mature the lung muscles). That includes also

cases of elective cesarean sections performed due to previous cesarean

sections, which are the most frequent reasons for repeating procedure. The

recommendations also restrict the indications for cesarean section in case

of significant prematurity what in turn is connected with more restricted

1

indications for resuscitation of extremely premature infants and babies

with extremely low birth weight.

Status

MEDLINE

Authors Full Name

Kornacka, Maria Katarzyna. Kufel, Katarzyna.

Institution

Klinik Neonatologii i Intensywnej Terapii Noworodka Warszawskiego

Uniwersytetu Medycznego w Warszawie, Polska. mariak@szpitalkarowa.pl

Date Created

20110930

Year of Publication

2011

4. [Analysis of the indications for the caesarean section delivery for

very low birthweight neonates (< 1500 g) delivered in I department

gynecology and obstetrics, Medical University in Lodz in 2006-2010].

[Polish]

Brzozowska M. Kowalska-Koprek U. Kus E. Berner-Trabska M.

Karowicz-Bilinska A.

Ginekologia Polska. 82(8):592-7, 2011 Aug.

[English Abstract. Journal Article]

UI: 21957603

UNLABELLED: Despite better care pregnant women receive nowadays, preterm

birth and prematurity remain to be the reason of many complications and

high mortality of neonates.

2

OBJECTIVE: The goal was to analyze the indications for cesarean sections

delivery for very low birthweight (<1500 g) newborns delivered in the I

Department Gynecology and Obstetrics, Medical University in Lodz.

MATERIAL: The data from 560 preterm caesarean sections were analyzed.

Detailed analysis referring to 120 cesarean sections resulting in

deliveries of very low birthweight neonates was performed. Maternal age,

parity neonatal weight and gestational age were assessed. The authors also

assessed the number of cesarean sections performed for extremely low

birthweight newborns, in particularly years and the rate of the

indications in the groups of gestational age.

RESULTS: The greatest number of the cesarean sections was done between

26-35 years of age of the patients (68,4%) in 28-32 weeks of gestation

(53,3%). The rate of cesarean section performed for very low birthweight

neonates was 2,3% of preterm caesarean sections. Fetal growth restriction

(IUGR) and the symptoms of intrauterine hypoxia were the indications for

cesarean sections in 33,4%, multiple pregnancy in 17,5%, abnormal fetal

presentation in 15,8%, intrauterine infection in 13,3% and placental

abruption in 11,7% of cases. The rate of the other indications was 11,7%

of cases. Conclusions: In our material the most frequent indication for

the cesarean section for very low birthweight neonates was fetal growth

restriction with the symptoms of intrauterine hypoxia.

Status

MEDLINE

Authors Full Name

3

Brzozowska, Maria. Kowalska-Koprek, Urszula. Kus, Ewa. Berner-Trabska,

Marlena. Karowicz-Bilinska, Agata.

Institution

Klinika Patologii Ciazy, I Katedra Ginekologii i Poloznictwa UM w Lodzi,

Polska. koala.mb@gazeta.pl

Date Created

20110930

Year of Publication

2011

9. Effect of prior cesarean delivery on neonatal outcomes.

Abenhaim HA. Benjamin A.

Journal of Perinatal Medicine. 39(3):241-4, 2011 May.

[Journal Article]

UI: 21426242

AIMS: To examine the effect of a prior cesarean delivery on neonatal

outcomes.

METHODS: We conducted a retrospective cohort study on all women with a

prior livebirth who delivered at the Royal Victoria Hospital between 2001

and 2006. We defined our exposure as a positive history for cesarean

delivery and used unconditional logistic regression analysis to estimate

the adjusted effect of a previous cesarean delivery on adverse neonatal

outcomes.

RESULTS: A total of 18,673 births took place of which 9708 were in women

with a prior livebirth (77.0% with no previous cesarean delivery and 23.0%

with a previous cesarean delivery). As compared to newborns delivered by

4

mothers with no prior cesarean delivery, increasing number of prior

cesarean deliveries was associated with an increasing risk of preterm

birth [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.09-1.39];

respiratory distress syndrome (OR 3.54, 95% CI 2.02-5.91); and admission

to the neonatal intensive care unit (OR 1.41, 95% CI 1.25-1.60). These

findings were predominantly due to differences in gestational age and mode

of delivery.

CONCLUSION: Having a prior cesarean delivery is associated with an

increased risk of adverse neonatal outcomes. Adverse neonatal outcomes in

subsequent pregnancies is additional evidence to suggest that unless

specifically indicated, cesarean delivery should be avoided.

Status

MEDLINE

Authors Full Name

Abenhaim, Haim A. Benjamin, Alice.

Institution

Obstetrics and Gynecology, Jewish General Hospital, McGill University,

Montreal, Quebec, Canada. haim.abenhaim@gmail.com

Comments

Comment in: J Perinat Med. 2011 Sep;39(5):615; PMID: 21767222

Date Created

20110510

Year of Publication

2011

5

16. [Descriptive analysis of maternal and neonatal characteristics in the

maternity of the Dona Estefania Hospital between 2005 and 2008].

[Portuguese]

Ventura MT. Gomes Mdo C.

Acta Medica Portuguesa. 23(5):793-802, 2010 Sep-Oct.

[English Abstract. Journal Article]

UI: 21144318

Between 2005 and 2008 there were 8413 newborns at the maternity of the

Hospital Dona Estefania (HDE), comprising about 8% of the total number of

newborns in Portugal in the same period. Fetal mortality (0,20%) met the

goal of the Portuguese National Health Plan (NHP) and was at the lowest

levels reported in the European Union. The percentage of preterm

deliveries (8,1%) and caesareans (31,9%), however, are still above the

goals established by the NHP, respectively, 4,9% and 24,8%. In newborns,

the odds ratio of a low Apgar index at five minutes was 1,35 for each 100

g of birth weight less and 1,33 for each gestational week less. Average

maternal age was 30,4 years old, with 3,8% being adolescents. About 22%

were foreign mothers, a number well above the Portuguese national average

of 9%. The percentage of preterm births and caesareans were lower among

Chinese mothers and quite variable among nationalities. Weight at birth

was found to correlate significantly with gestational age, type of

pregnancy (twins/singleton), foetus gender, maternal parity and age at

delivery. On average, when everything else remained constant, one

additional gestational week translated into more 176 g; a twin newborn

was, on average, 381 g lighter than a singleton, and a female newborn was,

6

on average, 48 g lighter than a male. We present percentile tables of

weight at birth by sex and gestational age (36-41 weeks) for newborns at

the HDE.

Status

MEDLINE

Authors Full Name

Ventura, Maria Teresa. Gomes, Manuel do Carmo.

Institution

Servico Ginecologia/Obstetricia, Hospital Dona Estefania, Lisboa.

Date Created

20101214

Year of Publication

2010

18. The effect of time intervals on neonatal outcome in elective cesarean

delivery at term under regional anesthesia.

Maayan-Metzger A. Schushan-Eisen I. Todris L. Etchin A. Kuint J.

International Journal of Gynaecology & Obstetrics. 111(3):224-8, 2010 Dec.

[Journal Article]

UI: 20855070

OBJECTIVES: To measure 3 intervals of time-induction of regional

anesthesia to delivery (I-D), initial skin incision to delivery (S-D), and

uterine incision to delivery (U-D)-in elective cesareans and to evaluate

the impact of the duration of these 3 components on short-term neonatal

outcome.

7

METHODS: We reviewed retrospective data on the duration of the components

from the computerized database of the obstetrics operation room at the

Sheba Medical Center, Tel Aviv, Israel, and from the medical records of

term neonates.

RESULTS: Sufficient data were available in 933 cases. The parameters

associated with longer time to delivery at any stage were epidural rather

than spinal anesthesia, maternal diabetes, previous cesarean delivery,

antihypertensive treatment, higher birth weight (3456 g and 3285 g for U-D

interval longer than 2 minutes and U-D interval up to 2 minutes,

respectively; P=0.02), and male fetus. The duration of the I-D, S-D, and

U-D intervals had no significant impact on any of the measured neonatal

parameters.

CONCLUSION: With regard to neonatal wellbeing, obstetricians have a

relatively large safety margin in the time taken for inducing regional

anesthesia and making the first and uterine incisions. Copyright Copyright

2010 Elsevier B.V. All rights reserved.

Status

MEDLINE

Authors Full Name

Maayan-Metzger, Ayala. Schushan-Eisen, Irit. Todris, Liat. Etchin, Abba.

Kuint, Jacob.

Institution

Department of Neonatology, Edmond and Lili Safra Children's Hospital,

Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University,

8

Tel Aviv, Israel. maayan@post.tau.ac.il

Date Created

20101105

Year of Publication

2010

20. Effect of the interval between onset of sustained fetal bradycardia

and cesarean delivery on long-term neonatal neurologic prognosis.

Kamoshita E. Amano K. Kanai Y. Mochizuki J. Ikeda Y. Kikuchi S. Tani A.

Shoda T. Okutomi T. Nowatari M. Unno N.

International Journal of Gynaecology & Obstetrics. 111(1):23-7, 2010 Oct.

[Journal Article. Research Support, Non-U.S. Gov't]

UI: 20688328

OBJECTIVE: To examine the effect of the interval between onset of

sustained fetal bradycardia and cesarean delivery on long-term neonatal

neurologic prognosis.

METHOD: A retrospective observational case-series performed with patients

who had sudden-onset and sustained (<100 beats per minute) fetal

bradycardia during labor. Fetal heart rate was monitored closely until

cesarean delivery. The effect of the interval between the onset of

bradycardia and delivery on neonatal neurologic prognosis was examined.

RESULTS: Among 2267 deliveries in 2002-2003 at Kitasato University

Hospital, 19 pregnancies met the inclusion criteria. Episodes of fetal

bradycardia were due to umbilical cord prolapse (n=5), placental abruption

(n=4), uterine rupture (n=3), maternal respiratory failure (n=1), and

other causes (n=6). Mean onset of fetal bradycardia to delivery interval

9

(BDI) was 20.5+/-8.9 minutes. Mean decision-to-cesarean delivery interval

was 11.4+/-3.9 minutes. BDI was negatively correlated with umbilical

arterial pH at delivery. There were 3 postnatal deaths. Neurologic

assessment at the age of 2 years revealed that 15 of 16 children were

neurologically normal. When the BDI was less than 25 minutes, all term

pregnancies led to normal neonatal neurologic development.

CONCLUSION: In the event of sustained intrapartum fetal bradycardia,

delivery by emergency cesarean within 25 minutes improved long-term

neonatal neurologic outcome. Copyright Copyright 2010 International

Federation of Gynecology and Obstetrics. Published by Elsevier Ireland

Ltd. All rights reserved.

Status

MEDLINE

Authors Full Name

Kamoshita, Emi. Amano, Kan. Kanai, Yuji. Mochizuki, Junko. Ikeda,

Yasuhiro. Kikuchi, Shinzo. Tani, Akihiro. Shoda, Takashi. Okutomi,

Toshiyuki. Nowatari, Masahiko. Unno, Nobuya.

Institution

Department of Obstetrics and Gynecology, Kitasato University, School of

Medicine, Sagamihara City, Kanagawa, Japan. unno@med.kitasato-u.ac.jp

Date Created

20100910

Year of Publication

2010

10

29. Neonatal outcomes and operative vaginal delivery versus cesarean

delivery.

Contag SA. Clifton RG. Bloom SL. Spong CY. Varner MW. Rouse DJ. Ramin SM.

Caritis SN. Peaceman AM. Sorokin Y. Sciscione A. Carpenter MW. Mercer BM.

Thorp JM Jr. Malone FD. Iams JD.

American Journal of Perinatology. 27(6):493-9, 2010 Jun.

[Comparative Study. Journal Article. Research Support, N.I.H., Extramural]

UI: 20099218

We compared outcomes for neonates with forceps-assisted, vacuum-assisted,

or cesarean delivery in the second stage of labor. This is a secondary

analysis of a randomized trial in laboring, low-risk, nulliparous women at

>or=36 weeks' gestation. Neonatal outcomes after use of forceps, vacuum,

and cesarean were compared among women in the second stage of labor at

station +1 or below (thirds scale) for failure of descent or nonreassuring

fetal status. Nine hundred ninety women were included in this analysis:

549 (55%) with an indication for delivery of failure of descent and 441

(45%) for a nonreassuring fetal status. Umbilical cord gases were

available for 87% of neonates. We found no differences in the base excess

(P = 0.35 and 0.78 for failure of descent and nonreassuring fetal status)

or frequencies of pH below 7.0 (P = 0.73 and 0.34 for failure of descent

and nonreassuring fetal status) among the three delivery methods. Birth

outcomes and umbilical cord blood gas values were similar for those

neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in

the second stage of labor. The occurrence of significant fetal acidemia

11

was not different among the three delivery methods regardless of the

indication. Thieme Medical Publishers.

Status

MEDLINE

Authors Full Name

Contag, Stephen A. Clifton, Rebecca G. Bloom, Steven L. Spong, Catherine

Y. Varner, Michael W. Rouse, Dwight J. Ramin, Susan M. Caritis, Steve N.

Peaceman, Alan M. Sorokin, Yoram. Sciscione, Anthony. Carpenter, Marshall

W. Mercer, Brian M. Thorp, John M Jr. Malone, Fergal D. Iams, Jay D.

Institution

Department of Obstetrics and Gynecology at Wake Forest University,

Winston-Salem, North Carolina, USA. scontag@lifebridgehealth.org

Date Created

20100525

Year of Publication

2010

34. Outcomes after internal versus external tocodynamometry for monitoring

labor.[Erratum appears in N Engl J Med. 2010 May 13;362(19):1849]

Bakker JJ. Verhoeven CJ. Janssen PF. van Lith JM. van Oudgaarden ED.

Bloemenkamp KW. Papatsonis DN. Mol BW. van der Post JA.

New England Journal of Medicine. 362(4):306-13, 2010 Jan 28.

[Comparative Study. Journal Article. Multicenter Study. Randomized

Controlled Trial]

UI: 20107216

BACKGROUND: It has been hypothesized that internal tocodynamometry, as

12

compared with external monitoring, may provide a more accurate assessment

of contractions and thus improve the ability to adjust the dose of

oxytocin effectively, resulting in fewer operative deliveries and less

fetal distress. However, few data are available to test this hypothesis.

METHODS: We performed a randomized, controlled trial in six hospitals in

The Netherlands to compare internal tocodynamometry with external

monitoring of uterine activity in women for whom induced or augmented

labor was required. The primary outcome was the rate of operative

deliveries, including both cesarean sections and instrumented vaginal

deliveries. Secondary outcomes included the use of antibiotics during

labor, time from randomization to delivery, and adverse neonatal outcomes

(defined as any of the following: an Apgar score at 5 minutes of less than

7, umbilical-artery pH of less than 7.05, and neonatal hospital stay of

longer than 48 hours).

RESULTS: We randomly assigned 1456 women to either internal

tocodynamometry (734) or external monitoring (722). The operative-delivery

rate was 31.3% in the internal-tocodynamometry group and 29.6% in the

external-monitoring group (relative risk with internal monitoring, 1.1;

95% confidence interval [CI], 0.91 to 1.2). Secondary outcomes did not

differ significantly between the two groups. The rate of adverse neonatal

outcomes was 14.3% with internal monitoring and 15.0% with external

monitoring (relative risk, 0.95; 95% CI, 0.74 to 1.2). No serious adverse

events associated with use of the intrauterine pressure catheter were

reported.

CONCLUSIONS: Internal tocodynamometry during induced or augmented labor,

13

as compared with external monitoring, did not significantly reduce the

rate of operative deliveries or of adverse neonatal outcomes. (Current

Controlled Trials number, ISRCTN13667534; Netherlands Trial number,

NTR285.) 2010 Massachusetts Medical Society

Status

MEDLINE

Authors Full Name

Bakker, Jannet J H. Verhoeven, Corine J M. Janssen, Petra F. van Lith, Jan

M. van Oudgaarden, Elisabeth D. Bloemenkamp, Kitty W M. Papatsonis,

Dimitri N M. Mol, Ben Willem J. van der Post, Joris A M.

Institution

Department of Obstetrics and Gynecology, Academic Medical Center,

Amsterdam, The Netherlands. j.j.bakker@amc.uva.nl

Comments

Comment in: N Engl J Med. 2010 May 13;362(19):1842; author reply 1842-3;

PMID: 20463346

Date Created

20100128

Year of Publication

2010

38. Pregnancy and perinatal outcome in women with hyperthyroidism.

Pillar N. Levy A. Holcberg G. Sheiner E.

International Journal of Gynaecology & Obstetrics. 108(1):61-4, 2010 Jan.

[Journal Article]

14

UI: 19766207

OBJECTIVE: To investigate pregnancy outcome for patients with treated

hyperthyroidism.

METHODS: A population-based study was performed comparing all singleton

pregnancies of women with and women without hyperthyroidism at the Soroka

University Medical Center, Be'er-Sheva, Israel, between January 1988 and

January 2007. Stratified analysis, using a multiple logistic regression

model, was performed to control for confounders.

RESULTS: During the study period, there were 185636 singleton deliveries

in the medical center. Of these, 189 (0.1%) were from women with

hyperthyroidism. Using multivariate analysis with backward elimination,

the following risk factors were significantly associated with

hyperthyroidism: placental abruption; cesarean delivery; and advanced

maternal age. No significant differences regarding perinatal outcome were

noted between the groups. Women with hyperthyroidism had significantly

higher rates of cesarean delivery than did women without hyperthyroidism

(20.1% vs 13.1%; P<0.004), even after controlling for confounders.

CONCLUSIONS: Treated hyperthyroidism was not associated with adverse

perinatal outcome. However, hyperthyroidism was found to be an independent

risk factor for cesarean delivery.

Status

MEDLINE

Authors Full Name

Pillar, Nir. Levy, Amalia. Holcberg, Gershon. Sheiner, Eyal.

15

Institution

Faculty of Health Sciences, Ben Gurion University of the Negev,

Be'er-Sheva, Israel.

Date Created

20091216

Year of Publication

2010

40. [Effect of general anesthesia used in cesarean section on

maternal-neonatal outcome of pregnancy complicated with severe

thrombocytopenia]. [Chinese]

Wei J. Liu GL. Liang MY. Wang SM.

Chung-Hua Fu Chan Ko Tsa Chih [Chinese Journal of Obstetrics &

Gynecology]. 44(9):665-8, 2009 Sep.

[English Abstract. Journal Article. Randomized Controlled Trial]

UI: 20079177

OBJECTIVE: To investigate the effect of general anesthesia on pregnancy

women with thrombocytopenia and neonate during cesarean section (CS).

METHODS: Sixty-five singleton pregnant women with low platelet count (< 50

x 10(9)/L) and gestation>35 weeks were allocated into general anesthesia

group (35 cases) and local anesthesia group (30 cases) randomly. The time

from skin incision to fetal delivery, the oxyhemoglobin saturation (SO2)

before and after anesthesia, the blood loss during operation, Apgar scores

at 1 min, birth weight,umbilical cord blood gas analysis were recorded.

RESULTS: The mean time from anesthesia induction to fetal delivery was

(9.7 +/- 3.5) minutes in general anesthesia group. The time from skin

16

incision to fetal delivery in general anesthesia group [(7.7 +/- 2.5)

minutes] was shorter than that in local anesthesia group [(12.5 +/- 3.0)

minutes, P < 0.01], while the operation time had no significant

differences. There were no significant difference for the value of SO2

before and after general anesthesia or local anesthesia (P > 0.05). There

was no significant difference for the blood loss [(471 +/- 245) ml vs.

(452 +/- 213) ml, P > 0.05], Apgar scores at 1 minute, birth weight and

umbilical cord blood gas analysis between the two groups (P > 0.05). There

had two infants with blue asphyxia in local anesthesia group while no

infant with asphyxia in general anesthesia group.

CONCLUSION: General anesthesia is safe to pregnant women with

thrombocytopenia during CS.

Status

MEDLINE

Authors Full Name

Wei, Jun. Liu, Guo-li. Liang, Mei-ying. Wang, Shan-mi.

Institution

Department of Obstetrics, Peking University People's Hospital, Beijing

100044, China.

Date Created

20100118

Year of Publication

2009

45. Adverse neonatal outcomes associated with trial of labor after

17

previous cesarean delivery in an inner-city hospital in Lagos, Nigeria.

Olusanya BO. Solanke OA.

International Journal of Gynaecology & Obstetrics. 107(2):135-9, 2009 Nov.

[Journal Article]

UI: 19647823

OBJECTIVE: To identify delivery methods and associated adverse neonatal

outcomes after previous cesarean delivery.

METHODS: A retrospective cross-sectional study in an inner-city maternity

hospital in Lagos, Nigeria, in which outcomes associated with delivery

methods were determined by multinomial logistic regression.

RESULTS: Of 435 eligible singleton deliveries, 171 (39.3%) occurred via

elective cesarean, 249 (57.2%) via emergency cesarean, and 15 (3.4%) after

successful trial of labor. Emergency cesarean delivery was associated with

low 1-minute Apgar scores compared with successful trial of labor. It was

also associated with low 5-minute Apgar scores compared with elective

cesarean delivery, in addition to hyperbilirubinemia and admission to the

special care baby unit. Successful trial of labor was less likely to be

associated with low 1-minute Apgar scores than was elective cesarean

delivery. The delivery methods were not associated with risk of

sensorineural hearing loss.

CONCLUSION: Trial of labor is common in this tertiary hospital among women

with previous cesarean delivery and is associated with high failure rates

and adverse neonatal outcomes with potential developmental risks.

18

Status

MEDLINE

Authors Full Name

Olusanya, Bolajoko O. Solanke, Olumuyiwa A.

Institution

Maternal and Child Health Unit, Department of Community Health and Primary

Care, College of Medicine, University of Lagos, Lagos, Nigeria.

boolusanya@aol.com

Date Created

20091006

Year of Publication

2009

43. Pregnancy outcomes of repeat cesarean section in Peking Union Medical

College Hospital.

Ma LK. Liu N. Bian XM. Teng LR. Qi H. Gong XM. Liu JT. Yang JQ.

Chinese Medical Sciences Journal. 24(3):147-50, 2009 Sep.

[Journal Article]

UI: 19848314

OBJECTIVE: To evaluate the effect of elective repeat cesarean section on

the maternal and neonatal outcomes.

METHODS: A retrospective clinic- and hospital-based survey was designed

for comparing the maternal and neonatal outcomes of elective repeat

cesarean section [RCS group (one previous cesarean section) and MRCS group

(two or more previous cesarean sections)] and primary cesarean section

(FCS group) at Peking Union Medical College Hospital from January 1998 to

19

December 2007.

RESULTS: The incidence of repeat cesarean section increased from 1.26% to

7.32%. The mean gestational age at delivery in RCS group (38.1+/-1.8

weeks) and MRCS group (37.3+/-2.5 weeks) were significantly shorter than

that in FCS group (38.9+/-2.1 weeks, all P<0.01). The incidence of

complication was 33.8% and 33.3% in RCS group and MRCS group respectively,

and was significantly higher than that in FCS group (7.9%, P<0.05). Dense

adhesion (13.5% vs. 0.4%, OR=7.156, 95% CI: 1.7-30.7, P<0.01) and uterine

rupture (1.0% vs. 0, P<0.05) were commoner in RCS group compared with FCS

group. Neonatal morbidity was similar among three groups (P>0.05).

CONCLUSIONS: Repeat cesarean section is associated with more complicated

surgery technique and increased frequency of maternal morbidity. However,

the incidence of neonatal morbidity is similar to primary cesarean

section.

Status

MEDLINE

Authors Full Name

Ma, Liang-Kun. Liu, Na. Bian, Xu-Ming. Teng, Li-Rong. Qi, Hong. Gong,

Xiao-Ming. Liu, Jun-Tao. Yang, Jian-Qiu.

Institution

Department of Obstetrics and Gynecology, Peking Union Medical College

Hospital, Chinese Academy of Medical Sciences & Peking Union Medical

College, Beijing 100730, China.

Date Created

20

20091023

Year of Publication

2009

89. Maternal and neonatal outcome after cesarean section: the impact of

anesthesia.

Gori F. Pasqualucci A. Corradetti F. Milli M. Peduto VA.

Journal of Maternal-Fetal & Neonatal Medicine. 20(1):53-7, 2007 Jan.

[Journal Article]

UI: 17437200

BACKGROUND: Among the anesthetic technologies used, regional anesthesia is

becoming the most common in cesarean section (CS) deliveries. Aim. This

retrospective survey examined the variables taken into account when

selecting the anesthetic technique to be used, and how this choice affects

the outcome for the mother and the newborn.

METHODS: One thousand eight hundred and seventy elective and emergency CS

were evaluated for anesthetic technique used, indications, and maternal

and neonatal outcome.

RESULTS: Of the 611 elective CS (32.6%), 206 (33.8%) were performed under

general anesthesia and 405 (66.2%) under regional anesthesia. Of the 1259

emergency CS performed (67.4%), 525 (41.9%) were under general anesthesia

and 734 (58.1%) under regional anesthesia. Conditions associated with a

newborn 1-minute Apgar score of <7 were general anesthesia and multiple

pregnancy (p<0.01); a 5-minute Apgar score of <7 was only associated with

multiple pregnancy. The most important factor for very low Apgar scores

was the presence of fetal malformations. Whatever the chosen technique,

21

neither maternal deaths directly or indirectly due to the anesthesia nor

major maternal and perinatal complications were found.

CONCLUSIONS: This survey confirms the preference for regional anesthesia

during elective cesarean sections and for general anesthesia in emergency

situations. Moreover, newborn outcome was found not to be influenced

either by the technique used or by the character of the procedure.

Status

MEDLINE

Authors Full Name

Gori, F. Pasqualucci, A. Corradetti, F. Milli, M. Peduto, V A.

Institution

Department of Clinical and Experimental Medicine, Section of

Anaesthesiology, Analgesia and Intensive Care, University of Perugia

School of Medicine, Perugia, Italy. bobo.gori@libero.it

Date Created

20070417

Year of Publication

2007

90. Comparison of effects of rapid colloid loading before and after spinal

anesthesia on maternal hemodynamics and neonatal outcomes in cesarean

section.

Nishikawa K. Yokoyama N. Saito S. Goto F.

Journal of Clinical Monitoring & Computing. 21(2):125-9, 2007 Apr.

22

[Comparative Study. Journal Article. Randomized Controlled Trial. Research

Support, Non-U.S. Gov't]

UI: 17265094

BACKGROUND: The effects of colloid loading after spinal anesthesia on

hemodynamics in parturients during cesarean section have not been fully

understood. This study tested the hypothesis that colloid loading after

spinal blockade can reduce hypotension compared with preloading, and

affect neonatal outcomes.

METHODS: A prospective, randomized, double-blinded study was performed in

54 healthy parturients (ASA I or II) undergoing elective cesarean section.

Patients were randomly allocated into one of three groups to receive rapid

infusion of 6% hydroxyethylstarch (HES) (70 kDa/0.5) before spinal

anesthesia (15 ml x kg(-1), HES preload group, n = 18), or rapid infusion

of HES after induction of spinal anesthesia (15 ml x kg(-1), HES coload

group, n = 18), or no rapid infusion (control, n = 18). The incidence of

hypotension, and the amount of ephedrine used to treat hypotension was

compared. Neonatal outcomes were also assessed by pH, base excess, lactate

concentration, and Apgar scores.

RESULTS: The incidence of hypotension was significantly lower in HES

preload and HES coload groups than control group (P < 0.01). Although

systolic blood pressure decreased after spinal blockade in all groups, the

lowest SBP after spinal blockade until delivery was significantly higher

in fluid loading groups than control (P < 0.001). Similarly, total dose of

ephedrine to treat hypotension was lower in fluid loading groups (P <

0.001). Umbilical cord pH, umbilical lactate concentration, and the

23

incidence of neonates with Apgar score <7 were similar.

CONCLUSION: Colloid loading after induction of spinal anesthesia was

similarly effective in reducing hypo- tension compared with preloading in

cesarean section.

Status

MEDLINE

Authors Full Name

Nishikawa, Koichi. Yokoyama, Naho. Saito, Shigeru. Goto, Fumio.

Institution

Department of Anesthesiology, Gunma University Graduate School of

Medicine, 3-39-22 Showa-machi, Maebashi City 371-8511, Japan.

nishikaw@med.gunma-u.ac.jp

Date Created

20070413

Year of Publication

102. Central fetal monitoring: effect on perinatal outcomes and cesarean

section rate.

Withiam-Leitch M. Shelton J. Fleming E.

Birth. 33(4):284-8, 2006 Dec.

[Journal Article. Research Support, Non-U.S. Gov't]

UI: 17150066

BACKGROUND: In a trend similar to continuous electronic fetal monitoring,

many hospitals are incorporating central fetal monitoring into labor and

delivery suites. The objective of this study was to investigate whether

24

the use of central fetal monitoring had an effect on neonatal outcomes or

cesarean section rate.

METHODS: This retrospective study involved patient data from deliveries

occurring at Women and Children's Hospital of Buffalo, Buffalo, New York,

between the years 2000 and 2003. In the period from January 1, 2000, to

December 31, 2001, central fetal monitoring was available, whereas in the

period from February 1, 2002, to December 31, 2003, it was unavailable.

Data on deliveries at Women and Children's Hospital of Buffalo were

obtained using the Western New York Perinatal Data System, which is an

electronic data set based on birth certificate information. The method of

delivery, admission to the neonatal intensive care unit, and 5-minute

Apgar scores less than 7 were compared for deliveries occurring with and

without the use of central fetal monitoring. These outcomes were further

subdivided into full-term and preterm deliveries.

RESULTS: Three thousand five hundred and twelve deliveries used central

monitoring and 3,007 deliveries did not. For full-term deliveries, in the

years with central fetal monitoring compared with the years without it, no

differences in the cesarean section rate (13.4 vs 14.5%, not significant

[NS]), the admission rate in neonatal intensive care unit (3.3 vs 3.3%,

NS), or the incidence of Apgar score less than 7 (0.6 vs 0.5%, NS) were

observed. For preterm deliveries, comparing the years with central fetal

monitoring with the years without, no differences in the cesarean section

rate (21.3 vs 21.3%, NS), the admission rate in neonatal intensive care

unit (17.7 vs 20.1%, NS), or the incidence of Apgar score less than 7 (7.0

vs 6.5%, NS) were observed. Analyses pooling all deliveries also failed to

25

show any differences in any of the parameters.

CONCLUSIONS: No statistically significant difference was demonstrated in

the rates of cesarean section, admission to the neonatal intensive care

unit, or incidence of Apgar scores of less than 7 associated with the use

of central fetal monitoring. Therefore, we could not identify any benefit

to the use of central fetal heart rate monitoring.

Status

MEDLINE

Authors Full Name

Withiam-Leitch, Matthew. Shelton, James. Fleming, Emily.

Institution

Division of General Obstetrics and Gynecology, University at Buffalo,

Women and Children's Hospital of Buffalo, Buffalo, New York 14222, USA.

Date Created

20061207

Year of Publication

2006

103. Planned cesarean versus planned vaginal delivery at term: comparison

of newborn infant outcomes.

Kolas T. Saugstad OD. Daltveit AK. Nilsen ST. Oian P.

American Journal of Obstetrics & Gynecology. 195(6):1538-43, 2006 Dec.

[Comparative Study. Journal Article. Research Support, Non-U.S. Gov't]

UI: 16846577

26

OBJECTIVE: The purpose of this study was to examine neonatal outcomes

among women with a planned cesarean and a planned vaginal delivery at

term.

STUDY DESIGN: This prospective survey was conducted on 18,653 singleton

deliveries that represent 24 maternity units during a 6-month period. The

data were retrieved from the Medical Birth Registry of Norway and analyzed

according to intended mode of delivery.

RESULTS: Compared with planned vaginal deliveries, planned cesarean

delivery increased transfer rates to the neonatal intensive care unit from

5.2% to 9.8% (P < .001). The risk for pulmonary disorders (transient

tachypnea of the newborn infant and respiratory distress syndrome) rose

from 0.8% to 1.6% (P = .01). There were no significant differences in the

risks for low Apgar score and neurologic symptoms.

CONCLUSION: A planned cesarean delivery doubled both the rate of transfer

to the neonatal intensive care unit and the risk for pulmonary disorders,

compared with a planned vaginal delivery.

Status

MEDLINE

Authors Full Name

Kolas, Toril. Saugstad, Ola D. Daltveit, Anne K. Nilsen, Stein T. Oian,

Pal.

Institution

Department of Obstetrics and Gynecology, Innlandet Hospital Trust,

Lillehammer, Norway. toril.kolas@sykehuset-innlandet.no

27

Comments

Comment in: Am J Obstet Gynecol. 2007 Aug;197(2):217; author reply 217;

PMID: 17689658

Date Created

20061129

Year of Publication

2006

104. Obstetric and neonatal outcomes in women who live in an urban

resettlement area of Delhi, India: a cohort study.

Chhabra P. Sharma AK. Tupil KA.

Journal of Obstetrics & Gynaecology Research. 32(6):567-73, 2006 Dec.

[Journal Article]

UI: 17100818

AIM: To study the pregnancy outcome, namely mode and place of delivery,

attendant at birth and perinatal mortality in an urban resettlement area

of Delhi, India, and to determine factors that affect the outcome.

METHODS: All the pregnant women (n = 909) in the area were enrolled and

followed until 7 days after delivery. We calculated the crude and adjusted

odds ratios for predictors of pregnancy related obstetric and neonatal

outcomes, using logistic regression analysis.

RESULTS: A total of 884 (97.3%) women could be followed up. Approximately

two-thirds of deliveries took place at home. Primigravida, more educated

mothers and mothers with non-cephalic presentation or complications were

more likely to deliver in a health facility (P < 0.05). Most deliveries

28

(97%) were vaginal, 2.5% were cesarean and 0.5% forceps deliveries.

Primigravida mothers, mothers with short stature, mothers with

non-cephalic presentation or complications had cesarean and forceps

delivery more often (P < 0.05). A perinatal mortality rate of 74.5 per

1000 live births was observed. Presentation of the fetus and complications

in the mother remained important factors.

CONCLUSION: The majority of deliveries in the under-privileged sections in

urban Delhi take place at home and the perinatal mortality remains high.

Status

MEDLINE

Authors Full Name

Chhabra, Pragti. Sharma, Arun Kumar. Tupil, Kannan Anjur.

Institution

Department of Community Medicine, University College of Medical Sciences

and GTB Hospital, Delhi, India. pragschhabra@yahoo.co.in

Date Created

20061114

Year of Publication

2006

105. The impact of abnormal autoimmune function on reproduction: maternal

and fetal consequences.

Gleicher N. Weiner R. Vietzke M.

Journal of Autoimmunity. 27(3):161-5, 2006 Nov.

29

[Journal Article]

UI: 17029731

The impact of abnormal autoimmune function on reproductive success has

remained a highly controversial issue. This is, at least partially, due to

the relative lack of demographic data from women with established

autoimmune diseases. We, therefore, investigated 163 women with proven

autoimmune diseases and 73 controls in a demographic study of reproductive

success and impact of abnormal autoimmunity on pregnancy and offspring.

Women with autoimmune diseases experienced fewer pregnancies overall

(p=0.04) and fewer pregnancy losses (p=0.05). Offspring from women with

autoimmune diseases demonstrated a significantly increased prevalence of

confirmed autoimmune diseases (p=0.04; OR 3.759; 95%CL 1.04-1.27), which

increased further if suspected, but not yet confirmed, cases were added

(p=0.001; OR 8.592; 95%CL 1.05-55.0). Women with autoimmune diseases

exhibited a trend towards lower cesarean section delivery during their own

birth and a significantly increased prevalence of disease in vaginally

delivered offspring (p=0.014; OR 6.041; 95%CL 1.32-38.22). Autoimmune

diseases impair female fecundity even before the diseases become

clinically overt. Offspring are at increased risk to develop autoimmune

diseases, though they may differ from those of their mothers. This risk

appears to correlate with mode of delivery and may be the consequence of

varying cell traffic dynamics with vaginal and cesarean section

deliveries.

Status

MEDLINE

30

Authors Full Name

Gleicher, Norbert. Weiner, Rebecca. Vietzke, Mary.

Institution

Centers for Human Reproduction (CHR), New York, NY 10021, USA.

ngleicher@thechr.com

Date Created

20061113

Year of Publication

2006 2007

113. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global

survey on maternal and perinatal health in Latin America.[Erratum appears

in Lancet. 2006 Aug 12;368(9535):580]

Villar J. Valladares E. Wojdyla D. Zavaleta N. Carroli G. Velazco A. Shah

A. Campodonico L. Bataglia V. Faundes A. Langer A. Narvaez A. Donner A.

Romero M. Reynoso S. de Padua KS. Giordano D. Kublickas M. Acosta A. WHO

2005 global survey on maternal and perinatal health research group.

Lancet. 367(9525):1819-29, 2006 Jun 3.

[Journal Article. Research Support, Non-U.S. Gov't. Research Support, U.S.

Gov't, Non-P.H.S.]

UI: 16753484

BACKGROUND: Caesarean delivery rates continue to increase worldwide. Our

aim was to assess the association between caesarean delivery and pregnancy

outcome at the institutional level, adjusting for the pregnant population

and institutional characteristics.

METHODS: For the 2005 WHO global survey on maternal and perinatal health,

31

we assessed a multistage stratified sample, comprising 24 geographic

regions in eight countries in Latin America. We obtained individual data

for all women admitted for delivery over 3 months to 120 institutions

randomly selected from of 410 identified institutions. We also obtained

institutional-level data.

FINDINGS: We obtained data for 97,095 of 106,546 deliveries (91%

coverage). The median rate of caesarean delivery was 33% (quartile range

24-43), with the highest rates of caesarean delivery noted in private

hospitals (51%, 43-57). Institution-specific rates of caesarean delivery

were affected by primiparity, previous caesarean delivery, and

institutional complexity. Rate of caesarean delivery was positively

associated with postpartum antibiotic treatment and severe maternal

morbidity and mortality, even after adjustment for risk factors. Increase

in the rate of caesarean delivery was associated with an increase in fetal

mortality rates and higher numbers of babies admitted to intensive care

for 7 days or longer even after adjustment for preterm delivery. Rates of

preterm delivery and neonatal mortality both rose at rates of caesarean

delivery of between 10% and 20%.

INTERPRETATION: High rates of caesarean delivery do not necessarily

indicate better perinatal care and can be associated with harm.

Status

MEDLINE

Authors Full Name

Villar, Jose. Valladares, Eliette. Wojdyla, Daniel. Zavaleta, Nelly.

32

Carroli, Guillermo. Velazco, Alejandro. Shah, Archana. Campodonico, Liana.

Bataglia, Vicente. Faundes, Anibal. Langer, Ana. Narvaez, Alberto. Donner,

Allan. Romero, Mariana. Reynoso, Sofia. de Padua, Karla Simonia. Giordano,

Daniel. Kublickas, Marius. Acosta, Arnaldo. WHO 2005 global survey on

maternal and perinatal health research group.

Institution

UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and

Research Training in Human Reproduction, Department of Reproductive Health

and Research, WHO, 1211 Geneva 27, Switzerland. villarj@who.int

Comments

Comment in: Lancet. 2006 Jun 3;367(9525):1796-7; PMID: 16753467

Date Created

20060606

Year of Publication

2006

136. The incidence of large fetomaternal hemorrhage and the

Kleihauer-Betke test.

Salim R. Ben-Shlomo I. Nachum Z. Mader R. Shalev E.

Obstetrics & Gynecology. 105(5 Pt 1):1039-44, 2005 May.

[Comparative Study. Journal Article]

UI: 15863542

OBJECTIVE: To assess the frequency of large fetomaternal hemorrhage and to

estimate its incidence in cesarean compared with vaginal deliveries.

METHODS: In this prospective cohort study, the study group was composed of

313 women who underwent cesarean delivery. Control subjects were 253 women

33

who delivered vaginally and were matched for age, parity, ethnic origin,

and gestational age. Ninety-six pregnant women at term, but before

delivery (prelabor group), were also included to determine whether

delivery itself is the cause of fetomaternal hemorrhage. Fetomaternal

hemorrhage was measured by using the Kleihauer-Betke test.

RESULTS: Twenty women (6.4%) in the study group and 17 (6.7%) in the

control group had a large fetomaternal hemorrhage (Kleihauer-Betke test >

0.4%). Five women (5.2%) in the prelabor group had a large fetomaternal

hemorrhage. The differences were not significant. A large fetomaternal

hemorrhage occurred in 14 of 146 (9.6%) women who underwent emergency

cesarean, compared with 6 of 167 (3.5%) who delivered by elective cesarean

(P = .04). In deliveries complicated by oligohydramnios, cord around the

neck, or low birth weight, a higher rate of large fetomaternal hemorrhage

was seen.

CONCLUSION: Our results indicate a rate of large fetomaternal hemorrhage

that is substantially higher than previously reported, with no difference

between vaginal and cesarean deliveries. This may reflect inaccuracies

with the current method used to estimate the degree of fetomaternal

hemorrhage.

Status

MEDLINE

Authors Full Name

Salim, Raed. Ben-Shlomo, Izhar. Nachum, Zohar. Mader, Rivka. Shalev,

Eliezer.

34

Institution

Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula,

Israel.

Comments

Comment in: Obstet Gynecol. 2006 Jan;107(1):206-7; author reply 207; PMID:

16394063, Comment in: Obstet Gynecol. 2005 Sep;106(3):642-3; author reply

643; PMID: 16135606

Date Created

20050502

Year of Publication

2005

152. Maternal and neonatal morbidity after elective repeat Cesarean

delivery versus a trial of labor after previous Cesarean delivery in a

community teaching hospital.

Loebel G. Zelop CM. Egan JF. Wax J.

Journal of Maternal-Fetal & Neonatal Medicine. 15(4):243-6, 2004 Apr.

[Comparative Study. Journal Article]

UI: 15280132

OBJECTIVE: To compare maternal and fetal outcomes after elective repeat

Cesarean section versus a trial of labor in women after one prior uterine

scar.

STUDY DESIGN: All women with a previous single low transverse Cesarean

section delivered at term with no contraindications to vaginal delivery

were retrospectively identified in our database from January 1995 to

October 1998. Outcomes were first analyzed by comparing mother-neonate

35

dyads delivered by elective repeat Cesarean section to those undergoing a

trial of labor. Secondarily, outcomes of mother-neonatal dyads who

achieved a vaginal delivery or failed a trial of labor were compared to

those who had elective repeat Cesarean delivery.

RESULTS: Of 1408 deliveries, 749/927 (81%) had a successful vaginal birth

after a prior Cesarean delivery. There were no differences in the rates of

transfusion, infection, uterine rupture and operative injury when

comparing trial of labor versus elective repeat Cesarean delivery.

Neonates delivered by elective repeat Cesarean delivery were of earlier

gestation and had higher rates of respiratory complications (p < 0.05).

Mother-neonatal dyads with a failed trial of labor sustained the greatest

risk of complications.

CONCLUSION: Overall, neonatal and maternal outcomes compared favorably

among women undergoing a trial of labor versus elective repeat Cesarean

delivery. The majority of morbidity was associated with a failed trial of

labor. Better selection of women likely to have a successful vaginal birth

after a prior Cesarean delivery would be expected to decrease the risks of

trial of labor.

Status

MEDLINE

Authors Full Name

Loebel, G. Zelop, C M. Egan, J F X. Wax, J.

Institution

Department of Obstetrics and Gynecology, St Francis Hospital and Medical

36

Center, Hartford, Connecticut 06001, USA.

Date Created

20040728

Year of Publication

2004

169. Neonatal outcome after trial of labor compared with elective repeat

cesarean section.

Fisler RE. Cohen A. Ringer SA. Lieberman E.

Birth. 30(2):83-8, 2003 Jun.

[Comparative Study. Journal Article]

UI: 12752164

BACKGROUND: Trial of labor after cesarean section has been an important

strategy for lowering the rate of cesarean delivery in the United States,

but concerns regarding its safety remain. The purpose of this study was to

evaluate the outcome of newborns delivered by elective repeat cesarean

section compared to delivery following a trial of labor after cesarean.

METHODS: All low-risk mothers with 1 or 2 previous cesareans and no prior

vaginal deliveries, who delivered at our institution from December 1994

through July 1995, were identified. Neonatal outcomes were compared

between 136 women who delivered by elective repeat cesarean section and

313 women who delivered after a trial of labor. To investigate reasons for

differences in outcome between these groups, neonatal outcomes within the

trial of labor group were then compared between those mothers who had

received epidural analgesia (n = 230) and those who did not (n = 83).

RESULTS: Infants delivered after a trial of labor had increased rates of

37

sepsis evaluation (23.3% vs 12.5%, p = 0.008); antibiotic treatment (11.5%

vs 4.4%, p = 0.02); intubation to evaluate for the presence of meconium

below the cords (11.5% vs 1.5%, p < 0.001); and mild bruising (8.0% vs

1.5%, p = 0.008). Within the trial of labor group, infants of mothers who

received epidural analgesia were more likely to have received diagnostic

tests and therapeutic interventions including sepsis evaluation (29.6% vs

6.0%, p = 0.001) and antibiotic treatment (13.9% vs 4.8%, p = 0.03) than

within the no-epidural analgesia group.

CONCLUSIONS: Infants born to mothers after a trial of labor are twice as

likely to undergo diagnostic tests and therapeutic interventions than

infants born after an elective repeat cesarean section, but the increase

occurred only in the subgroup of infants whose mothers received epidural

analgesia for pain relief during labor. The higher rate of intervention

could relate to the well-documented increase in intrapartum fever that

occurs with epidural use.

Status

MEDLINE

Authors Full Name

Fisler, Rita E. Cohen, Amy. Ringer, Steven A. Lieberman, Ellice.

Institution

Department of Pediatrics, Massachusetts General Hospital, Harvard Medical

School, Boston, Massachusetts, USA.

Date Created

20030519

38

Year of Publication

2003

181. Obstetrical intervention rates and maternal and neonatal outcomes of

women with gestational hypertension.

Gofton EN. Capewell V. Natale R. Gratton RJ.

American Journal of Obstetrics & Gynecology. 185(4):798-803, 2001 Oct.

[Comparative Study. Journal Article]

UI: 11641654

OBJECTIVE: The purpose of this study was to determine the obstetrical

intervention rates and maternal and neonatal outcomes of women with

gestational hypertension.

STUDY DESIGN: Induction and operative delivery rates and indices of

maternal and neonatal morbidity were determined in women (37-41 completed

weeks) with gestational hypertension (n = 979), preeclampsia (n = 165),

chronic hypertension (n = 187), and control subjects (n = 11,434) in a

retrospective review of St. Joseph's Health Care Perinatal Database from

November 1, 1995, to October 31, 1999. Data were analyzed by chi-square

test, analysis of variance, Dunnett's t -test, and pairwise chi-square

tests with Bonferroni correction.

RESULTS: The induction and cesarean delivery rates in gestational

hypertension were similar to preeclampsia and chronic hypertension groups

and almost double of control subjects. The length of labor and postpartum

stays and the incidence of operative vaginal delivery, postpartum

hemorrhage, and neonatal intensive care involvement were greater in the

gestational hypertension group than in the control subjects.

39

CONCLUSION: Women with gestational hypertension had obstetrical

intervention rates much higher than control subjects and similar to those

with preeclampsia and chronic hypertension.

Status

MEDLINE

Authors Full Name

Gofton, E N. Capewell, V. Natale, R. Gratton, R J.

Institution

Department of Obstetrics and Gynecology, St. Joseph's Health Care, Lawson

Health Research Institute, University of Western Ontario, London, ON,

Canada.

Date Created

20011019

Year of Publication

2001

10. Maternal and neonatal effects of single-dose epidural anesthesia with

lidocaine and morphine for cesarean delivery.

Niruthisard S. Somboonviboon W. Thaithumyanon P. Mahutchawaroj N.

Chaiyakul A.

Journal of the Medical Association of Thailand. 81(2):103-9, 1998 Feb.

[Clinical Trial. Journal Article. Research Support, Non-U.S. Gov't]

UI: 9529839

Two per cent lidocaine (18-20 ml) with epinephrine 1:200,000 plus 4 mg of

morphine was given as a single epidural injection over 3 minutes for

40

elective cesarean section in 60 healthy mothers at term. It provided

effective, safe and adequate analgesia in the postoperative period. There

was no evidence of neonatal depression related to the epidural morphine as

judged by Apgar scores at 1 and 5 minutes and umbilical venous pH at

birth. Maternal and umbilical venous levels of morphine were measured and

found to be low at birth. However, this study was done only in healthy

mothers not in labor and having a term fetus. We do not recommend using

this technique in complicated obstetric patients.

Status

MEDLINE

Authors Full Name

Niruthisard, S. Somboonviboon, W. Thaithumyanon, P. Mahutchawaroj, N.

Chaiyakul, A.

Institution

Department of Anesthesiology, Faculty of Medicine, Chulalongkorn

University, Bangkok, Thailand.

Date Created

19980423

Year of Publication

1998

Pregnancy outcomesFor this study, we considered pregnancy complications orhigh risk pregnancy (hypertensive disorder of pregnancyor gestational diabetes), method of delivery, gestation orpreterm birth (normal, premature), birth weight (measuredin grams) and placental weight (measured in grams)as pregnancy outcomes. Hypertensive disorders in pregnancy(HDP) were diagnosed at birth by a consultantobstetrician and defined as a diastolic BP over 90 mmHgon at least two occasions beyond 20 weeks gestation associatedwith proteinuria and/or excessive fluid retention(defined as generalized oedema including the face and

41

hands and excessive weight gain) [29]. For the purpose ofthis study, all delivery methods were grouped into threecategories: normal delivery, caesarean delivery and others(forceps, ventouse, assisted breech and combined methods).Preterm birth was defined as normal if gestation wasmore than 36 weeks and premature if gestation was 21 to36 weeks. Birth weight, placental weight and methods of

delivery were obtained from the obstetric records.

ConclusionsWe found that pre-pregnancy obesity and excess weightgain during pregnancy were associated with greater oddsof caesarean delivery and pregnancy complication, heavierbirth and placenta weights. Excess GWG was associatedwith greater length of hospital stay independent ofpre-pregnancy BMI, maternal life style, pregnancy complicationsand caesarean delivery. Inadequate GWG orpre-pregnancy underweight was associated with greaterrisk of preterm births. The relationship between prepregnancyobesity and increased length of hospital staywas fully mediated by pregnancy complications and caesareandelivery in this study population. Our results highlightthe importance of routinely collecting accurate dataon weight, height and weight gain throughout pregnancy,both to identify women at increased risk of health carerequirements and so that other studies can replicate theresults. In recent years, most high-income countries haveseen a trend towards rapid discharge of mothers andbabies after delivery in order to reduce the risk of hospitalinfection, improve rapid integration of the new-borninto family life and provide a more efficient healthcareservice. The main implication from this study is that, aswell as causing adverse perinatal and longer term outcomes,excessive weight gain during pregnancy may alsolead to adverse pregnancy outcomes and extended healthcare utilization in obstetric care. If our results are replicatedin other cohorts, further research needs to determinethe mechanisms linking these pathways of excessGWG to adverse pregnancy outcomes to longer hospitalstay and identify means of supporting healthy weightgain in pregnancy.Mamun et al. BMC Pregnancy and Childbirth 2011, 11:62http://www.biomedcentral.com/1471-2393/11/62

Page 7 of 9

Neonatal outcomes after vaginal and caesarean breechdeliveryLouis-Jacques van Bogaert, Asha MisraTo the Editor: The safety of vaginal breech delivery is stilla matter of debate. Definite evidence that caesarean breechdelivery improves mortality and morbidity is lacking.1 Themeta-analysis by Cheng and Hannah found a 3- to 4-foldsignificantly higher perinatal mortality rate (PNMR) andneonatal morbidity with planned vaginal delivery (VD)

42

compared with planned caesarean section (CS).2 On the otherhand, in a Dutch survey where 95% of 247 women with aterm singleton breech were allowed to labour, 84% deliveredvaginally and had a normal neonatal outcome. The feasibilityof VD was determined by normal progress of labour in the firststage with no signs of fetal distress.3 Another Dutch surveycompared the PNMR in breech presentation with that in vertexpresentation in singleton pregnancies; it was concluded thatbreech presentation is not coincidental but a consequence of‘poor fetal quality’.4

According to Cunningham et al., if hydrocephaly is excluded,the head is flexed, the biparietal diameter is less than 10 cm, afootling breech is ruled out, and the fetus is estimated to be ofaverage weight, a VD can be anticipated.5

In developing world settings, and especially in ruralconditions, a proper management plan before the onsetof labour is often not achievable. The unpopularity of theprospect of a CS prompts women to delay admission to thelabour ward until in established labour.In a series of 181 consecutive breech presentations, 64 (35.4%)had a VD, and 117 (64.6%) a CS. Table I lists the comparativematernal and fetal details. VD patients were older and ofhigher parity; the birth weights were lighter. The 1-minuteApgar score was significantly lower. The other parameters(5-minute Apgar score, fresh stillbirth rate, early neonatalmortality rate, and PNMR) were similar. The overall PNMRwas 83 per 1 000, 2.5 times higher than that in the institutionover the last 2 years.The aim of this survey was not to argue against CS forbreech presentations when a VD is deemed unwarranted,either for feto-maternal reasons or lack of skills in breech VD.The purpose was to find out about neonates’ outcomes inconditions where planning is often impossible. In view of thehigh PNMR in both groups, it also supports the suggestion thatbreech presentation is a consequence of poor fetal quality.References1. de Leeuw JP. Breech presentation. Vaginal or abdominal delivery? MD thesis,Rijksuniversiteit Limburg, Maastricht, 1989.2. Cheng M, Hannah M. Breech delivery at term. A critical review of the literature. ObstetGynecol 1993; 82: 605-610.3. Roumen FJME, Luyben AG. Safety of term vaginal breech delivery. Eur J Obstet GynecolReprod Biol 1991; 40: 171-176.4. Schutte MF, van Hemel OJS, van den Berg C, van de Pol A. Perinatal mortality in breechpresentation as compared to vertex presentation in singleton pregnancies: An analysis basedon 57,819 computer-registered pregnancies in the Netherlands. Eur J Obstet Gynecol ReprodBiol 1985; 19: 391-399.5. Cunningham FG, MacDonald PC, Gant NF, et al. Williams Obstetrics. 20th ed. London:Prentice Hall, 1997.Saint Rita’s Hospital, Glen Cowie, LimpopoLouis-Jacques van Bogaert, MD, MMed (O&G), MCOG (SA), MMed (AnatPath), MPhil, DPhil, PhDAsha Misra, MB ChB, Dipl ObstetCorresponding author: L-J van Bogaert (ljfvanbo@lantic.net)Table I. Comparative features between vaginal and caesarean breech deliveriesVaginal breech Caesarean breechN = 64 (35.4%) N = 117 (84.6%) t pAge (years) 29.8 ± 7.1 27.1 ± 7.0 2.4 0.01Parity 2.4 ± 2.0 1.3 ± 1.6 4.0 < 0.0001Birth weight (g) 2 760 ± 748 3 107 ± 503 3.7 0.00031-minute Apgar 7.2 ± 2.3 7.9 ± 1.5 2.5 0.0165-minute Apgar 9.2 ± 2.5 9.6 ± 1.3 1.4 0.165-minute Apgar < 7 2 (3.3%) 3 (2.7%) 0.06* 0.80Fresh stillbirth rate 4 (6.3%) 5 (4.3%) 0.34* 0.56Early neonatal death 3 (5.0%) 3 (2.7%) 0.57* 0.45PNMR (/1 000) 109 68 0.91* 0.34* 2.

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